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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 f j NOH <br /> ] <br /> 3. Description of work to be completed: <br /> I <br /> �ecrnntinn �f vrn vinmant to <br /> he used: <br /> - - <br /> a - <br /> P <br /> 5- All equipment is State certified or approved_ YES [j NO [] <br /> . i <br /> Vii. Docontamination Procedures: <br /> a_ Will piping be decontaminated priorto removal? YES ] NO '! <br /> b- Identify contractor performing decontamination-- <br /> Name <br /> econtamination: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 /> I <br /> i <br /> e_ Rinsate Hauler and permitted Treatment, Storage& Disposal Facility- <br /> Hauler <br /> acilityHauler Nam Phone <br /> 2 i <br />