Attachment_15_-_Gas_Free_Certificate.docx

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Okinawa Off-Island Hazardous Waste Removal and Disposal
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SP450018R0011
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Attachment 15_Gas Free Certificate

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Attachment 15 Gas Free Certificate

GAS FREE ENGINEERING CERTIFICATE

REQUESTING ACTIVITY

REQUESTING PERSON
TEL.
LOCATION
ITEM AND PURPOSE OF TEST
ITEM SERIAL NO:
CERTIFIED DATE
TIME
CERTIFY 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 CONDI·TIONS IN CONTRAST TO THOSE THAT EXISTED AT THE TIME OF TEST, THEY MUST STOP WOK IMMEDIATELY. CONTACT G FE PERSONNEL FOR RETEST AND RECERTIFICATION. ALL CHANGES IN CONDITION OR WORK PROCEDURES OTHER THAN THOS STATED ABOVE WILL VOID THIS

CERTIFICATE.

NAME OF TECHNICIAN (PRINT LEGIBLY)

TECHNICIAN SIGNATURE/DATE/TIME

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