Laserfiche WebLink
Tanknoiogy,Inc. Confined Space Entry safety Policy i00-06=A-Entry Permit Rev C <br /> Checklist/Permit <br /> Rev: C Feld Form <br /> Date Effective: 9/08/2005 Page 1 of 2 <br /> I <br /> Instructions: Tanknology requires that this form is completed for all jobs that involve ANY work in forecourt(tankfield). A copy must be <br /> submitted with the raw data file.Sections I and II must be completed for all sites. Sections III and IV to be completed as appropriate. <br /> SECTION I GENERAL INFORMATION <br /> Date: -l `C.", W.O.#.. <br /> YQ <br /> Site name/#: � lb Technician(s): J•Sct U <br /> pA <br /> Scope of Work: L' p e "al c aces: <br /> �.•� v- ES�G STP S 1 Fill Su 1 Vault 1 Other: <br /> SECTION II NO CONFINED SPACE ENTRIES PERFORMED AT SITE <br /> A. Work performed does not require removing sump lids <br /> B. Work only requires visual observation into sumps <br /> y <br /> C. 7�All work will be conducted without bodily entry using tools <br /> D. All work performed will be completed from prone position with no risk of falling in sump. <br /> E. No confined spaces present. Des <br /> F. Work requires entry,proceed to ion III <br /> Lead Technician SignatureDate - a - 1 <br /> SECTION III ALTERNATE ENTRY/NON-PROS RECLASSIFICATION <br /> A.Alternate Entry(check to confirm that ALL requirements are satisfied) <br /> I. All employees trained <br /> 2. All other hazards eliminated(list) _ <br /> 3. Ventilation and monitoring prior to entry demonstrate ability to maintain safe atmosphere <br /> 4. Continuous ventilation and monitoring during entry <br /> 5. No customer or other requirements to classify space as permit-required <br /> 6. If work performed can change atmosphere Alternate Entry will be cancelled <br /> B.Atmospheric Tests Monitoring Equipment Make/Model: Cal.Date: Bump tested(YIN) <br /> Test must be taken in the following order: Acceptable <br /> Test to be Taken Limit Test Results <br /> Name of Space(may list multiple spaces) Reg STP,,etc. <br /> Depth to bottom of space Feetllnches <br /> TIME HOUR I MINUTE <br /> %of OXYGEN(02) 19.5-23.5% <br /> %of LEL flammable concell4rations =0(none) <br /> OTHER(if applicable) Toxic(or N/A) <br /> Initials of Lead Technician Initials <br /> C. Safe R uirements LARLIies to all C.S.Entries Yes No N/A Comments <br /> 1. Area barricaded _ <br /> 2. Lockout/Tagout completed and verified _ <br /> 3. Sources of ignition controlled _ <br /> 4. Pressure relieved from piping _ <br /> 5. Cleaning(flushing/washing)done. <br /> 6. Hotwork permit obtained ' <br /> 7. Other <br /> SECTION III CONTINUED ON NEXT PAGE <br /> COMPANY CONFIDENTIAL Cd Tanknology Inc.,2012.All Rights Reserved. <br /> Kitilid copies of this document are uncontrolled. The current version is available in the Tanknol On-Line Document Control S stern <br />