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, <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ NO [] <br /> 2. Spec sheets attached for equipment to be installed YES,4 NO [] <br /> 3. Description of work to be completed: <br /> SEC 4-r Ac0FU LT-, <br /> 4. Description of equipment to be used: <br /> SEC= ,AT Aca�V-D 6 � W - 1 u ,)_ <br /> 5. All equipment is State certified or approved. YES NO [] <br /> 6. Decontamination Procedures: <br /> Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Ide ' contractor performing decontamination: <br /> Name Phone( } <br /> Address City Zip <br /> C. Describe method to be used for decontamination: <br /> d. D7how rinsate material will be stored onsite pn to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility�\: <br /> Hauler Name Phone(__) <br /> 2 <br />