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RETROFIT OR REPAIR <br />1. Site map enclosed YES [ ] N <br />2. Spec sheets attached for equipment to be installed YES NO [ ] <br />3. Description of work to be completed: <br />..0 ..iii! 11141:. ,1 <br />4. Description of equipment to be used: <br />A <br />5. All equipment is State certified or approved. YE-1NO [ ] <br />6. Deco mination Procedures: <br />a. Will pip be decontaminated prior to removal? YES[] NO[] <br />b. Identify contrac performing decontamination: <br />Name Phone(_) <br />Address city Zip <br />C. Describe method to be used for de c mination: <br />d. Describe how rinsate material will be stored opsit rior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Fa ' ity: <br />Hauler Name Phone(_) <br />