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L <br /> RETROFIT-OR REPAIR <br /> 1. Site map enclosed YES NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed: <br /> 42 CL lu <br /> S _ r�eyY <br /> -i-tion of ane einment to he t t�eri <br /> r- _ <br /> a _ <br /> i <br /> -- <br /> 5_ All equipment is State certified or approved_ YES j] NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping he d�,Montamirmated prior to removal? YES [j NO [] <br /> =a_ Identify contractor performing decontamination: <br /> Name <br /> -----__... _.___ Phone <br /> Address <br /> City <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 <br /> acility:Hauler Name Phone( <br /> 2 <br />