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• RETROFIT.OR REPAIR <br />1. Site reap enclosed YES j ] NO[] <br />2. Spec sheets attached for equipment to be installed YES [ ] NO ( ] <br />3. Description of work to be completed: <br />4i&ociod <br />!t A-crintinn of eni tinment to ha i iri <br />ce <br />Vol %4d U7_ � 3VI -oaa <br />5_ All equipment is State certified or approved- YES [ ] <br />6- Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination - <br />Name Phone <br />Address City <br />c_ Describe method to be used for decontamination: <br />NO [ ] <br />YES[] NO[] <br />Zip <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 />