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THE <br /> MARK Confined Space Entry Permit <br /> IncGROU <br /> ENGINEERS 3 GEOLOGISTS, INC <br />' Contract Job Number <br /> Operating Area Good for this date Only 19 <br /> Specific vessel, equipment or construction <br /> Work to be done <br />' PERCENT TESTS <br /> LOWER OTHERS ATMOS <br /> EXPLOSION PERCENT BENZENE TOLUENE XYLENE H's co PHERE <br /> TIME LIMIT OXYGEN (ppm) (PPM) (PPM) (PPM) (PPM) CLASS INITIAL <br /> CHECK LIST Initial PERSONNEL <br /> yes Apply <br /> Not PROTECTIVE EQUIPMENT <br /> ^may EYES <br />' ❑ chemical Goggles <br /> All lines leading to and from confined space have been blinded or disconnected ❑ Face shield <br /> ❑ Safety Glasses <br /> Electrical service disconnected or locked out ❑ welders Mask <br /> All grounding and bonding wire In place Sony <br /> ❑ Ermfonmental Surt ❑ Pia ❑alq+ <br /> All ignition sources have been isolated ❑ Heavy Sud ❑ Pvc ❑Nox-� <br />' ❑ Light PVC Suit <br /> Breathing supply and alarms Necked and are In proper condition ❑ Yelow Tyvek Suit <br /> [3 White TyvekSuit <br /> The complete respiratory supply system has been checked and Is in proper condition <br /> EXTRELUTIES <br />' All safety harnesses and life IInes checked and In proper condition ❑ Hard Hat <br /> ❑ Gloves <br /> Required protective clothing gloves,toots etc being used ❑ soots ❑ Pvc ❑ #4*w« <br /> 0 Hoods ❑ Pvr: ❑ Nowp <br /> Outside safety watch trained In emergency procedures and resuscitation ❑ FoatCarenngs <br /> All emergency systems such as air packs,fire extinguishers,backup breathing supply, <br /> alarms,etc,ready for use RESPIRATORY <br /> ❑ Sii#Contained Respirator <br /> Special warning/caution signs are posted ❑ How Una Respirator <br /> ❑ Cartridge Respirator <br /> No employee with facial hair,eye glasses or other glasses,or other gas tight obstructions Cartridge Type <br /> will do work which require a respirator,or act as emergency standby ❑ Dust Resprator <br /> Employees will not wear contact lenses in an atmosphere where a respirator is required EOUIPMENT REQUIRE=D <br /> ❑ Fire Etdtnguisher <br /> 0 Fire Blanket <br />' 0 Charged Water Hose <br /> 0 Corrbustkile Gas Indicator <br />' Special Instructions <br /> Completed By rnDate <br /> Mae Printed Signature <br /> FIELD COPY(White) FILE COPY(Yelkrw) Protect Safety Dlticer Review <br />