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If RETROFIT OR REPAI* <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 />127d1l2 ZEA j se �`c i« 1f% �cy0 '7� Sarn/J <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES A, <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />7111111- <br />Address <br />NO [] <br />Phone( ) <br />City <br />C. Describe method to be used for decontamination: <br />YES[] NO[] <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 />I.F111IMMUMMM <br />2 <br />