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Tripod

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CONFINED SPACE ENTRY PERMIT DATE & TIME OF ISSUE EQUIPMENT I.D. EQUIPMENT LOCATION EXPIRATION WORK TO BE DONE CONFINED SPACE APPROVAL QUALIFIED PERSON OTHER QUALIFIED PERSON EMPLOYEE(S) TO ENTER SUPERVISOR CHECKLIST ON OTHER SIDE MUST BE COMPLETED BEFORE APPROVAL CHECKLIST SPECIAL REQUIREMENTS Lockout - De Energizer Lines Broken - Capped or Blanked Purge - Flush or Vent Ventilation Secure Area Breathing Apparatus Resuscitator - Inhalator Escape Harness Tripod Emergency Escape Unit Lifelines Fire Extinguishers Lighting Protective Clothing Yes No TEST(S) TO BE TAKEN (Valid for one 8-hour turn only)

CS626900
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