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RETROFIT-OR REPAIR <br /> 1. Site map enclosed YES [] NO [] <br /> p. Spec sheets attached for equipment to be installed YES [J. NO [] <br /> 3. Description of work to be completed: <br /> 4. Description of equipment to be used: <br /> 1129C (A ib <br /> 5. All equipment is State certified or approved. YES [] NO [] <br /> 6. Decontamination Procedures: <br /> a_ Will piping be decontaminated prior to 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 Narne P6ione( ) <br /> 2 <br />