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RETROFIT OR REPAIR <br />1. Site map enclosed YES [I NOW <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work tQQ b�e� completed: <br />4. Description of equipment to be used: <br />y&W 6uek e E e 41 u btac Pcef (c mc CotJ <br />5. All equipment is State certified or approved. YES 4f NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />b Identify Contractor performing decontamiriafionll <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 />