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RETROFIT OR REPAIR <br /> _ Site map enclosed YES ] NO [] <br /> 2_ Spec sheets attached for equipment to be installed YES[]_ NO[] <br /> 3- Description of work to be.completed; <br /> 4-- Description of-equipment to be used: <br /> 6_ All equipment is State ce►fiied or approved. YES i J NO <br /> -6- Decontamination Procedures_. . <br /> a_ Will piping be decontaminated prior-to rernovai? YES [ NO[ - <br /> b_ Identify contractor performing decontami ation: - _—_-.- -- _ <br /> Name Phone(___L_j. <br /> Address City Zip <br /> c- Describe method to be used for decontamination: <br /> -:^- ''' -.L-.' L,..-.�f--_YfL L_ J 1. <br /> L_ Dest�be fid 7i vSa' !flalellal Villi Ue�Wied oltsme E1:EUI W(fEalIiS�JIi!lC�_UttSAC_ <br /> e. Rinsate Ha Wer and permitted Treatment, Storage&Disposal_FadV. . <br /> i-laWer Name Phonef ) <br /> 2 <br />