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RETROFIT OR REPAIR <br />1. Site map enclosed YES [ ] NO <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be completed: <br />S <br />4. Description of equipment to be used: <br />CL <br />5. All equipment is 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 Z <br />Address ity Zip <br />C. Describe method to be used for*contamination: <br />d. Describe how rinsate material Will be store site prior to manifesting offsite: <br />I, <br />e. Rinsate Hauler and p rmitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(__) <br />2 <br />