Document wgLzjOoBEr9yEBnaaKkngwkwD

INDUSTRIAL HYGIENE SURVEY BENZENE AIR SAMPLING PROGRAM AIR SAMPLING SURVEY CHECKLIST FOR SUPERVISORS S EMPLOYEES CHECKLIST \ HYGIENIST: ______________________ _________________________ DATE: SUPERVISOR/EMPLOYEE INTERVIEWED: TITLE: DEPARTMENT: A. GENERAL QUESTIONS 1. In what specific areas/locations in the plant do you believe or work where benzene gases and/or vapors are being released? a. b. ; g. c. ____^^ d. e. f. h.__ i. 2. Supervisor: What tasks or special jobs in the plant do you feel require employees under your supervision to be exposed to benzene gases or vapors? Employee: What tasks or special jobs do you perform in the plant that you feel exposes you to benzene gases or vapor? f. 9h. i. e. NOTE: For each location and/or special job listed. Checklist #2 shall be completed. MC ;i000l6':>'4P- INDUSTRIAL HYGiENE SURVEY BENZENE AIR SAMPLING PROGRAM CHECKLIST n NAME : ______________________________________________________________ DATE : LOCATION: EQUIPMENT INVOLVED: OPERATION: SPECIAL JOB ROUTINE JOB ITEM YES NO COMMENTS B. PERSONNEL RELATED QUESTIONS 1. Are personnel/you required to work on this equipment? Take samples? Service the equipment? 2. Are personnel/you required to work near (within 50 feet) of' this equipment? 3- How many employees normally work on this equipment? 4. What frequency do these employ ees/you work on this equipment? Weekly? Monthly? 5. Do personnel/you take certain precautions when working on or near this equipment? 6. What type of precautions do your personnel/you take? 7. What length of time do person nel/you normally take to obtain samples or service this equip ment? 5 min.? 15 min.? 1 hr.7 8. Are there any other tasks per sonnel/you perform on or near this equipment that requires them/you to be present longer than one hour? 9. Do personnel/you work on this equipment normally only during the day shift? 10. What areas of the plant do they/you routinely visit, ser vice or maintain excluding special jobs? MCD 000016349 CHECKLIST n ITEM YES NO C. EQUIPMENT AND/OR OPERATIONAL QUESTIONS 1. What materials are involved in the operation? 2. ' What gases or vapors are re leased in addition to benzene? 3- Does the equipment vent the gases or vapors steadily or periodically during the opera tion or task they/you perform? 4. What specific equipment part releases the benzene gases? 5* Is the equipment located in side a buiIding? 6. Is the equipment located outs i de? 7. Does the equipment release more benzene gases and/or vapors during any particular shift? What shift? Why? COMMENTS MCD 000016350 BENZENE FIELD AND LABORATORY SAMPLING DATA REPORT CHECKLIST #3 EMPLOYEE NAME: OCCUPATION: __ BIRTHDATE: SAMPLING DATE SUPERVISOR: _ SHIFT: 1 . Report filed by: ___ Date: 2. Routine job YES NO Q Special job Special job YES NO Q oco_c (a) Number of employees involved __ <b) Number of employees invicinity UceJ Q I ndoors YES Outdoors YES NO NO Direction and 5. Weather conditions: Wind Velocity 6. Employee trained in proper use and care of monitor YES NO 7. Personal monitor installed and fitted properly YES NO Personal monitor frump calibration date _____ 9. Time sampling began 10. Time sampling ended AM AM PM PM 11. Pump serial number _____ 12. Tube and filter operable YES NO . Date of analysis: 2. Time of analysis: AM 3. Samp)inq duration: hours 4. Volumetric flowrate of smapling: 5. Quantity of carbon disulfide used for analysis: 6. Gas chromatoqraph model: 7. Analysis of samples: PM Liters/min. ml . (a) Gas chromatograph sample peak readings: 1. Benzene H- 2. Toluene oc oa. 3. Xylene 4. ' UJ cc 5. CO <_1 6. Total ppm ppm ppm ppm ppm ppm ppm (b) Oesorption efficiency: 8. Pump recalibrated YES NO If not calibrated, when last calibrated? Date: 9. Tube and activated charcoal re-installed? HOD oouoitf 'Abl BENZENE PEAK CONCENTRATION SAMPLING FORM CHECKLIST #k 1. Hygienist: 2. Sampling date: ___^ 3- Area of plant: k. Specific location sampling unit installed or measurements taken: 5* Time sampling beqan AM PM 6. Time sampling ended AM PM 7. Total sample time _____________ 8. Personnel in vicinity of sampling area YES NO M* Y6.^. '.'iisfirt'. distance.- from, samp-1-i-ng. po^nfc2 _ 10. What purpose is this sample being performed? (a) Personnel work within 5"10 feet of the equipment? ___ (b) Personnel work 10 feet or 50 feet of the equipment? __ (c) Probable high concetnration level? ________________________ MCI) 000016352 BENZENE SURVEY CONCENTRATION SAMPLING FORM CHECKLIST 5 1. Hygienist: 2. Sampling date: 3. Area of plant: A. Specific location sampling unit installed or measurements taken: 5. Time sampling began 6. Time sampling ended AM AM PM PM 7. Total sample: 8. Personnel In vicinity of sampling area YES NO 9. If YES, what distance from sampling point? i'"C' rtfiat purpose is this sample being perferrred^ (a) Personnel work within 5 10 feet of equipment? ____ (b) Personnel work 10 feet or 50 feet of the equipment? _ (c) Probable high concentration level? __ 11. Instrument Serial Number: ^________ 12. Date of last calibration: ________________________________________ 13. Atmospheric Data: Temperature: _ Humidity: Wind Direction: Wind Velocity: Weather Observation:_____ 14. Test Results: Benzene ppm_______________ _______________ Toulene ppm Xylene ppm cUQOOrt n0W