Brega Petroloum Marketing Co =(t)m Lai gy gu Bay lh Us Work Permit System wy de Gai ‘COLD WORK PERMIT CeCe 2 Loar Ta Dat - Period Validity Nc adhe 2 own . perspec ge gS permit No; —__\__| + tunel fy] Area | Location : a +: ¢iyai] Equipment : 2 Boxall Pin) SRE Doncrption of Merk ta beeches iiesea pn Answer with ( /) where applicable : ssid! gall yi ( qe) We ge Ayla cians Precaitions required Is tho equipment property blinded or disconnected? | i [eee remnas se | ot Is equipment adequately ventilated 7 ( fis uses 5 Asia a | 02 Has the gas test been mado ? | tan seisd | 03 Is the equipment or area free of combustible gus? F: $NA pa es ay clonal Ja | 94, Is the equipment de-energized / de pressured ? (O[ saa niet ost oe cia de os | 08 | Ist, n Yourjudgoment, safe to do this work 2 Tas glow Jal atin 5d | 06 a shld as Sag BM lhl J ch A ‘confi thatthe require olton hs boon made andthe plants save o work Work requested by : + daa ie ‘understand the hazards involved in above permitted Ahi sig nda) hn tt Dy 4 pal Jal ghd gar fork and the limitaions required have been ox tome Work and the li 8 rea 0 been oxplained aa \ : Signature of authorized craftsman 2 ay ay 6d 5 yy ca Ka a ny al sae Cy pally al yaad | have investigated the equipments , the work location and made sure of the up six points [sate anprovat:§ ——— e + Lot sue) The white : for work performer yp J ag ‘The blue : for work requester Sah ls 83) The : for safety office Hola bang / 61a) etch ay