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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 />abandon remote fill port and cap at tank top <br />4. Description of equipment to be used: <br />none <br />5. All equipment is State certified or approved. YES [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name N/A Phone <br />Address suite City <br />C. Describe method to be used for decontamination: <br />Triple rinse <br />YES [ ] NOW <br />ME <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Rinsate will be containerized in labeled DOT approved drums and transported under hazardous <br />waste manifest to an appropriate disposal facility. <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name N/A Phone <br />2 <br />