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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO-0 <br /> 2. Spec sheets attached for equipment to be installed YES NO [ ] <br /> 3. Description of work to be completed: ll <br /> i�� hy-k-C-L t C,I'll + k-"L #k t <br /> oew 'P�40 C - tl Pb"V <br /> 4. Description of equipment to be used: <br /> �-e J 51,1 <br /> 5. All equipment is State certified or approved. YES P( NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phon <br /> Address ity Zip <br /> C. Describe method to be used for e onta nation: <br /> d. Describe how rinsate material will e storedXnsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permi ed Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone( ) <br /> 2 <br />