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RETROFMOR REPAIR <br />1. Site map enclosed YES f ] NO [] <br />2. Spec sheets attached for equipment to be installed YES[] NO [ ] <br />3. Description of work to be completed: <br />0 fif�_- D30 YOO 7 (0 <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(__=) <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 />