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RETROFTOR 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 /> ctn \ , -Q r-' O 1 <br /> Descrip!!n of ernt.: ma. to h . used- <br /> 5. All equipment is State certified or approved_ YES)d NO [J <br /> F. Deconl-: riinaiior, Procedures: <br /> a. Wi11 piping be decontaminated priorto removal? YES [ ] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone=_) <br /> Address city Zip <br /> C. Describe method to be used for decontamination: <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 /> 2 <br />