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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 /> c 0 <br /> 4_ Description of ent tinmPnf to be used: <br /> 5- All equipment is State certified or approved_ YES NO [] <br /> i <br /> i <br /> T) °c:1.)-,'Uu nination Procedures: <br /> 'X`11 pip ng be decontarninatE,d trxi0i h, rernovai% Y ES F N( ] <br /> b- i'dcntif�y contractor perforw ng der:c:itamiv nation: <br /> Name <br /> Address <br /> City -- <br /> c- Describe method to be used for decontamin,)tion: <br /> d. Describe hove rinsate material Mil be stored onsite prior to manifesting offsite. j <br /> ' I <br /> e. R-Insate hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name <br /> Phone( <br /> 2 - � <br />