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RETROFITRETROFITOR 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 /> 4. Description of equipment to be used: <br /> 5. All equipment is State rdrb ied or approved. YES [] No <br /> `. Decontam i nation Procedures: <br /> a_ Will piping be decontaminated prior to removal? YES l] O [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) I <br /> I <br /> Address city_ Zip <br /> C. Describe method to be used for decontamination: <br /> d. Describe hdW tiosate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> I . <br /> Mauler Name _ kone(_—___) _ <br /> 2 <br />