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a ` <br /> RE 1 ROF I,OR REPAIR <br /> 1. Site map enclosed YES [] NO [] <br /> 2. Spec sheets attached for equipment to be installed YES [I NO [I <br /> 3. Description of work to be completed: <br /> 4 Description of equipMent to he used: <br /> i <br /> ® - 1 <br /> 5_ All equipment is State certified or approved- YES [] NO [I <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated priorto removal? YES [] NO [] <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 />