Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 1 63 of 53 8 Doc u m e n t Identif icat ion S E L 018 P age Nu m b e r 13 of 19 Doc u m e n t C r e ation Dat e J a nua r y 1 2013 Im p le m e n tat ion Dat e o n Re vised Doc u m e n t Apr il 26 2016 120 A P PENDIX A CO N F INE D SP A C E E N T R Y P E R M IT F O R M C O N F I N E D S P A C E E N T R Y P E R MI T Per m i t N um ber D at e o f Ent r y Locat i on and Des cr i pt i on o f C onf i ned S pac e s Purpos e of E nt r y Schedu l ed S t a r t D a t e Schedu l ed En d D at e Schedu l ed Tim e of Ent r y A M P M Schedu l ed Tim e of Exi t A M PM Wor k er s i n c har g e o f en t r y Entr an t s A t t end ant s P r e E nt ry Au t ho ri z at i on C hec k t hose i t em s be l ow w hi ch ar e app l i c abl e t o y our conf i ned spa c e e n t r y pe r m i t O xy g en D ef i ci en t A t m os pher e O xy g en Enri che d A t m osphe r e W el d i ng cu t t i ng Fl am m abl e Atm osphe r e Tox i c Atm osphe r e Eng ul f m ent Ene r g i z ed El ec t r i c E qui p m ent Ent r apm ent H az ar dou s Chem i ca l Sa f et y P re caut i ons Se l f C ont ai n ed Bre at h i n g A ppar at us V ent i l at i on P r o t ec t i v e G l ov es A i r Line R es pi r a t or Lin e l i nes R es p i r a t o r s Fl am e Resi s t an t C l o t hi n g Fi r e Ex t i ng ui she r s B ar r i c ade Job Are a Lock out T ag out Sig ns Pos t ed C l ea r an ce Se cur ed Lig ht i ng G r oun d Fau l t I nt er r up t er E nvir on m ent al C ond i t i on s T e st s T o B e T ak en D at e T i m e Re T es t i ng D at e T i m e O xyg en O xyg en Low er Exp l os i v e Li m i t Low er Exp l os i v e Li m i t T ox i c A t m osphe r e T ox i c A t m osphe r e I nst r um ent s Used I nst r um ent s Used Wor k er c onduc t i ng sa f e t y che ck s si g nat ur e R em ark s on t h e ove ral l c o nd i t i on o f t he con f i ned sp ace EN T R Y A U T H O R I Z A T I O N A l l ac t i o ns a nd or condi t i ons f or sa f e e n t r y ha v e be en pe r f o r m ed Per son i n cha r g e of t he e n t r y P l ea se P r i n t EN T R Y C A N C EL LA TI O N E ntr y has be en co m ple t ed a nd al l en t ran t s have l e f t t he spac e Per son i n cha r g e of t he e n t r y P l ea se P r i n t