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<p class="MsoNormal">APPROVED<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"> <img width="180" height="45" style="width:1.875in;height:.4687in" id="_x0000_i1025" src="https://ucriverside.az1.qualtrics.com/CP/Graphic.php?IM=IM_8HvGTwJPt7awyvX" alt="Graphic.php?IM=IM_8HvGTwJPt7awyvX"><br>
<strong><span style="font-size:12.0pt;font-family:"Arial",sans-serif">HOT WORK PERMIT REQUEST</span></strong><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><br>
<strong><span style="font-family:"Arial",sans-serif">FACILITIES SERVICES AND OTHER DEPARTMENTS</span></strong></span></b><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><br>
-----------------------------------------------------------------------------------------------------</span><span style="font-family:"Arial",sans-serif"><br>
</span><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">HOT WORK IS BEING PERFORMED BY:
</span></strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Contractor under UC Riverside Facilities Services or other department supervision (small renovation or repairs)<br>
<br>
<strong><span style="font-family:"Arial",sans-serif">PERMIT REQUESTOR:</span></strong> Jessica Perez<br>
<strong><span style="font-family:"Arial",sans-serif">DEPARTMENT: </span></strong>Botany and Plant Sciences</span>
<o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">PHONE NUMBER:</span></strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> 951-827-5133<br>
<strong><span style="font-family:"Arial",sans-serif">EMAIL: </span></strong>jessica.perez@ucr.edu</span><o:p></o:p></p>
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<p class="MsoNormal"><br>
<strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">PROJECT MANAGER/SUPERVISOR:
</span></strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Mien Van de Ven<br>
<strong><span style="font-family:"Arial",sans-serif">PHONE NUMBER: </span></strong>951-523-9023<br>
<strong><span style="font-family:"Arial",sans-serif">EMAIL: </span></strong>mien@ucr.edu<br>
<br>
<strong><span style="font-family:"Arial",sans-serif">PERSON PERFORMING HOT WORK: </span>
</strong>Carlos Medina carlos@ss-plus.com<br>
<strong><span style="font-family:"Arial",sans-serif">COMPANY/DEPARTMENT: </span></strong>Scientific Services Plus
<br>
<strong><span style="font-family:"Arial",sans-serif">PHONE NUMBER: </span></strong>619-517-2688<br>
<br>
<strong><span style="font-family:"Arial",sans-serif">PERSON PERFORMING FIRE WATCH: </span></strong>Matt Ulrich<br>
<strong><span style="font-family:"Arial",sans-serif">COMPANY/DEPARTMENT: </span></strong>Botany & Plant Sciences<br>
<strong><span style="font-family:"Arial",sans-serif">PHONE NUMBER: </span></strong>951-827-4004<br>
----------------------------------------------------------------------------------------------------------------------------- </span>
<o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black;background:lightgrey">JOB DETAILS</span></strong><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> <br>
<strong><span style="font-family:"Arial",sans-serif">JOB START DATE: </span></strong>06/03/2020 8:30 AM<br>
<strong><span style="font-family:"Arial",sans-serif">JOB END DATE: </span></strong>06/03/2020 4:00 PM<br>
<br>
<strong><span style="font-family:"Arial",sans-serif">LOCATION - BUILDING/FLOOR/ROOM</span></strong>: Batchelor Hall Room 2164 (off the dock)<br>
<br>
<strong><span style="font-family:"Arial",sans-serif">JOB DESCRIPTION: </span></strong><br>
Repair Growth Chamber</span><span style="font-family:"Arial",sans-serif"><br>
</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><span style="font-family:"Arial",sans-serif"><br>
<br>
</span><strong><span style="font-size:12.0pt;font-family:"Arial",sans-serif">THE FOLLOWING PRECAUTIONS HAVE BEEN ACKNOWLEDGED AND WILL BE IN PLACE WHENEVER POSSIBLE (FOR EXCEPTIONS - SEE COMMENTS BELOW)</span></strong><span style="font-family:"Arial",sans-serif"><br>
</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> <br>
<strong><span style="font-family:"Arial",sans-serif">General:</span></strong></span>
<o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif">, Available sprinklers, hose streams, and fire extinguishers are in service and operable<br>
, Hot work equipment is in good repair<br>
, Fire detection equipment protected from false activation<br>
, PPE is used to protect workers from physical and chemical hazards while hot work is being performed</span><o:p></o:p></p>
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<p class="MsoNormal"><br>
<span style="font-size:10.0pt;font-family:"Arial",sans-serif"> <strong><span style="font-family:"Arial",sans-serif">Within 35 feet (11 meters) of work:
</span></strong></span><o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif">, Flammable liquids, dust, lint, and oily deposits are removed/cleaned<br>
, Explosive atmosphere in area is eliminated<br>
, Floors are swept and clean<br>
, Combustible floors are wet down and/or covered with fire protection blankets<br>
, Other combustibles are removed when possible or else covered with fire protection blankets or metal shields<br>
, All wall and floor openings are covered<br>
, Fire protection blankets are suspended beneath work<br>
, Ducts and conveyors that might carry sparks to distant combustible materials are protected or shut down</span><o:p></o:p></p>
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<p class="MsoNormal"><br>
<strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Fire Watch/Hot Work area monitoring:
