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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 />Gi'n� <br />1�Y\e_ Oce)At—L CA - <br />4. Description of equipment to be used: <br />s <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 <br />Address <br />Pho <br />City <br />C. Describe method to be used for decontamination: <br />NO [] <br />YES[] NO[] <br />Zip <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 />Phon <br />