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A <br /> RETROFIT-OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES (j NO [] <br /> 3. Description of work to be completed: <br /> via 0Aid-)id <br /> 4_ Description of emiinmant to he 1 iced: <br /> s _ <br /> pr <br /> f <br /> 5. All equipment is State certified or approved- YES [j NO (j <br /> 6. De=: ;< amination Procedures: <br /> a. VV ill piping be decontaminated prierto ecmovAl`., NO [ <br /> b_ Identify contrac',or pciforminc; decontaminab,,n: <br /> .lame <br /> IrAdress city 7- <br /> -- ------ -- -- — - 1p —-= — <br /> C_ Describe method to be used fo:-decontamination: <br /> u. Describe how rinsate matenai wi.i be stored onsite prior to manifesting offsite. <br /> e. Rinsate Hauler and permiYLed Treatment, Storage& Disposal Facility: <br /> Hauler Name Phone( j <br /> 2 <br />