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05/04/1999 11:49 209-935-4767 PnSTNET PAGE 04/10 <br />CONFMI D SPACE ENTRY PEWMJT <br />General Location of Work: Get -N -Go Market 574 West Grant Road, Tracy,California <br />Exact Name of Confined Space: UST insaction &_pomible 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 />RE UJRED CONTROLS <br />Done N/A Explanation <br />Isolations & Lockouts Tr Out <br />Ventilation Natural or Mechanical <br />Personal Protective Equipment <br />Boy Harness & Line Hoist <br />Einer ency Li hts <br />Communications (verbal, Radio, Tug <br />Signals, Air Horn etc_ <br />Emergency Procedures Review <br />Groundin & Bonding <br />Welding Permit <br />Fire Extinguisher <br />Area Security Post & Fl <br />Rescue Service Contacted <br />AIR TESTING <br />(Continuous air monitoring required at all <br />times unless otberwise noted. <br />Results <br />Time <br />>fIy Results <br />Time <br />By <br />Results <br />Time By <br />(Acceptable Limits in Parenthesis) <br />Ox yen 19.5 - 23.5% <br />Lower Flammable Limit (<10% <br />Carbon Monoxide <35 m <br />Hydrogen Sulfide <10 zn <br />Other/Comments <br />Instrument Used: GasTech Model. GT201 Serial No.. 9827127 <br />"WrILAMLPIRMIT ISSUED: Time/Date to Time/Date 12 hours max. <br />Certified Confined Space Monitor Initial Review: <br />Supervisor(s) Acknowledgement: 1 understand that I am responsible for ensurit►g 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 />( l--• l 1 ( l I ) <br />PERMIT WILL REMAIN AT SrM UNTIL JOB IS COMPLETED <br />