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Tanknology Ina Palsy 100-29-A <br />I trail N. Mop.Ifxprecswe5, Spire 500 Au+rte rX 70750 (000) 96111010 <br />JOB CLEARANCE FORM & �Wd, V2412014 <br />SITE SAFETY CHECKLIST - OVF <br />ae -Nam" <br />assioul <br />`rgeu A� ie a <br />l ILvP <br />< All site personnel have been informed <br />r <br />"' ,q -, - % -, 7:�- <br />&- -1 <br />Ant,ral aneLiepm.r. <br />ime <br />Travel Time <br />Ot ars on alta <br />Ne <br />1. .. Remove all "Lockout/Tagout" devices. <br />2. I : Run all pumps and verity there are no leaks: <br />Impact Valve Test Ports under dispensers <br />Leak Detector Threads on STP's <br />loc Safety Vest . Safety Glasses .'S ring Gbvas HeaProtectine <br />Steel Too Boots Splash Goggles I Hard Hat Other <br />✓ PRE-TEST PROCEDURES (Chock each Item completed or mark ^ If not applicable) <br />1. A� Discuss safety procedures with site personnel Nearest hospital <br />2. Prior to fuel deliveries the UST system must be placed back Into working order. <br />3. Secure entire work area with barricades (cones, flags, and caution tape, pennant flags, or other perimeter guard). <br />4. Piece fire extinguishers and `No Smoking' signs in the work area <br />5. Implement LockouVTagout per API 1646 (when accessing product piping during tasks) <br />All applicable equipment disabled during teal($) Secure the crrcud breaker(s) with lockout devices and tags <br />Secure noules with 'Out of Service' begs and nylon ties. Verify LOTO Is complete by trying to opeei t pumps. <br />I Close ball valves or check valves on DrbduCt Di Dino. i Disconnect eleetncal'bavonet' conn ., from the STPIaY <br />OGeneral safety Checks: <br />< All site personnel have been informed <br />^ria <br />Fuel delivery has been informed. <br />RKrewnuawe amsa eprawnt Ry. Sign. <br />Is a fuel delivery due today? <br />LOTO procedures have been dirrwssed and agreed. <br />r pr..µ,((U-17-4,) - )-- <br />Work areas barricaded to protect workers, staff & public. <br />I have diswssed job clearance form with technician. <br />✓ POST-TEST PROCEDURES (Check each Hem completed or mark - it not applicable) <br />1. .. Remove all "Lockout/Tagout" devices. <br />2. I : Run all pumps and verity there are no leaks: <br />Impact Valve Test Ports under dispensers <br />Leak Detector Threads on STP's <br />Functional Elements & Relief Screws <br />3. Install lead wire seal on all test plugs S leak detectors that were, serviced. <br />Count LD threads: Ll— 1-2— 1-3— <br />1-4— L5_ L6_ <br />4. Check following components operational: <br />❑ ATG probes, sensors, & caps <br />L 1 Ball floats, dry breaks & caps <br />❑ Cathodic protecfion operational <br />Containment sumps are dry <br />❑ Dispensers & POS operational <br />Dispenser panels are replaced <br />❑ Drop tubes, fill adapters & caps <br />Leak detectors & vent tubes <br />❑ Manhole covers and sump lids <br />U Monitoring system is operational <br />❑ Shear valves are open <br />Siphon limes and manifold valves <br />Siphon lines and manifold valves <br />J STP fittings and bayonet connectors <br />❑ Vents (not capped, plugged or isolated) <br />5. �L Remove barricades. <br />Work ■rtile has been left tidy & safe. ) <br />Site staff are aware of work status includirig any rertlaming lactation. Changes to equipment are documented and communicated.Nixes <br />Ag inddents, near ineidonts, and unsafe situations reporte/")d. R L 1' H. ftttN i.V <br />CONPID11t <br />4) Tanknology Inc., 2011. All Rights Reserved. <br />