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Oct 21 05 01 : 26p C ., ie Brown (2rLQ1 461-6342 p. 1 <br /> �Imo,I'P - <br /> a�I3'� RETROFIT ORREPAIR <br /> m <br /> I- Stt p rtclosed YES f] NO[] <br /> 2_ Spec sheets attached for equipment to be installed YES[j. N4[] <br /> 3- Description of work.to be.completed: <br /> � / a <br /> I t2Q f lS r�lP�3t to be used: <br /> - D id// ;I . <br /> 'All equipment is-State certiff6d or approved_ <br /> Decon arnination Procedures_. . <br /> a. . Will piping be de'co'ntaminated pdsor-to removal?. - YES f]- NO S <br /> Y p 9 -- <br /> b_ lderz.d ,coritii�c o erf®rmsrz decont�a-:�ina�or&: <br /> Narrse Plxin. <br /> Address City Zp <br /> c: Describe method to be used for decon6 tion,, <br /> G_. 3Je$f���Je'[1CFelV It(tJd_Y rizatGzial s:cot v��tuG'zs t7reSK6. :tui to ti€astesractaa vetSstc <br /> - <br /> e: f;i e l amen and <br /> permitted Treatmrel,Storage&Dis Fac ity <br /> hauler <br /> Name <br /> PhorieC __j <br />