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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 /> � . a, At, 10 d/14 �J'1011 <br /> 0ji <br /> I <br /> E)ecYrintinn of Pnuinmanhe 1 sed:t in <br /> , r - Y - - <br /> . f <br /> alt equipment is State certified or approved_ YES [j NO [] <br /> 6. Decontamination Procedures <br /> a. Will piping be decontaminated priorto removal? YES [] No i i <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 /> e. Rinsate.Hauler and permitted Treatment, Storage & Disposal Facility_ <br /> Hauler[dame — Phone( � <br /> 2 1 <br />