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RETROFIT -OR REPAIR <br />I- Site map enclosed YES [ I NO [ I <br />2_ Spec sheets attached for equipment to be installed YES ] NO [ 3 <br />3_ Description of work to be completed - <br />p, <br />n cy 'fir. <br />a <br />4 oC!-`TfY1'tw! of eq Yinment In he f ised: - <br />i - <br />` ,C <br />5_ All equipment is State certified or approved YES [ NO[I <br />C_ Decontamination Procedures: <br />a_ Will piping be decontaminated priorto removal? YES j j NO'. i <br />b_ Identify contractor performing decontamination= <br />Name _Phone( } <br />Address <br />City Zip — – — <br />c_ Describe method to be used for decontamination: <br />d_ . Describe..how rinsate matenaa vAll be stored onsAe prior to manifesting' uffsite <br />- i <br />i <br />i <br />e_ Rinsate.Hauler and permitted Treatnent, Storage & Disposal FaciliEy_ <br />Hauler Mame Phone( <br />2 <br />