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RETROFIT.OR REPAIR <br /> 1. Site map enclosed YES)C NO [l <br /> 2. Spec sheets attached for equipment to be installed YES NO [] <br /> Com. <br /> 4. Description of equipment to be used; <br /> V C3 <br /> d?IV L <br /> Ail erg;: ,p: gent is State certified E aat pr 3 N:�' -y- NO 1 01._ <br /> 5 Decr.ntamination Procedures: <br /> Will piping be decontaminated prior to removal? v':- []S NU x <br /> t;. _',-ntify contractorpe,iorirE*ti!:I <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 N� Phone(__) <br /> 2 <br />