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s _ <br /> RETROFIT-OR REPAIR <br /> 1. Site map enclosed YES j NO [j <br /> 2- Spec sheets attached for equipment to be'installed YES[]_ NO [] <br /> 3- Description of work to be.completed_ <br /> r <br /> y� of ftj,�&,k CgIn <br /> 4-- Descri n of equipment to be u = <br /> S: All equiprnerit is-State ced ffiied or approved. YES[j 110 IF <br /> "6_ Decontamination Procedures.: . _ - <br /> a- witi piping be decontaminated prior-to removal? YES [ <br /> ---- b- Identifjr:con2iacA®c performing decnnQ, aon_ - ------ -- - <br /> Name Phone <br /> Address . City : rp <br /> c_ Describe method to be used for decontamination.':. <br /> -=n"- " -- la,.�` a t_._Yt`i_ ."s.__ .. i_- .._ 't., -- 1,_c'_,_- if Ref <br /> _ 0&sf fibe fid itiiSdcY ad�it�Yrc3t v��ttre�s ostssc� av asgasiuracux�.vc,SRe <br /> e: Mnsate Hau' ler andpeg mitted TreatmerC Storage&Disposal FacHity: . <br /> -Phone <br /> - 'r{auler a :.. -. <br />