Reliance | Industries Limited Reliance Project Management System Dahej Manufacturing Division- Expansion Project Respirator Fit Testing Record 10087-2-HSEF-CHK-GE-031 19.04.14 Issued for Implementation Rad ~ Date Revision Details Prepared By Checked By Approved ByReliance Project Management System _Respirator Fit Testing Record Revision Details 10087-2-HSEF-CHK-GE-031 Date: 19/04/2014, Rev. 0 RECORD OF REVISIONS _| Issued for ImplementaticReliance Project Management System 10087-2-HSEF-CHK-GE-031 19/04/2014, Rev. 0 Respirators Potentially | Yes No Comments Required on Job? Half-Face Cartridge | Half-Face Dust _ Half-Face Fume Full-Face Cartridge Full-Face Canister Full-Face SCBA (Airpak) Quarter Face Passed Failed Isoamylacetate (IA) Saccharin (Sa) Other Respirators that fit Brand Facepiece | Test Agent Comments Size Amount Respirators that did not fit Brand Facepiece | Test Agent Comments Size Amount Tester (signature) Date Note: This form is referenced in Procedure 10087-2-HSEF-DWP-GE-040. Respirator Fit Testing Record (10087-2-HSEF-CHK-GE-031) © 2014 Reliance Industries Ltd. Page 3 of 3