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RETROFIT OR REPAIR <br />1. Site map enclosed YESA NO [ ] <br />2. Spec sheets attached for equipment to be installed YES,f NO [ ] <br />3. Description of work to be completed: <br />1,z �71- 2 <br />4. Description of equipment to be used: <br />SCF Pr-� � Ac'ttFb C)?w F--1FrGu�(Q7 G"Z-% 10)--% <br />5. All equipment is State certified or approved. YESA <br />6. Decontamination Procedures: <br />Will piping be decontaminated prior to removal? <br />b. tify contractor performing decontamination: <br />Name PhonE <br />Address ----,city <br />C. Describe method to be used f contamination: <br />NO [] <br />YES[] NO[] <br />Zip <br />d. DescribjD-Kow 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 />