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RETROFMOR 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 />4. DeSCriptinn of eqUinm nt to he used - <br />CP to to Lt 1 o 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 manifesiting offsite: <br />e. Rinsate -Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( <br />