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RETROFIT_OR REPAIR <br />1 _ Site map enclosed YES [I NO [I <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 />Z D <br />5. All equipment is State certified or approved. YES [I NO[] <br />6. Decontamination Procedures <br />a. Will piping be decontaminated prior- to removal? YES [ j NO[] <br />b. Ident4 Contractor performing decontaminations <br />Name Phone( <br />Address city Zip <br />C. Describe method to be used for decontamination: <br />d. Describe: l d4; rihsate material vrill'be stores: onsite prior to !nanifestir q- nffsite- <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name _ Phone(__j <br />2 <br />