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rlr m rLUUN PAGE 04 <br /> • RETROFIT OR REPAIR • <br /> 1. Site map enclosed YESA NO [I <br /> 2. Spec sheets attached for equipment to be installed YES Ti( NO [] <br /> 3. Description of work to be completed: 111 <br /> IIISIAL a-l") k1d)-iA 7 Q1j F�! ILL <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YESK NO [] <br /> 6. Decontamination Procedures: IAF (-ik <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phoneme �) <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 />