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s <br />0 <br />RETROFIT -OR REPAIR <br />1 _ Site map enclosed YES [ ] NO[] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO[] <br />3. Description of work to be completed: - <br />4- Descr{nf;nn of vn� tinmPnf' to by used: <br />. <br />_ n <br />v t 0�9qM_QC5 <br />b- All equipment is State certified or appro ed_ YES [ j NO[] <br />Decontamination Procedures- <br />a_ Will piping be dRlcontafnu-A,-. cd priorto removal? {p_�; a g <br />b. Identify contractor pefforminr,7 decontamination -- <br />Name <br />Address C; <br />C_ Describe method to be used of decontamination: <br />d. Describe how rinsate mate rial will be stored onsite prior to manifesting oftsste: <br />e. Rinsate Mauler and permitted Trea ent, Storage & Disposal Facility- <br />Hauler <br />acilityHauler Name Phone( <br />