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• RETROFIT OR REPAIR • <br /> 1. Site map enclosed YES [] NO x <br /> 2. Spec sheets attached for equipment to be installed YES �J NO [] <br /> 3. Description of work to be completed: �1 <br /> "Ph(kZ (� <br /> 4. Description of equipment to be used: <br /> f2G� V � S �YI - f�2 3 in <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 Name Phone(_) <br /> 2 <br />