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• RETR OFIT,OR REPAIR • <br /> . <br /> . Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES <br /> NO [] <br /> 3. Description of work to be completed: <br /> Q�MD�T'� �x�S ►IJP tl_�- va R. <br /> 'S'0 M S <br /> 4. Description of equipment to be used: <br /> 3/ Ir,3 NO [] <br /> 5. All equipment is State certified or approved. YES <br /> g, Decontamination Procedures: ��A <br /> YES [] NO [] <br /> a. Will piping be decontaminated prior to removal? <br /> b. Identify contractor performing decontamination: <br /> Phone(__) <br /> Name <br /> City Zip -- <br /> Address <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 /> 2 <br />