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RETROFIT OR REPAIR <br />1- Site map enclosed YES [] NO j ] <br />2. Spec sheets attached for equipment to be installed YES j ] NO f; <br />3_ Description of work to be completed: - <br />5 _es�6 Minn of Pnt s(ramvrti¢ to be t rt <br />tcn <br />i - - <br />5- -All equipment is State certified or approved_ YES [] NO[] <br />i <br />6- Decontamination Procedures: <br />a_ Will piping be decontaminated priorto removal? <br />YES j ] NO -I <br />b- ldentify contractor performing decontamination= <br />Name Phone( <br />Address <br />` — City <br />I <br />c_ Describe method to be used for decontamination <br />d_- <br />Describe how rinsate rnaferi� wiii be stored onsite prior to manifesting offsite <br />i <br />e_ Rinsatee-Hauler and permitted Treatrnent, Storage & Disposal Facility_ <br />Hauler Blame Prone(__ _� { <br />. I <br />2 <br />