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• RETROFIT OR REPAIR <br /> . 1. Site map enclosed YES [y NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO [ ] <br /> 3. Description of work to be completed: " <br /> pec/ "-/A )act,/( '612 Lemli <br /> FX I V L/y 30 9- ZY0 1 <br /> 4. Description of equipment to be used: <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 /> 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 />