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RETROFIT OR REPAIR <br />1. Site map enclosed YES [ ] NO [K <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 />NAA I-99t—D 2000 <br />5. All equipment is State certified or approved. YES J�t NO [ ] <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 />YES[] NO[] <br />Zip <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e <br />Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( ) <br />0 <br />