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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 />VIC- 101 -fl. <br />4. Description of equipment to be used: <br />Phil -T& Sill cy+tfi2�nry+cr►} 1wc 5 . Jel�r;3 by r fisble adaptor° s <br />Q MU drop iyb , t1cwri son bras. dos} a -so � usky pressuw�/y:cyuw� vein} <br />5. All equipment is State certified or approved. YES <br />6. WA Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name Phone <br />Address <br />K <br />YES[] NO[] <br />City __Zip <br />