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1. <br />2. <br />3. <br />RETROFIT OR REPAIR <br />Site map enclosed YES f NO [ ] <br />Spec sheets attached for equipment to be installed YES [ ] <br />NO [I <br />4. Description of equipment to be used: <br />5 <br />6 <br />0 <br />0 <br />All equipment is State certified or approved. YESAi NO [ ] <br />Decontamination Progedures. , <br />a. Will piping be decontaminated prior to removal? YLS [ NOV <br />b. Identify contractor performing decontamination: <br />Name C— Phone 9c /fid <br />�� 4SC� o Zip <br />Address <br />C. Describe method to be used for deconta,i^-+i^ <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 11114 Phone(_) <br />2 <br />