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f ' ATTACHMENT 12 REMEDIATION MANAGEMENT-AUTHORIZATION TO WORK PRF-TASK IIAZARI.) RENIEW IASK 1. 2. 2. r 3. 3. 4. 4. 5. 15. 6. 16. I. H dro en Sul lde 2. Benzene 3. Diesel 4. H drocarbon 5. Acid 6. Lead 7. Carbon Monoxide 8. L)Asbestos 9. Caustic 10. Gasoline 11.0 HeavyMetals 12. NORMS 13.❑Other II.�;fA��not�s ENERGYU2290 Radiation 20. Electric 21. Pneumatic 22. Thermal-Steam H draulic 24. Pressure 25. Mechanical 26. Fluids&Gases Gravitadonaf 128. Other OTHER POTEN'T'IAL HAZARDS 34.ja Walking/WorkingSur aces 35. 9 Traffic I36. Workin at Hct his 37. Pinch Points 38.❑ Weather 39.El Noise 40. Grinding 4 LLJ HemE ui ment 42.❑Sharp Edges 43. Hot Work 44.❑Security 45.❑Con ested Area 46.❑Overhead Work 47.El Body Position 48.❑Static Posture 49. j Wind 1 50.Cl-Rotating E ui ment 51. Li tin 52. Housekee fn 53. spills 54. Underground Utility 55.❑Slo ms& Terrain 56. Con fined S ace 57.0 Vibration 58. Ground Disturbance 59.❑Rigging 60. Vehicle Sae -Drivin 61.❑Repetid Motion 62.❑ Container/Drum Labels 63. Waste 1 64. Head Cold Stress65. Hand&Power Tools 66.F1 Fitness to Work 67. Oen Pie 68. Boom Swin 69.L1 ting 1 70.C3 Exposure to Poisonous Plants/Animals/Bugs 71.El Overhead Electrical 72.Lj Au ur/Drill Stem 1 73.El Other RE t)IRED SAFLTV PRC'CA-UT IONS 79. Sae Glasses 80. ❑Goggles 81. Face Shield 82. [:]Ear Plus 83. Re ectf ve Vest 84. Hard Hat 85. ❑Es a Pack 86. SafetyToe Shoes 87. Ear Mus 88. Respirator. 89. FRC 90. Su lied Air 91. Topical Creams/R eUants 92. Gloves: 93. Fire Watch 94. ❑Drip Pans 95. Ll Plastic Sheetin 96. Lj Vac Trucks 97. Fall Protection 98. Barricade 99. Fire Blanket 100.El UpwindAreas Checked 101.El K*rnly Signs [E102 F O Area 103.❑Lie Lines 104. Fire LA wisher at Jobsue 105.❑S lin Prohibited Seal Manholes Sewers and Catch Basins 107. Communication Method 108. Wddfn Shields 109. Continuous Monitoring 110.D Wet Down Area 111.n Ladder T ie O 112. Lag Lines 113.Q Active Site Hazard Communication 114. Fence O Area +115.LJ Other RE UIRED PROCEDURES Dri1Gn MOC 0 Tra rc Control I Ll LOT0181inding 10 Hoist/Li tin Journ Hazard Assessment RE UE ED PERMITS Hot Work 10 Ground Disturbance Con ned ace El Workin rom He! his None Lo tol tEmoloveetal Signatures:I have reviewod and undaatmd the conditions of this paman it d its attachments. I will report ha"doos conditions or ads identified on this job site to 1• w 2. my Supervisor andlor HP Representative so they can ne eoffccW as neceuuy. 4. 5. 6. 7. 8. 9. 10. 11. 12. Onsite Proiect Manager: Date:W--T0-d1>,6 Location of Site Work: S emit, Site: if I 13 Date/Time Issued: AM/PM Date/Time Issued: AM/PM Is HASP on Site I Ll Is ERP on Site Is JSA on Site Authorization Signature: Date: CottocoPhilliPSIBP 60 SECOR International Incorporated 1SECOR Project No. u t.