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1. <br />2 <br />3 <br />M <br />RETROFIT.OR REPAIR <br />Site map enclosed YES [I NO [I <br />Spec sheets attached for equipment to be installed YES [ ] NO [ J <br />Description of work to be completed: <br />- <br />Description of equipment to be used: <br />C5 g'q <br />5. All equilment is State certified or approvea. YESX NO [ <br />6. Decontamination Prccedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor perfori- iii �g decontamination: <br />Name <br />Phone(_ <br />Address City <br />C. Describe method to be used for decontamination: <br />YES[] NO[] <br />Zip <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(__) <br />