Environmental Health & Safety	E H & S TEL NO: (818) 677-2401 FAX NO: (818) 677-5853 MAIL DROP: 8284
	Confined Space Sampling Results
	(Permit Spaces Only)

Event:	Time:	% Oxygen Reading	% Explosimeter Reading	Hydrogen Sulphide Reading	Carbon Monoxide:	Detectable Odors:
EXIT IF READINGS ARE:		% 02	% OF LEL	H2S PPM	(CO ppm)	OBSERVED	DESCRIBE
			Greater than 9% of the LEL	Greater than 9 ppm.	Greater than 34 ppm.	YES/NO	IF YES
PRE-ENTRY READINGS:
VENTILATION STARTED:
ENTRY INTO PR SPACE:
TE + 1 HRS:
TE + 2 HRS:
TE + 3 HRS:
TE + 4 HRS:
TE + 5 HRS:
TE + 6 HRS:
NOTE: GAS DETECTION EQUIPMENT MUST BE OPERATIONAL DURING THE ENTIRE OCCUPANCY OF A "PERMIT REQUIRED CONFINED SPACE" AND AN "ALTERNATE ENTRY PROCEDURE CONFINED SPACE".