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RETROFIT -OR REPAIR <br />1. Site reap enclosed YES [I NO [] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO [ ] <br />3_ Description of work to be completed: <br />s _ (? n _ <br />- Description of equipment to by used: <br />All equipment is State certified or app,oved- YES [ ] NO [ 1 <br />Decontamination Prc)c(-durese <br />Will piping by decont Arriinate: J prig, to i ei.-I oval? Y <br />Identify contra(rtor perforrmnq dec ontarraination: <br />Name <br />Phone <br />Address <br />c . Describe method to be used for deconta nination: <br />d. Describe how rinsate rriaterial v,ifl see stored onsite prior to mai iife�;tinp offsitr!_ <br />i <br />i <br />e. Rinsate Hauler and permizted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( <br />2 <br />