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Nork Order: 2279400
<br />Taaknolo� line.
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<br />JOB CLEARUNCE FORM &. e-, Rn
<br />Tier Ned: 24-04:3Mti
<br />SITE SAFETY CHECKLIST — ONT ,
<br />l -l? 1N_�'.S COti�ll�f:�l"1:11. i 'I lnicnuttry} roc..'ON All Richt, Ke,iened.
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<br />Tanknology Inc. 11000 N. MoPac Expressway, Suite 500, Austin, Texas 78759
<br />Street less ,
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<br />(�Add
<br />Arrival Time:
<br />Oeparture Time,
<br />Trac el Tirn
<br />VFhers on site
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<br />Scope of Warn and Tasks PorfrFrmeFl tJSA's mmutit t>~ available forall ]asks):
<br />5 r l VL
<br />kepairs zefffqLdpi-nefil.orPN sPrpv,ded' cop f'"Al V f14-1-3"JA1
<br />I 1Vk.'iidi�
<br />allow up aGtinnti r� rrad, 'X4.111111.4. lek commenH'
<br />PPE- PERSOMAL PROTECTIVE EQUIPMENT il'MO MED (Chock items used or morin - 01 a lrca6la
<br />Satety Vest Safety Glasses dIC Glpves _. Hearing Protection
<br />(Steel Tot Boats 5pla;h Gnyglas Harrf clot Other
<br />.l PRE-TEST PROCEDURES fiChock each item cam feted ar mark -• if nota ficabie
<br />I [Discuss safety procedures with Slte personnel Nearest hospital. As + I
<br />2. Pnor to fuel t4elivenss thaUST system rTtustbO placed clack into working order. �` "
<br />3. Secure entire work area with barricades (cones, cards, and 1.P1LtiUr1 tape. pennant flags. or other perimeter guard).
<br />4. Flace fire, extinguishers and `t~tu Smoking" signs in the work arca.
<br />5. Implement LuckoutfTatgout Per API 1646 (when accessing produrt piping during tasks)
<br />All applic,�hl. s,nuiprrwnl flinabl-ed during tostts). Shr:u a the 6rcu•t break.erf,)with IackoF.I devices and taps
<br />.Seca, a nozzle, ulth'CJut -Y Servke-' tag, Arid nyv5n ties. Verity LUYU is r;oloplete by trying 1c operate piiM S.
<br />oea hall val'Ves or mi(jwk waives an product piping. Disurcuiect electrical' bayonet.' cwnnF.1.1.01 from the STP(5)
<br />SIGN 1#4
<br />x- lzc riles ame Idead zc- a �, S �nawre
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<br />General Safety Checks;
<br />X1 sit- purSan,,N heve bccn Vo:rned.
<br />+
<br />Fuel el'+ h has bee, hilcirmeJ
<br />ii: r:Riyni^crr9nl re.48.f: t Signatu•e
<br />N a ru21 del ivory dole inday"r
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<br />LOTCr nrocedwea t1mve beau o15C 5 and agreed
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<br />YAcrk arP;vk 14rrlr;+3ced to protect wr rke"s, 51x61 jlllhk
<br />—
<br />have detussed jute cicaranc tr'.chnrc,an
<br />POST-TEST PROCEDURES Check each item completed or mark " it nota htabfe
<br />1. Fgen 311 "LockouVragout devir ns
<br />_ tun wIR pumps and +e ih'there are no leaks. Impact Vglve Test Purls urdef dispensers
<br />Leak DQtEYclnr l breads un STF'S Functional Elements & Hali48crews
<br />a. Instal! lead wire Seal on all test Pikig.q e. Ieak detectors that were wr'viccd
<br />Count La Threads' L1 L2 L3 L4 _ L5 L8
<br />_
<br />d Check following inompnnerits operational: — K ATG probes sen r�rs, sr caps
<br />.r
<br />r� Ball floats. dry breaks & caps Cathodic protection operational
<br />CcrtqJnmert Sumps are dry 1 Dispensers & FOS 6porational
<br />Dispenser parelS are •eplacacl Drop tubus' fill adwtc-rs & caps
<br />Leak cetectors & went tubes P Mlanholy covers and sump Gds
<br />Monitoring system is cjperalioncTl Sheat VAlvyS are QPUF1
<br />Siphon finis Fan; manifold valves 'siphon lines and manifold valves
<br />LxC STP littings and tnaynnel wonectors Vents foot capper, plugged of isolated]
<br />R8iyteve barricadeG.
<br />SIGN OUT & Dwatar. VeririCatton of Work (OVF) _�.: 7�hru :Fr h;sir 0 � I mid TeL"" 0211 SIgO5UJr9
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<br />General Safety Checks:
<br />M4 rk eroa has been left tidry 8 ::acv. W
<br />�.,17,.
<br />S-ts Staff' ate aware g JI avcrk r,�alu5 includinany remaining r5uiklih r. /I3itRuvm,'^,.`y6+e Narre /1: on, Sigmbr:.,
<br />Changes to oquipment are do L—r,1euilFAd and co'rlmuntcatec.
<br />All inuderil; nz?ar inciderts, and unsafe 5iltli)hor's rflCXte:
<br />Silo Fr;prr.•:rir1F1:,P f:.,nrrB 1_
<br />l -l? 1N_�'.S COti�ll�f:�l"1:11. i 'I lnicnuttry} roc..'ON All Richt, Ke,iened.
<br />fFnnlrclupie+4l.Illi�iC4mr<•nrPre 'urcnntnl:lrcl_ Tlirrnr:ilrrz. Frrisa-:uildKxuri.. 7,,:Fknnln,a't�n•LxI_D:�CF1111 it{rn'c'.I1s:,eIt11
<br />Tanknology Inc. 11000 N. MoPac Expressway, Suite 500, Austin, Texas 78759
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