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RETROFIT OR REPAIR <br /> 1. Site map enclosed YES ( I NO <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> o41�,,,61 fit-e rag U-7� Cad ✓ 0 1 S s <br /> /7-7 S"�I <br /> 4. Description of equipment to be used: <br /> lead j6'tdL_ <br /> 5. All equipment is State certified or approved. YESP NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? 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 stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name _Phone( ) <br /> 2 <br />