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Y <br /> RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [] NO [ <br /> 2. Spec sheets attached for equipment to be installed YES NO [] <br /> 3. Description of work to be completed: <br /> 4. Description of equipment to be used: <br /> 1— r,>'?cXD ®C <br /> 5. All equipment is State certified or approved. YES [ NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? PAI 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 how rinsate material will be stared onsite prior to manifesting offsite: <br /> kIA- <br /> e. Rinsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Name I4 ��" Phone <br /> 2 <br />