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1. <br />2. <br />3. <br />RETROFIT OR REPAIR . <br />Site map enclosed YES [I NO k] <br />Spec sheets attached for equipment to be installed YES NO [ ] <br />4. Description of equipment to be used: <br />�eQ ia-t4a�).ad� cu� Sly <br />5. <br />6 - <br />All equipment is State certified or approved. YES [(r <br />Decontamination Procedures: <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 />NO[] <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! 1 <br />2 <br />