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FEB 95 '99 14:45 FR r01•ITAIHMENT SOLUTIONS814 542 5020 <br />ENTRY PERMIT M <br />TI_i —151©8958425 P. 14,'2'17-1 <br />FOR PERMIT REQUIRED SPACES <br />I Location: Description of confined area: I Permit nulnber-- Permit date: <br />481-j99 <br />i <br />Description of work: <br />Time issued: Time expired: <br />I <br />Required if ENTRY CHECKLIST: to be completed by Name of Entry Supervisor (prinq <br />Name of authorized attendant(s) <br />checked Entry Supervisor/Attendant or Entrant <br />Confined space preparation <br />I -i All lines including vonm tc, br. di%annnwttad And blPn Ked Op Clobc ' 1 Or%t wnerleve ;::C3stble, all tanks valves cwsed and locked. <br />L All mnrrrlaal powar 5wilc reE is kid oil. otherwise, eleatncal mwit ies taygea alf. <br />C Mecnamcal isemticn acnicvet: ny ai%connnatmg hnkagmfr or 'amnr ng art19 teas or Ct,,xrs otherwise, dpuipment with mechankal Putti. Mucked to prevent rutulwn. <br />0.1ammg will be peRo•('�aej •;Om outside of Confined souse as much us pc.s.oie cc fare antenng. <br />Cvnr�r" Scace vertep '.v'^.:lowers; all av2dariln vrtnnlannn nocr�' n, <br />Expected hazards <br />3urnmq, vwleing, brac.ng, c• :oark.oreducmg oecradons otannrc + fila. -as a n •n vunrx narmlt n!rNn nbt9rn?a'? ❑ '+es ❑ Nu <br />Toxic cormsive ar aamm;.c:r. matCrldlf: are OreSeni Of Urged tri wCu, p'OOeuarc._ <br />j ❑ Toxic atmospAere may yriewp due to work procedure-, de -%crone.^. f -am want;, ovxnanumn of ra5lnusl C"Inloals, of nature of QJnhOed sp:'cet <br />Low oxygen concanttAhnn may olloreeent or produced during entry. <br />Employee Qualifications Name of authorised entrants Date SSN <br />_ _ J - <br />Trained <br />❑ Aft a ilitif yeeb required to enter must have current (annual Conf nee Space C. -.a <br />❑ Stendbv employee has cuaent Confined Space Card. <br />❑ Number of rnirsontr Iltrnted in absolute minimum. i <br />i <br />�. t:nnaby stationed nuimice wnere heisne Caen See all autivity In tan& na joo duties i <br />d5+.ulnrd which call bum .oration. <br />I <br />Standby trained in tngr eul?rPR: otherwise Medical or Fire Deparbacnt mert_^d or 2nrrr. <br />Nnnm%t tntrpnnnc% OrJdtdd with amerpeney numbers and instrucdnns. <br />f Fire precautions <br />[ Fire exhn usher immeciatmy available (TYfxtA k t;:) -dark rcm%tant tad% prnvtoed it narnrn�ble pr'.•cNnt <br />[ Hnt Wnrk Fant reewireO. ❑ SPurk resistant tool% provided if flammnme present <br />monitoring results <br />Toxicity <br />Atmospheric testingo,% LEL% ppm or <br />m i'm3 <br />Air manitor oominaa, ann vaned In flood working order. 6ATOfA <br />tett <br />❑ 4n rnundui is within curent calibration. Curing <br />Rn <br />_ <br />-� 61r MnniMr.rynrrl Ar!n Rnn.•.r,nn nnnlinr,n.,!Iv nn nen .unrYn. •n n�.n n <br />uI remotely positioned. <br />-�7 <br />u Emplcyrr, in%buctnd in matt ciantlnetl space immediately when ma -m sounds. <br />Personal protective equipment �. <br />(Check Requirement) <br />71H;iW hat -7 <br />Respirator ❑ Hard hat <br />r❑r� <br />13Facr. %nlrld IJ Air -heti reswretor ❑ Face Shruld <br />❑r rugplee ❑ SCOA ❑ Goggles <br />Hearing P atr:chon ❑ I] Hearing ProtaCbcn <br />Clther ❑ Other ❑ Other <br />rRescue and emergency <br />❑ trnergrnr; &:,3A equipment on nand and ready for Immediate. rum by [3 All entrants. wear narnrr.%and cnnnnualiy aEarhCa to uMune. <br />standby ( q pMAX y Or <br />Unlc-r. retdeval a tri mint would Inrrnafirt nvr:.rall ilia At U t ) I <br />would not Conb'1bUte to the irbuue c ( the entiunt) <br />❑ Siunabti unde ntands metheas of emergency clan to athat ❑ pre -entry safety meeting acid emplayerr. brtetna on rr...dur. <br />Five Deoultment ofuGedures. <br />Authorization Signature (required before ent T� y <br />:?Ignalure Ot entry ptioaMsor <br />-Ja:r. Time <br />Slgbatule of atlendsnt <br />Dule <br />Time <br />signature of autnorRod enlfsnl <br />Jctc n:: <br />481-j99 <br />