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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 [] NO [] <br /> 3. Description of work to be completed: <br /> ------------ <br /> 4. Description of equipment to be used: <br /> LV.ete� <br /> 5. All equipment is State certified or approved. YES [] NO [) <br /> 5. Decontaminat,on Procedures: <br /> � [] <br /> a. Will piping be decontaminated prior to removal? YES t, NO <br /> b. Identify contractor performing decontamination: <br /> Name <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 <br /> 2 <br />