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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO <br /> 2. Spec sheets attached for equipment to be installed Y E Sy, NO ( ] <br /> 3. Description of work to be completed: <br /> Ct l lG V` <br /> 4. Description of equipment to be used: <br /> - `1 9 q .--� Y C) - b <br /> 5. All equipment is State certified or approved. YES° . NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b; '_Idemi#y contracfor performin j.decontamination: . <br /> Name Phonw ) <br /> Addressity Zip <br /> C. Describe method to be usec o deconta nation: <br /> d. Describe how rinsate material w' be store onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone( ) <br /> 2 <br />