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RETROFIT-OR REPAIR <br /> 1_ Site map enclosed YES j) NO E I <br /> 2_ Spec sheets attached for equipment to be installed YES NO j 3 <br /> 3. Descript-ion of work to be completed: <br /> v <br /> A DeSCrintinn of nnTinrnent to F�� used: <br /> r- v <br /> r <br /> 5.. All eqr-tipment is State certified or approved. YESNO <br /> l3 II <br /> 6_ Decontamination Procedures. <br /> a_ Will piping be decontamilriated priorto removal? YESNO I <br /> b. Identify contractor performing decontamination_ <br /> Name <br /> Address <br /> — City Zrp -- <br /> c: Describe method to be used for decontamination- <br /> d- <br /> Describe how rinsate material wil'i be stored onsite prior to manifesting offsite_ <br /> - I <br /> e. Hinsate Hauler and permitted Treahent,Storage& Disposal Facility_ <br /> Hauler Name Phone(_____} i <br /> i <br /> 2 - i <br />