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1. <br />2. <br />3. <br />RETROFIT.OR REPAIR <br />Site map enclosed YES [] N'6 [ ] <br />Spec sheets attached for equipment to be installed YES[] <br />Description of work to be completed: <br />N,6 [ ] <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES <br />6. 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 [I <br />YES[] NO[] <br />WE <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 />