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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO U <br /> 2. Spec sheets attached for equipment to be installed YES NO [ ] <br /> 3. Description of work to be completed: <br /> a <br /> CiC n 6'1 tine.. <br /> BOOP rxy-IJ� `tk" CP '>n�ty_ M-Lh 6 Q o-IUM lr I�4no� <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YESY NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NOK <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) <br /> Address city Zip <br /> G. 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 />