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RETROFIT -OR REPAIR <br />Site map enclosed YES j J NO j ] <br />2_ Spec sheets attached for equipment to be installed YES [ J. NO [ J <br />3_ Description of work to be. completed: <br />4-- Description of equipment to be used. <br />'.5- All- equipmerit is State certified or approved. YES j J NO [ J <br />'6_ Decontamination Procedures: <br />a. Wil1 piping be decontaminated prior- to removal? YES j J NO [ J <br />b. ldentify.cbnfiact®r performing decontamination_ -- <br />Name Phone( ) <br />Address City Zip <br />C_ Describe method'to be used for de contamination; <br />d. Describe W4 rinsate material Yn7l be stored onsite prior to manifesting offsite <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility... <br />Hauler Name Phone, <br />2 <br />