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0 RETROFIT OR REPAIR 10 V\) t <br />1. Site map enclosed YES [] <br />NO [ ] <br />2. Spec sheets attached for equipment to be installed YES [] NO [ ] <br />3. Description of work to be completed: <br />v\ �� r{ t` OV . <br />a <br />4. Description of equipment to be used: <br />5. All equipment is State certified or approved. YES W NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO DI <br />b. Identify contractor performing decontamination: <br />Name Phone(_) <br />Address <br />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 Name <br />F <br />Phone(_) <br />