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. 18/2005 <br />i <br />04:01 683433 <br />I, . Site map enclosed <br />RETROFIT OR REPAIR <br />YES H"�' NO I <br />2. Spec sheets attached for equipment to be installed YES () <br />3- Description of work to be completed: <br />4, <br />`5, <br />I <br />Description of equipment to be used: <br />NO ( ) <br />PAGE e3 <br />All equipment is State certlfled or approved, YES I NO f j <br />Decontamination Procedures: <br />a. Wily piping be decontaminated prlor to removal? YES[) NO [ j <br />b. Identify contractor performing decontamination: <br />Name Phon+aL ? <br />Address City Zip <br />C' Describe method to be used for decontamination; <br />d. Descrlbe how rinsate material VAII be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitte Treatment, Storage & Disposal Facility: <br />Hauler Name PhoneL_�__j <br />------------- <br />`A <br />