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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 />5f , 1, \tet d `�/�L.�� 1 4,� <br />4_D�oc�ronlinn of ensrinmt?nf !n beused: <br />Y .., - <br />7 <br />3_ <br />All equipment is State certif=ied or approved_YES NO [ � <br />i <br />6_ Decontamination Procedures: <br />a_ Will piping be decontaminated priorlo removap YES f I tk`O, <br />b_ Identify contractor perforrninn decontamination: <br />Name _ Phone( } <br />Address <br />city Zip ----- <br />E <br />C_ Describe method to be used for decontamination: <br />ascribe f�ov� dr..safe rI eateiial will be stored onsite prior to manifesfing offsite_ <br />1 <br />e_ Rinsate Hauler and permitted Treatment, Storage & Disposal Facility_ <br />Hauler [Marne Phone( } - <br />