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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[] <br /> 3. Description of work to be completed: <br /> 4. Description of equipment to be used: <br /> 5. All equipment is State certified or approved. YES NO [I <br /> 6. Decontaminatio rocedures: <br /> a. Will piping be d ntaminated prior to removal? YES [] NO[] <br /> b. Identify contractor pe ming decontamination: <br /> Name one _) <br /> Address city Zip <br /> C. Describe method to be used for de n mination: <br /> d. Describe how rinsate mater I will be stored onsi rior to manifesting offsite: <br /> e. Rinsate Hauler a permitted Treatment, Storage &Dispose acility: <br /> Hauler Name Phone_____) <br /> 2 <br />