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RETROFIT,OR REPAIR <br /> 1. Site map enclosed YES j] NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [I <br /> 3. Description of work to be completed: <br /> o2 &-M-) <br /> 4. Description of entrin—ent to he used: <br /> () 0 77 <br /> 5. All equipment is State certified or approved. YES [] NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated priorto removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phoneme=) <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 />