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RETROFIT -OR REPAIR <br />1- Site map enclosed YES j ] NO <br />2- Spec sheets attached for equipment to be installed YES ( ] <br />NO[] <br />_ r�ecyrintinn t�f ani cinment to be used: <br />FAVA"6 qmG <br />S Ali equipment is State certified or approved_ YES[] ILIO [ I <br />i <br />C_ Decontamination Procedures. <br />a- Will piping be decontaminated priorb removal? YES No ` I <br />b- Identify contractor performing decontamination_ <br />Mame _ Phone( <br />Address <br />City Zip <br />c_ Describe method to be used for decontamination- <br />d- Describe how rinsate material wiii be stored onsite prior to manifesting o#fsste: <br />e- Rinsate Hauler and permitted Treahent, Storage Disposal Facility_ <br />Hauler !lame Phones --J- <br />