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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [] NO '13 <br /> 2. Spec sheets attached for equipment to be installed YES [ NO [] <br /> 3. Description of work to be completed: <br /> -C i <br /> v <br /> 4. Description of equipment to be used: <br /> 5. All equipmentis State certified or approved. YES 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 decontamin on: <br /> d. Describe how rinsate material w' a stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler an permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone) <br /> 2 <br />