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i <br />RETROEIT_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 />4. Description of equipment to be used: <br />r <br />5. All equipment -is State certified or approved. YES NO [.1 <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.Hau ler and permitted Treatment,. Storage & Disposal Facility: <br />Hauler Name Phone( <br />i <br />