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0 RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [ ] N01VJ <br /> 3. Description of work to be completed: <br /> I� vvwU-0, VM Gbza-oa S4-fz, 16, 0309 /00 <br /> 4. Description of equipment to be used: <br /> Znso4�Glytit 1 G6 zavo seer. 0(oo3/y� <br /> 5. All equipment is State certified or approved. YESR NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) <br /> Address city Zip <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 />