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RETROFIT OR PAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [] NOW <br /> 3. Description of work to be completed: <br /> f n e o L) 2 I �( <br /> 4. Description of equipment to be used: <br /> "�-�'► �'o�r�f �h �d u��e��' �s2 Ul �.PIL � j�, 2/z�� <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 /> 2 <br />