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8/2085 09:02 <br />EHD. <br />RETROFIT OR REPAIR <br />1.. Site map enclosed YES NO <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of wotto be completed: <br />LN <br />PAGE 03 <br />4. Description of equipment to be used: <br />I% <br />or <br />5. All equipment is State certified or approved. YES I <br />NO I <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES -NO[] <br />b. Identify contractor perfo ing decontamination: <br />Name <br />I - hone( <br />Address r city --ZIP <br />c. Describe method to be used fortc ontamination: <br />I S <br />d. Describe how rinsate material ll be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permittedt, Storage & Disposal Facility: <br />Hauler Name 77 Phoneme J <br />2 <br />