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RETROFIT_OR REPAIR <br /> 1. Site map enclosed YES [] NO [] <br /> 2_ Spec sheets attached for equipment to be installed YES []_ NOH <br /> ] <br /> 3. Description of work to be.completed: <br /> 4-- Description of equi ment to be used: <br /> -5_ All-equipment is State cerhTiied or approved- YES[] N0[ <br /> 6. Decontamination Procedures_- . <br /> a. Will piping be decontaminated prior-to removal? YES [J NO [] <br /> b_ ldentify.contractor performing decontamination: _.,---- -.– <br /> Name PhoneL-_) <br /> Address city Zip <br /> C. Describe method to be used for decontamination. <br /> d_ Deseribe W-;4 rinsate materialvrdI be stored onsite prior to manifesting.offsite <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone(__] <br /> 2 - <br />