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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 [ ] NO [ <br />3. Description of work to be completed: <br />4 Descrintinn of equipment to be used: <br />a <br />-EKE <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 Phone(_=) <br />Address city Z i p <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 />N <br />