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ATTACHMENT 12 <br /> REMEDIATION MANAGEMENT-AUTHORIZATION TO WORK <br /> VR.F'-TASK 11AZAM) REVILEV <br /> TASK <br /> 2. 2. <br /> 3. 3. <br /> 4. 4. <br /> 5. 5. <br /> 6. 16. <br /> ('11L.N11CA1_./ <br /> I. 0 Hydrogen Sulfide 2. 0 Benzene IT 0 Diesel 1 4. HydrocarbonEl Acid 1 6. Lead <br /> 7.[j Carbon Monoxide 8. 0 Asbestos 1 9.El caustic I 10.Ej Gasoline ttEl Lead <br /> -El Heavy Metals <br /> 12.Ej NORMS 13.00ther <br /> HAZAIII)PLIS J=NERG <br /> 19. Radiation 20.Q Electric 21.0 Pneumatic 22.El Thermal-Steam <br /> 23. YmIraitUc L14-LI-Pressure 1 25.Ll Mechanical 26.Ll Fluids&Gases <br /> 27. Gravitational I 28.El Other <br /> OTHER POTENTIAL HAZARDS <br /> 34. Walking/Working Sur aces 35.�ra Ic 136.Ej WZrklq at ff Lights 37 Pinch Points <br /> 38. Weather 39.El Noise 40.0 Grinding 1 -4170-Heayy Equ4pmens 42.El sharp Ed es <br /> 43.El mot work 44.-E]Secudy 45.D Congested'Area 46.El Overhead Work <br /> 47.❑Body Position 48.0 Static Posture 49.'Ll Wind 1 50.0 Rotating Equipment 51.El Lf tin <br /> 52. ffousek aRiqg 53.C3 Spills 54.El underground utility 55.El slopes& Terrain <br /> 56. Pmqftned Space 57.El Vibration _ 58.[:1 Ground Disturbance 1 59.L1 Rigginz <br /> 1 60. Vehicle Safety-Driving 6-17 0-Repeddve Motion 62.[A ContainerContainerlDrum Labels <br /> -j 63.Ll Waste 64.[1 Heall Cold Stress 65.0 Hand A Power Tools 1 66.El Fitness to work <br /> 111MV7.Ll Open Pipe 68.L1 Boom Swing 69.[1 Lighting 1 70.El fg!osure to Poisonous Plants/Animals lBugs <br /> W F71.[I Overhead Electrical 72.0 AMur/Drill Stem 1 73.0-Other <br /> REQ1.11RED S.A.LFETY PREC-AUTIONS <br /> 79. tV 81. Face Shield 1 82. F3 Ear 183j��g R <br /> A �e Glasses- 80. Sg�cfive Vest <br /> 84. Hard Hat 85. Lj Esc e Pack 86. D4 Safety Toe Shoes, 1 87, LjEar Muffs 88, EMIrator. <br /> 89. FRC go. [I sup M <br /> 'pue4AIr 9 1. 0 To Cream/R chants 92. Gloves. <br /> 93. ❑Fire Watch 94. Q Drip Pans 95. Q Plastic Sheeting %. .LJ Vac Trucks 97. 9 Fail Protection <br /> 9 <br /> Barricade 99. [1 Fire Blanket =100upwInd Areas Checked .101.0Warnfn signs <br /> 102. EL&g qff Area 103.U Life Lines 104.L]Fire Exon ufsher at JobsUe 105.[1 Sampling Prohibited <br /> -70-6 Seat Manholes,Sewers,and Catch Basins 107.Lj Communication Method 108.Lj Welding Shields <br /> 109.0 Continuous Alonito!ing I 110.L1 We(Down Area 111.Ll Ladder 77e Off <br /> 112.Q Tag Lines 1 113.0 Active Site Hazard Communication <br /> 114.El Fence OffArea 1 115.U Other <br /> RE!2UIRED PROCEDURES <br /> U VnEnj El MOC I [I Traffic Control I [-I L0r01Bg!!AW I [I Hoist ILifting I TTJ-ourn!2 Hazard Assessment <br /> REQUIRED PERMITS <br /> Hat Work Ground Disturbance 1EICon[medS I D None <br /> pace El woridrogfrom Heights <br /> CAmtry adj)ffmolmmeft)6iffustures;I hm reviewed and ttadersLamd.the conditions of this <br /> pamsit and its x"achtnents- I will report hazudous conditions or acts identified on this job site to 2. <br /> my Supervisor andlor BP Representative so they can ne corroded as ncocssM, 4. <br /> 5. 16. -7. 8. <br /> 9. 10. 11. 1 12. <br /> Onsite Project Manager- I Date• Location of Site Work: 1 -4 <br /> Site: 4V- _ EDate/Time Issued: AM/PM Date/Time Issued: <br /> LJ Is HASP on Site I LJ Is ERP on Site Ll Is JSA on Site <br /> Authorization Signature: Date: <br /> 0 <br /> CorownzillipsffiP 60 SECOR IntematiorW Incorporated <br /> 'SECOR Project No, <br />