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40 <br />RETROFIT.OR REPAIR <br />1. Site map enclosed YES [ ] NO [ I <br />2. Spec sheets attached for equipment to be installed YES <br />3. Description of work to be, completed: <br />Replacing <br />-f. Description of equipment to be used: <br />on - i ucket <br />NO [ ] <br />5. All equipment is State certified or approved. YES NO [ <br />6, Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />-- <br />- b. Identify contactor performing tiecontaminateon: -7 <br />Name Phone(_______) <br />Address -- <br />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 <br />2 <br />