Laserfiche WebLink
S3ElflIVN 019 OANCON <br />ANCON <br />CONFINED SPACE ENTRY <br />Effective date cc--1-0 20 70 Duration: From <br />Cl) Permit issued to ArkGoa <br />0 -a <br /> Description of Work CU.A.A-t FiStaltn, -441 <br />Facility _ Specific Location <br />Hazards: El Flammable 0 Corrosive D Reactive 0 Toxic D Temperature >1000 or <500 0 Engulfment <br />Other Hazards _aftHt. &am__ <br />Equipment/piping depressurized & vented <br />Equipment/piping blinded, blanked, or disaligned <br />El Powered (forced air) ventilation <br />Other <br />9IP <br />144142asiii, _xt4 S1vek1I.7 4 +4 <br />lii <br />Electric, hydraulic, pneumatic & mechanical energy sources <br />shut-off & locked out. (zero energy state) <br />Vessel/space steamed, cleaned, or washed <br />Entry Type: Horizontal* Vertical 0 <br />Ill PARALLEL VERIFICATION <br />NON PERMIT-REQUIRED CSE <br />VALID FOR ONE SHIFT ONLY <br />../P.M.: To I WA) EMIR M. <br />W30 <br />40- <br />10ALEL tf <10% <br />initiate r nutty <br />°A, LE L OTHER NORM TEMPERATURE <br />(degrees) % Oxygen <br />1030 <br />Tested <br />by <br />AcTion LESS THAN 19.5% <br />Levels MORE THAN 23% <br />ii iiIIela HYdrc Wm) <br />10 30 <br />tar- <br />5 PPM <br />Carbon Monoxide BENZENE <br />(SO ppm) (p ra)_ <br />te39 /030 <br />IAS <br />20 PPM <br />0.5 PPM <br />QI Continuous <br />Monitoring <br />Instrument <br />Serial # <br />Most Firment <br />Calibration <br />Field Calibration O.K. <br />Type <br />Time <br />O( PPM <br />A-5 <br />Xylene (50 ppm , Toluene (50 ppm), Aromatic Hydrocarbon (5 ppm), <br />Ammonia 112 ppm), Mineral Spirits (50 ppm), Methanol (100 ppm) <br />PROTECTIVE EQUIPMENT (OPERATIONAL) <br />Warning signs, barricades O Fire equipment in place <br />ci Barricade tape/cones • Ground fault circuit interrupter <br />*t, Ventilation Fan or Blower • Lighting (hazardous location rated) <br />PERSONAL PROTECTIVE EQUIPMENT <br />Airline respirator (supplied air) 11-Gloves <br />if Other Respirator <br />Self Contained Breathing Apparatus <br />Specify _Fon FAL( ,),Ft., 0), <br /> AT Boots <br />52, Hearing protection <br />k Rain Gear <br />RESCUE PROCEDURES AND EQUIPMENT <br />Emergency Phone Number <br /> <br />/ <br />Location of Phone/Radio (ftySitlit <br />RESCUE EQUIPMENT ON SITE: <br />Full body harness/lifeline 0 Davit/Tripod <br />Rescue winch 0 Other <br />Designated Rescue Team: <br />Emergency Assembly Area: <br />POTENTIAL EMERGENCY SITUATION(S) <br />ACTIONS TO BE TAKEN 12,„D pee-1 <br />Grounding and/or Bpnding <br />0 Ladder <br />Other <br />Safety glasses <br />Fall protection/arresting equipment <br />Chemical splash goggles <br />Other <br />111 Rescue Plan Complete <br />Facility # <br />Customer Representative # <br />CSE COMMUNICATION <br />Radio communication <br />Rope signals <br />Visual hand signals <br />Other: <br />0 Sound <br />0 Visual Other <br />CONFINED SPACE ENTRANT(S) <br />We(I) have reviewed the potential emergency situations and actions to be taken. We(I) are familiar with all rescue equipment, and <br />communication methods. See entrant employee roster section of the permit for additional signatures. <br />CONFINED SPACE ATTENDANT signatures if attendant changes) <br />I have checked all rescue and communication equipment and reviewed all emergency actions to be taken with authorized entrants <br />QUALIFIED PERSON/ENTRY SUPERVISOR <br />I have c6mpleted or properly evaluated all portions of this permit and verified that acceptable entry conditions exist. All personnel <br />have reviewed the conditions of the permit and are adequately trained to perform this job. <br /> <br />ENTRY SARVISOR TIME/DATE <br /> <br />RELIEF ENTRY SUPERVISOR TIME/DATE <br />OPERATIONS