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RETROFIT -OR REPAIR <br />A <br />11- Site reap enclosed YES [ j NO [ j <br />2_ Spec sheets attached for equipment to be installed YES [ } _ NO [ ] <br />3_ Description of work -to be -completed: <br />a <br />4-- Description of equipment to be used: <br />: b_ F1ll equipment is State ceri��ed or approved. YES f j NO j <br />6. Decontamin.ation Procedures=- . <br />a: <br />Will piping be decontaminated prior- to removal? YES [ ] NO[], <br />b_ tdentify:carikaci®r perf®rming decors mina on. <br />Name Phone{ <br />Address City Zip <br />c. Describe method- to be used for decontamination_ <br />o Describe ho'Wfitisa a material will -be stored onsite _prior to manifesting_ offsite - <br />e. Rinsate Hauler and permitted Treatment, Storage &'Disposal Facility: . <br />Phone_} <br />i-iaisler Name - - <br />2 " <br />