</span></strong><o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif">, Fire watch will be provided during and for at least 30 minutes after work stops<br>
(including lunch and break times)<br>
, Fire watch is supplied with suitable fire extinguishers and fire fighting equipment<br>
, Fire watch is trained in the use of fire extinguishing equipment and in sounding emergency alarm<br>
, Additional fire watch may be required in adjoining areas, above, and/or below<br>
, Fire watch will verify isolated fire detection equipment is returned to normal operation</span><o:p></o:p></p>
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<p class="MsoNormal"><br>
<strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Work on walls, ceilings and/or roofs:</span></strong>
<o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Does not apply<br>
</span><o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">Work on enclosed equipment:</span></strong>
<o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif">, Enclosed equipment is cleaned of all combustibles<br>
, Containers have been purged of flammable liquids and vapors<br>
, Pressurized vessels, piping, and other equipment removed from service, isolated, and vented</span><o:p></o:p></p>
</div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> <br>
<strong><span style="font-family:"Arial",sans-serif">OTHER PRECAUTION(S) TAKEN (IF APPLICABLE):
</span></strong></span><o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> Spoke to Physical Plant who communicated with the Fire & Life Safety supervisor. They submitted a work order# 20W027813 on our behalf for the fire alarms to be looked at and
monitored during the repair.</span><o:p></o:p></p>
</div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> <br>
<strong><span style="font-family:"Arial",sans-serif">COMMENTS (WHY PRECAUTION(S) CANNOT BE PUT INTO PLACE):
</span></strong></span><o:p></o:p></p>
<div style="margin-left:30.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
</div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span><span style="font-family:"Arial",sans-serif">
</span><o:p></o:p></p>
<div>
<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">
</span></strong><em><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif"> </span></b></em><b><i><span style="font-size:10.0pt;font-family:"Arial",sans-serif"><br>
<em><span style="font-family:"Arial",sans-serif"> End of Request</span></em></span></i></b><b><i><span style="font-family:"Arial",sans-serif"><br>
<em><span style="font-family:"Arial",sans-serif">-----------------------------------------------------------------------------------------------------------------------------</span></em></span></i></b><b><span style="font-family:"Arial",sans-serif"><br>
</span></b><strong><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black;background:lightgrey">EH&S Approval </span></strong><strong><span style="font-size:14.5pt;font-family:"Arial",sans-serif;color:black;background:lightgrey">
</span></strong><o:p></o:p></p>
</div>
<p class="MsoNormal"><strong><i><span style="font-size:12.0pt;font-family:"Arial",sans-serif">------------------------------------------------------------------------------------------------------</span></i></strong><span style="font-family:"Arial",sans-serif"><br>
<br>
</span><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">EH&S APPROVAL: T. Stark</span></strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif"><br>
<br>
<strong><span style="font-family:"Arial",sans-serif">PERMIT START (DATE): 6/3/2020
</span></strong><br>
<br>
<strong><span style="font-family:"Arial",sans-serif">PERMIT EXPIRES (DATE): 6/4/2020</span></strong><br>
<br>
<strong><span style="font-family:"Arial",sans-serif">APPROVAL SENT TO FS (DATE): 6/3/2020</span></strong><br>
<br>
<strong><span style="font-family:"Arial",sans-serif">COMMENTS:</span></strong><br>
</span><span style="font-family:"Arial",sans-serif"><br>
</span><strong><i><span style="font-size:12.0pt;font-family:"Arial",sans-serif">------------------------------------------------------------------------------------------------------</span></i></strong>
<o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black;background:lightgrey">Send work completion notice to hotwork@lists.ucr.edu </span></strong><strong><span style="font-size:14.5pt;font-family:"Arial",sans-serif;color:black;background:lightgrey">
</span></strong><span style="font-family:"Arial",sans-serif"><br>
</span><em><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif">------------------------------------------------------------------------------------------------------</span></b></em><span style="font-family:"Arial",sans-serif"><br>
</span><em><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:blue">Select reply and complete the below information before sending.</span></em><o:p></o:p></p>
</div>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"> <br>
</span><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">JOB COMPLETED ON (Please specify DATE and TIME):</span></strong><br>
<o:p></o:p></p>
<p class="MsoNormal"><strong><span style="font-size:10.0pt;font-family:"Arial",sans-serif">SUBMITTED BACK TO EH&S (DATE):</span></strong><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif"><br>
<br>
<strong><span style="font-family:"Arial",sans-serif">SUBMITTED BY:</span></strong></span></b><br>
<br>
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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