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RETRORTOR REPAIP <br />1. Site map enclosed YES [] NO [] <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of work to be completed: <br />0,,ho-noe,'jnc\ cq,, ro�xj I )ts <br />4. Description of equip -Ment to be used: <br />av, <br />NO [] <br />0 <br />5- All equipment is State certified or approved- YES NO[] <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[ I 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 />