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PHYSICAL HAZARDS 0 <br />Heat SlipjripFall <br />Cold Noise <br />Rain Underground Hazards <br />(au usA ) <br />Fog L,-- Overhead Hazards <br />PERSONAL PROTECITVE EQUIPMENT - <br />• <br />Excavation -s /Trenches <br />i-�Moving Equipment <br />Other. <br />R = Required A = As Needed <br />Hard Hat Safety Eyewear (Type) <br />Safety Boots Respirator (Type) <br />A Orange Vest Filter Type k-)0-tDe>L,1- <br />A Hearing Protection <br />Tyvek Coveralls <br />.5 Minute Escape Respirator <br />MONITORING EQUIPMENT <br />Organic Vapor Analyzer <br />Oxygen Meter <br />Combustible Gas Meter <br />H2S Mete <br />WJ3.G.T. <br />Sample # <br />Name <br />Date <br />Time On <br />Gloves (Type) <br />Other <br />PID with lamp off 0,eV <br />Draeger Tube <br />Passive Dosimeter <br />Air Sampling Pump <br />Filter Media <br />Signature Name (Printed) <br />Off <br />Laboratory Used <br />,v (on ),� Q —riin" 'M^T^ti IR 1 con <br />Sample # <br />Name <br />Date <br />Time On - <br />OF, <br />Date <br />