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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 [ ]. <br />NO [] <br />3. Description of work to be. completed: <br />QCJ <br />4_ Description of equipment to be used: <br />C) 1 C 21 C) ---------- <br />0 C) <br />� c � 0C) <br />5. All equipment is State certified or approved. YES NO [I <br />6. Decontamination Procedures: <br />] N <br />a_ Will piping be decontaminated prior to removal? YES [ <br />-- <br />b. Identify contactor performing decontamination: - _- <br />Name Phone( ) <br />Address <br />city Zip <br />C. Describe method to be used for decontamination: <br />sate material will be stored onsite prior to manifesting offsite:. <br />d_ Describe :pow riri <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />_ <br />2 <br />