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' RETROFITOR REPAIR <br /> 1. Site map enclosed YES [] NO [J <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> 4_ [ escrintinn of eni einment to her aced: <br /> f <br /> L <br /> - i <br /> 5. All equipment is State certified or approved_ YES [J 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 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 />