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RETROFIT -OR REPAI 0 <br />1. Site map enclosed YES NO <br />2. Spec . sheets attached for equipment to be installed YES <br />3. Description of work to be. completed: <br />C' <br />e, r - V-�' <br />4. Description of equipment to be used: <br />NO H <br />C <br />5. All equipment is State certified or approved. YES NO <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />mb. Identiyonrdecontamination: <br />Name Phone( <br />Address city --------- Zip <br />C . Describe method to be used for decontamination: <br />ate material will be stored onsite prior to manifesting offsite.:. <br />d. Describe :loomrins, <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />