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• RETROFIT OR REPAIR* <br /> 1. Site map enclosed YES [] NO [,/� <br /> 2. Spec sheets attached for equipment to be installed YES 141 NO [] <br /> 3. Description of work to be completed: <br /> Lt-a k- ap <br /> /, P.�U� <br /> ul 122 tae- ✓l [�n <br /> i ✓ C o h o-� wa a'rt' <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 />