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TANKNOLOGY -- UNDERGROUND LE <br />CHEVRON <br />Customer: <br />CHEVRON USA <br />DETECTION SYSTEM - (V6.2 Page 1 <br />HOU04._ 24-131963 - Apr 11, 1995, 16:32 <br />Site 0: <br />95775 <br />Service Order&: <br />131963 <br />Address: City/St: Zip: <br />301 W.KETTLEMAN LN. LODI, CA 95240- <br />: IC::::`: •............x....11: .I._ y::::::,. q:::::r d:::::a� a::::::: :::: IC::::a <br />The following items must be signed for prior to starting tank and/or <br />line testing at site: <br />1) The location representative understands that PRIOR to FUEL DROPS the Unit <br />Manager must stop testing and place the complete station back into working <br />order . <br />2) The location representative understands that the pumps, dispensers and <br />electrical supply must stay disabled throughout the test. <br />3) All associated power breakers have been turned off for testing. <br />4) Magnetic signs have been placed on power breaker boxes. <br />5 ) Out of Service bags are on dispenser nozzles. <br />6) Padlocks are on dispenser nozzles. <br />7) Check valve is closed. <br />8) Bayonet connector is disconnected from pump. <br />9) All safety procedures have been discussed with all station personnel. The <br />Location Representative and Tanknology Unit Manager have each confirmed <br />that the Tag and Lockout procedures are in effect. <br />The Location Representative agrees that the above items were explained <br />and completed prior to the start of Tank and/or Line Testing. <br />Location Representative's Name <br />Unit Manager Name: <br />RANDY ALDRIDGE <br />062 <br />Loc. Rep. Signature: <br />.__.........:.......✓..................................... <br />Unit Mgr. Signature: <br />a - <br />....c -A ...................................................... <br />r <br />