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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 /> � V — <br /> dA 44 JL <br /> 4. Description of equipment to be sed: <br /> N� 4 eA 6Ah-"-- M <br /> 5. All equipment is State certified or approved. YES�Q NO [] <br /> 6. Decontamination Procedures: , <br /> a. Will piping be decontaminated prior to removal? S [] NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name Phone <br /> Address ity Zip <br /> C. Describe method to be used for deco amination: <br /> d. Describe how rinsate terial will be o e opsite prior to manifesting offsite: <br /> M— <br /> e. Ri to Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone( <br /> 2 <br />