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RETROFIT.OR REPAIR <br /> 1. Site reap enclosed YES [] NO [] <br /> 2. Spec sheets attached for equipment to be installed YES j] NO [] <br /> 3. Description of work to be completed: <br /> ho-,n6io 0-1)07 Wb�o/&J10 c <br /> / 3 oc ' <br /> Desc = tin.- f equi Ment to be used- <br /> 5- All equipment is State certified or approved_ YES (j NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated priorto 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 />