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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 [] NO [] L (i <br /> 3. Description of work to be coVeled: <br /> )-b <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES'q NO [ ] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phon ) <br /> Address city Zip <br /> C. Describe method to be us or deco t"amination: <br /> d. Describe how rinsate mater' I will be sto d onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(_) <br /> 2 <br />