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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 /> 4_ Descrintinn of enUinment to he <br /> used- <br /> 4241 <br /> 5- All equipment is State certified or approved_ YES () NO[] <br /> 6 Decontamination Procediirvs: <br /> a- Will piping be decontaminated priorto removal? YES [] NO ' i <br /> b_ Identify contractor perform-Ing decontamination;_ <br /> Name Phone( ) <br /> Address <br /> City Zip��--- <br /> c: Describe method to be used for decontamination: <br /> d- Describe hove 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 /> i <br /> 2 <br />