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A12002 17:07 2094663 3 FIFTH FLOOR qj <br />RETROFIT OR REPAIR <br />1. 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 />M <br />E <br />4. Description of equipment to be used: <br />PAGE 02 <br />5. All equipment is State certified or approved. YES W NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES (] NO [ <br />b. Identify contractor perforriling 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 Trrz <br />nt, Storage & Disposal Facility: <br />Hauler Name 0 Phone( ) <br />K <br />