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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO [q/ <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO [a <br /> 3. Description of work to be completed: <br /> P:CT'LA 6C S'7 F I L L S U/`1 E�-NtS 02 IV CL it)t iZ 2C& i <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES [.,]� NO [ ] <br /> 6. Decontamination Procedures: X'/14- <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. <br /> ffsite:e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(_) <br /> 2 <br />