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RETROFIT OR 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 /> 4. Description of equipment to be used: <br /> Ve( !!ter 1Z �S� ?g43S-Q - 3s <br /> 5. All equipment is State certified or approved. YES [ J NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminaXdentaminat <br /> oval? YES [ ] NO [ ] <br /> b. Identify contractor performiion: <br /> Name Phone( <br /> Address z city Zip <br /> C. Describe method/o be used for decontamination: <br /> d. Describ ow 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 />