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Work Order: 2269825 <br /> Tanknology Confined Space Entry safety Policy 100-06-A-Enov Permit Rava <br /> Checklist/Permit <br /> Rev: C Field Form <br /> Date Effective 91D8/2005 Page 1 of 2 <br /> IDStructions: Tanknology requires that this font is completed far all jobs that involve ANY work in forecourl(tankfeld). A copy must he <br /> submitted with the mw data file.kieiiotls I_an i 11 inusLe SeID0I4Wfill.ilea.. &ration:III and IV m be completed as aPPmpriate. <br /> SECTION 1 GENERAL INFORMATION ppl�yy <br /> Date: W. M: vt_7TJ 2 <br /> —_ <br /> Site namNC: �� /�� Tc icianls): <br /> _ <br /> oI c 1rL---_�- - - -- ca: - - <br /> 5coiv:nl'Work: 's potentinl confined spaces: <br /> '-M. ' \i—S-/t -__ Q. _-_-_. ____- __. I'Swnn( Fill Summa Vnntt_Other. <br /> SECTION 11 NO CONFINED SPACE ENTRIES PERFORMED AT SITE <br /> A. Work performed docs col require removing sump lids <br /> R. Work only requires visual ohselalion into sumps <br /> C. All work will be conducted without bodily entry using Awls <br /> D. )d All work performed will be completed from prone position with no risk of falling in sump. <br /> Jr. No cnnlined spaces present. Describe: <br /> F. Work requires entry.procced to section III <br /> Lead Technician Signature -- Date lo' 2 2'G� <br /> .. ......_...__ .. ... ............ . <br /> .............. ........._..... .. ......._.... .........._... .................. ....._.... . ... .._.... <br /> SECTION 111 ALTERNATE ENTRY/NON-PRCS RECLASSIFICATION <br /> A.Alternate Entry(check to confirm that ALL requirements arc statistical) <br /> 1._L All employees trained <br /> 2. All odun haprds climmuted(list) <br /> 3. Ventilation and mom luring prior it)entry demonslmtc ability to maintain safe atmosphere <br /> a._-_- -Continuous ventilation and monitoring during entry <br /> 5. - No customer or other recluirements At classify.space as permit-required <br /> (. - - If work Inn6nned can change atmosphere Alternate Enary will he canceled Q �/ <br /> R.Atmospheric TMs Monitoring Equipment Make/Mrrdcl: A �/._�i�+- (:oLDmc:Z'.?dy1C5 Rontpusted(YIN)y <br /> Test most he taken in the fallowing order: ALeVU'bl, <br /> Test to be Taken Test Result. <br /> Name oi'Sp:cc(may hat multiplespoccq Depth to hottom o7 TIME �� -V%ufOXYGEN(0,) 0A �•%ofLEL Flammable con,cnlntiam � <br /> OTHER(ilapplicable) _ Tosic(or N/A) <br /> Initialsof Lead Technician Initials <br /> C. safety Rectuirements A lies to all C.S.Entries Ycs No N/A Comments <br /> I. Area harricadud <br /> 2. IamkoupTagant completed and verified <br /> 3. Sourecsofignitioncenlmlled - — - <br /> 4. Pressure rchcved fmen piping -_ <br /> 5. Cleaning done ----- <br /> G. ilotwork permil obtained <br /> 7. Other <br /> SECTION Ill CONTINUED ON NEXT PAGE <br /> COMPANY CONFIDENTIAL k)Tanknology Inc.,21WR.All Rights Reserved. <br /> Punted w ics ofthis docununt are uncommillcd. The current version i_available in the T.nkn.logy ChiAJae Document Comma System <br /> Tanknology Inc. 11000N.MoPac Expressway, Suite 500,Austin,Texas 78759 <br />