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RETROFIT OR REPAIR <br />1- Site map enclosed YES'[ NO I J <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 />5. All equipment is State certified or approved. YES <br />N' t 6. Decontamination Procedures: <br />a Will piping be decontaminated pnor to removal? <br />b- Identify contractor performing decontamination <br />NO [ ] <br />YES[] NO[] <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( i <br />