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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES, NO [] <br /> 3. Description of work to be completed: <br /> �►TC� Act v D L r T V lL <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YESJ+ NO [] <br /> 6. Decontamination Procedures: <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 tobe oecontamination: <br /> d. Describe how rinsate material will be stored on ' prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(__) <br /> 2 <br />