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N RETROFIT OR REPAIR N <br />1. Site map enclosed YES NO [ ] <br />2. Spec sheets attached forequipment to be installed YES (] NOfi <br />3. Description of work to be completed: <br />C l�� A 2611 -71C- <br />4. <br />611 -71C-4. Description of equipment to be used: <br />2-2 <br />-- <br />/l."� <br />5. All equipment is State certified or approved. YES (>] NO [ ] <br />6. Decontamination Procedures: I <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 />YES[] NO[] <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 />I <br />