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,a <br /> RETROFIT.OR REPAIR <br /> 1. Site map enclosed YES j J NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> oro I e, r Xm&V.- <br /> rlecCrantinn of gnninment to he isg�i: <br /> Ln -- <br /> SL t. 26 l -- <br /> 5_ All equipment is State certified or approved_ YES NO [I <br /> dei=c ritami ation Procedures: <br /> W III pip g be decontaminated prior to �emovat? YES, j ] NO [J <br /> Identify cont ctor performing decoruaminabon: <br /> Mame _—_ __ P <br /> Address ---- --- city-- Zip --- <br /> c: Describe method to be us for d contamination: <br /> d. Describe how rinsate aerial wiil stored onsite prior to manifesting offsite: <br /> e. Rinsate_ auler and permitted Treatment, Storage & Disposal Facility: <br /> H ler Name Phone(__,l <br /> 2 <br />