Attach 12 - Gas Free Certificate.pdf
PDF 135 KB Posted
- Solicitation number
- SP450023R0016
- Issued by
-
Defense Logistics Agency
About this file
This document is an example gas free certificate for tank cleaning services. The certificate indicates oxygen, combustible gas, and toxicity levels found during testing, and whether the space is safe for personnel, hot work, or shipping. It requires the requesting activity, item and serial number, test equipment used, and levels of oxygen, combustibles, and toxins found. The certificate also specifies any required personal protective equipment and notes that conditions may change, requiring retesting before further work. It includes spaces for the technician's name, signature, and date.
The related federal contract opportunity is solicitation number SP450023R0016 from the Defense Logistics Agency for hazardous waste removal and disposal services off-island in Okinawa. It provides for tank cleaning and certification, as well as removal and disposal of hazardous materials. Offerors should be qualified in hazardous waste handling and able to meet all regulatory requirements for transportation and disposal. The response date and award timing are not specified.
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Text version
Off-Island Okinawa Contract Renewal, PR 23-BE-116 Attachment 12
Gas Free Certificate (example)
GAS FREE CERTIFICATE
REQUESTING ACTIVITY
REQUESTING PERSON TEL. LOCATION
ITEM AND PURPOSE OF TEST:
TANK CLEANING
ITEM SERIAL NO:
CERTIFIED DATE TIME EXP. DATE
TEST EQUIPMENT MODEL NUMBER EQUIPMENT SERIAL NUMBER
OXYGEN (02)
COMBUSTIBLE
%LEL
TOXICITY
%PPM
□ NOT SAFE FOR PERSONNEL ----------------- NOT SAFE FOR HOT WORK
□ SAFE FOR PERSONNEL --------------------- NOT SAFE FOR HOT WORK
□ SAFE FOR PERSONNEL--------------------- SAFE FOR HOT WORK
□ CLEANED AND PURGED
□ INERTED NOT SAFE FOR PERSONNEL INSIDE -- SAFE FOR PERSONNEL
AND HOT WOKR OUTSIDE
□ PROVISIONAL ENTRY FOR CLEANING ONLY
□ CERTIFIED FOR SHIPPING, TRANSPORTATION AND STORAGE ONLY
REQUIRED PERSONNEL PROTECTIVE EQUIPMENT
□ AIR LINE RESPIRATOR □ AIR PURIFYING RESPIRATOR
□ CHEMICAL PROTECT GOGGLES □ CHEMICAL PROTECT GLOVES
THIS CERTIFICATE INDICATES THE CONDITIONS THAT EXISTED AT THE
TIME OF TESTING. WORK PERFORMED SHOULD BE DONE WITH CAUTION.
IF ANY PERSON WORKING IN THE AREA NOTICE ANY CHANGE OF
CONDITIONS IN CONTRAST TO THOSE THAT EXISTED AT THE TIME OF
TEST, THEY MUST STOP WOK IMMEDIATELY. CONTACT CONTRACTOR
PERSONNEL FOR RETEST AND RECERTIFICATION.ALL CHANGES IN
CONDITION OR WORK PROCEDURES OTHER THAN THOSE STATED ABOVE
WILL VOID THIS CERTIFICATE.
NAME OF TECHNICIAN (PRINT LEGIBLY)
TECHNICIAN SIGNATURE/DATE/TIME
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