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RETROFIT OR REPAIR <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 />4. Description of equipment to be used: <br />UAW -LL,( <br />M <br />5. All equipment is State certified or approved. YES E] NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Pho (�) <br />Address City Zip <br />C. Describe method to be u e4 for dec tamination: <br />d. Describe how rinsate m erial will be stored onsite prior to manifesting offsite: <br />e. Rinsate uler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( ) <br />2 <br />