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RETROFIT -OR REPAIR <br />1- Site map enclosed YES j ] NO ( 1 <br />2_ Spec sheets attached for equipment to be installed YES NO j ] <br />3_ Description of work to be completed_ <br />�- Dos Yi')T1i'iflrl o PfJt t7=ZTl1PTlf ZFl F)P ftCP({- <br />._r„Y. _ <br />5TPML- <br />5_ All equipment is State certified or approvedYES [ ] NO ( J <br />b. Decontamination Procedures: <br />a_ Will piping be decontaminated priorto removals YES NO 1 <br />b_ Identify contractor performing decontamination_ <br />Name _ Phone( <br />Address <br />City Zip <br />G- Describe method to be used for decontamination: <br />i <br />i <br />d_ Describe how nnsate matPriI uii€i <br />be stored onitz prick to manifesting offsite: <br />i <br />i <br />e. Rinsate.Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Prone( ) <br />2 i <br />