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a <br />RETROFIT -OR REPAIR <br />1, Site map enclosed YES [ ] NO [] <br />2. Spec sheets attached for equipment to be installed YES (]. NO [ j <br />3. Description of work to be, completed: <br />4_ Description of equipment to be used: <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 hdW ritisate material will- be stored onsde prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( <br />2 <br />