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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 j ] NO [ ] <br />3. Description of work to be completed_ <br />(lcryr rsninn of en►sinment to he roved_ <br />v <br />i <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 [ j NO [ <br />b. Identify contractor performing decontamination: <br />Name <br />Address City Zip _ -- <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e_ Rinsate,Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(____� <br />