- Work Order t - - - -- - -

engrofoods

Time: c5\ )>?"

Expl,.llon Tim, \ ,..,
ENGRO FOODS LTD
EXCAVATION & CIVIL WORK PERMIT
R11d lnmucllon1 on th• back of th• Card Copy

lioul'I
?> tl\'/ Hour:s
Oatt:f i l - o \ 20
Date.· cJ ·~~ ' 20 "' •
--
1
~
This authorizes Mr. .:~~?~~~~~~:3;,.__~~ ---;=::--:-~r;-
Area
In
at location (marked)
NOTE: )
In lht following lick ( ✓ whichever It appllc1bl1. YES NA NO

1. Have drawing, been c;h~ckld (Dwg. No: @DD

2. Are there any electrical cablea underground? D C9D
3. Arv there any telephone Cabl11 underground? □ rn-□
4. Are thert any Instrument llnH / cablH underground? □ mo
5. Are therv any g11 lines underground? D G D
• · An there any llwtrt underground ? D ca-<□
7. Art thert any flrt water llnn underground? D B□
8. Art thtrw any acid t"cau1tlc I 1t11m llnH underground? 0 0 0
9. Art tha cabl11 / lln11 underground proptrlY, d...n,rglzed &
dl1conn1cttd? D ~ D
10. Are the plpllnes underground llolattd, d11pr111urlzed, emptied
& blinded et 1nd1. D ~D
11 . la• power (electrical/ pneumatic / hydraulic) driven equipment ,.,...
. required and permitted for drill Ing? . D ~ D
12. II tholing rtqulrtd? 0 t:~r 0
SPECIAL PROTECTIVE EQUIPMENT REQUlRED ,
0 Full Face Man O Face Shield ' 0 Rubber Shoet
0 Frati Alt MIik O Scott Air Pak O Rubber Gloves
c:s::J1fo91JIH D Apron O Ear Protectlvea

: .m• of pt~ on •::gned ~~:h

t , •~ra·,9Cond~ ?.

Any other precaution,. : ' ""- ' \ Q

~
INITIATED BY: CO~NEDBY CO-SIGNED

CIVIL ENGR. Elect. Designate · Utilities Designate

Approved by (Engg ..Manager)

I undemand·lh• prec1ultlo11• to be taken to excavate/ conatruct In the marked area. It 11 my

mpon11bUlty to clean up after GOmpletlon of the job 111d lnrfomthe aulhrtzod peraon.

Operator of Power · Maintenance Person

Driven Eq11lpm•nt

Exltnded upt.,__ ___ Hourw on·- -._ _ 20-._ _ _ by _ _ _ _.;...._

Nam, of lncomln9Ar11 Operator-..- - -- - - -

Signature .of Incoming
N.ime of Incoming Operator
Malntenenc, Ptrso,•.__ __ _ _ _ _ _ __

lnt~ing M1lnten1nc1
Per.on'• Lock Number Signature of Incoming
Electrical Valve
Maintenance Ptl'$on
Job Completed D · Time; _ _ _ _ _ Hou111
Job lmcompl• te CJ Oil zo ___

Art■ taken ov ■r after completloi, of Job and cl11n up Malnlen1nce Person

. NOTE; All WOil Pt nnlt 1/'HI Ill Non- Sinollnt~at Clvll Designate