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Dec 27 02 12:30p ie Brown <br />IS 461-6342 <br />RETROFIT -OR REPAIR <br />1. Site map enclosed YES [ j NO <br />[j <br />2" Spec sheets attached for equipment to be installed YES [ ] NO <br />I? <br />3" Description of work to be completed: <br />G <br />4. : Description of equipment to be used: <br />5. All equipment is State certified or approved. YES <br />NO <br />5" Decontamination Procedures: <br />a" Will piping be decontaminated prior to removal? <br />YES [ j NO [ j <br />b. Identify contractor performing decontamination: ' <br />Name PhoneL__�_j <br />Address City Zi <br />C. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone____) <br />2 <br />p.2 <br />