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RETROFIT OR REPAIR <br />1 Site map enclosed YES [] NON <br />2. Spec sheets attached for equipment to be installed YES ]�Q <br />1 Description of work to be completed: <br />Uf/tNIYC x1571N6 <br />4. Description of equipment to be used: <br />N- <br />5. All equipment is State certified or approved. YES <br />6. Decontamination Procedures: All --f <br />/ d <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination. <br />Name Phone <br />Address _ City <br />C. Describe method to be used for decontamination: <br />NO [ ] <br />NO[] <br />0A <br />q - <br />YES [ ] NO[] <br />I <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 />G <br />