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06/03/1999 16:37 7077451.477 OCIH PAGE 03 <br /> CONFINED SPACE ENTRY PERMIT <br /> General Location of Work: Get-N-Go Market, 574 West Grant Road Tracy, California <br /> Exact Name of Confined Space:UST,inspection&possible repair <br /> Possible Atmospheric Hazards, in any: Oxygen deficiency,organic vapors(gasoline/diesel) <br /> Possible Safety&Related Hazards: Slips,trips,falls,traffic,flammable atmosphere <br /> Hazardous Materials to be used/generated YES or NO (If yes,list by chemical name): <br /> REQUIRED CONTROLS Done N/A Explanation <br /> Isolations& Lockouts Try-Out <br /> Ventilation(Natural or Mechanical <br /> Personal Protective Equipment <br /> Body Harness& Line,Hoist <br /> Emergency Lights <br /> Communications(Verbal,Radio,Tug <br /> Signals,Air Horn,etc. <br /> Emergency Procedures Review <br /> Grounding&Bonding <br /> Weldinit Permit <br /> Fire Extinguisher <br /> Area Security Post&FI <br /> Rescue Service Contacted <br /> AIR TESTING Results Time By Results Time By Results Time By <br /> (Continuous air monitoring required at a0 <br /> times unless otherwise noted <br /> (Acceptable Limits in Parenthesis <br /> Oxygen 19.5 -23.5% <br /> Lower Flammable Limit <IO% <br /> Carbon Monoxide <35 <br /> -Hydrogen Sulfide <10 m <br /> Other/Comments <br /> instrument Used: GasTech Model: GT201 Serial No.: 9827127 <br /> INTIAL PERMIT ISSUED: Time/Date to Time/Date 12 hours max. <br /> Certified Confined Space Monitor Initial Review: <br /> Supervisors)Acknowledgement: I understand that l am rr-ponsible for ensuring that attendants and entrants are <br /> properly trained(includes review of this permit)and that all permit requirements and related confined space entry <br /> procedures are met for this entire operation. <br /> Permit Renewals(time/date/person) <br /> PERMIT WILL REMAIN AT SITE UNTIL JOB IS COMPLETED <br />