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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [j NON <br /> 2. Spec sheets attached for equipment to be installed YES [l <br /> NO <br /> 1 Description of work to be completed: <br /> . - •r_,y e �,�s Aiv e <br /> /U <br /> 4. Description of equipment to be used: <br /> Ex,Err� E� —/r - <br /> X/fM Tl G 5f vo <br /> 5. All equipment is State certified or approved. YES <br /> NO [] <br /> 6. Decontamination Procedures: ///111� <br /> a. Will piping be decontaminated prior to removal? <br /> YES [] NO [] <br /> b. Identify contractor performing decontamination.- <br /> Name <br /> econtamination:Name Phone( <br /> Address City <br /> 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 />