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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 [ ] <br />3. Description of work to be completed: <br />—0 Ids <br />4. Description of equipment to be used: <br />5, <br />6. <br />NO [I <br />4u"�'itL <br />Al! equip, hent is State certified or approved. YES [ J NO [ J <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] N.. l <br />b. Identify contractor performing decontamination: - -- <br />Name Phone(__) <br />Address City Zip <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 Phone(__) <br />2 <br />