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RETROFIT OR REPAIR -, <br />1. Site map enclosed YES 0 NO [ ] <br />2. Spec sheets attached for equipment to be installed YES [ NO [ ] <br />3. Description of work to be com ted: I <br />1 ty a ;ted' o [1rYSaZ C "to'v" An CCr1- h ()4 <br />L k!T_ E -0R Uk-I�,► • A <br />4. Description of equipment to be used: <br />:3QQ- cel sl z;Fs <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 />