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• RETROFIT OR REPAIR • <br />1 _ Site map enclosed YES [) NO [I <br />2_ Spec sheets attached for equipment to be installed YES [ j. NO [ j <br />3- Description of work,to, be. completed: <br />ha M, (M) <br />4-- Description of equipment to be used: <br />5_ E J1. equipment is Slate certified or approved_ YES [I NO [I - <br />6_ Decontamination Procedures=- - <br />a. Will piping be decontaminated prior- to removal? YES [I NO [I - <br />b Identifjr contiactor performing decontamination_ _� _---_-:— -- - <br />Name Phone} <br />Address City Zip <br />C. Describe method to be used for decontamination: <br />d_ Describe hoW i'insa`e material vriil`be stored onsite prior to manifesiing_offsite <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phoned } <br />2 <br />