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Received on 10/23/2019 <br /> W.O.# AST-6702749 SJC EHD - CR <br /> TeavitCe 11,1 Polity IC0.29.A <br /> IIWON.MOPx Eiprt¢¢way,SulIe 500Pu ,n.TX]B1591BW1969-001U gi <br /> JOB CLEARANCE FORM& Rosters:104114 <br /> SITE SAFETY CHECKLIST—OVF <br /> site Name <br /> IS, Ativa. O-N <br /> 191cn Hryh wY+y <br /> 27 <br /> Amrel Tlme: OaparNre Lme. w me, sm¢xe. <br /> L, <br /> Scor90 OM1entl • PeROrmed(JSA'a muel6e aealleble Maltaaka): <br /> ReWirsb Equipment Or PmaideP <br /> Follow-Up eClianS Rgmred',tyuipment isaleletl;comments: <br /> PoE.PERSONAL PRO T/VE EQUIPMENT REQUIRED Checx Xema uaeJ or mark-i/nota ovW¢ <br /> / y'Vest Safely Glesaea bve¢ Otas her PMed'lon <br /> LT steal Tce HOW J SpIa511 Gop9ba ❑ HaN Hal � 01M1er <br /> ✓ PRE-TEST PROCEDURES fip��s 11 Is.comedushadded-deavok in mat agglacquival <br /> 1. Discuss safety procdtlurea with site personnel. Nearest hospital: _ <br /> 2. 'J Prior to fuel delivenea the UST system must he placed back into working order. <br /> 3. ❑ Seems entire work area with barricades(cones.Flags,and caution tape pennant flags,or other perimeter Speed). <br /> 4. ❑ Place that extinguishers and'No Smoking'signs in the work area. <br /> 5. n Implement Lockouffagout per API 1 Suit(when accessing product piping during tasks) <br /> All applicable equipment stabled during tect(51. J S¢cmetne cimliltMpkerya)wife bdwW tlevkes anO ta3s. <br /> Secure rules with'Out or convince'bags and nylon ties. ❑ Vedfy LOTOlammpletebytryiWg operatepumpa. <br /> Close ball valves of check valves on product piping. 1� Oiaconnedeletlncal'OayoneC conlredgrhom lha STP(5j. <br /> SIGN IN rein emwa.a an do us <br /> General Safety Checks: <br /> All stta personnel have been informed / <br /> Fuel delivery has been informed, p <br /> mega¢a <br /> Is a el dales,due toay9 <br /> d <br /> LOTO prowdures have been discussed and agreed. Zj"Mmarl y x <br /> WorkareaabamtadedfoprMect welkers,alaRB pubic ei <br /> I have diffraction form war technician. <br /> ✓ POST-TEST PROCEDURES ene<xexnrcern�a¢of�a.marx — amooreaela <br /> 1. ' Removeall'LookoultragouPdevices. <br /> 2. ] Run a 11 pumps and verify there are no leaks: ❑ impel Valve Test Ports under dispensers <br /> ❑ Leak Detector Threads on STP'5 ❑ Functional Elements&Relief Screws <br /> 3. ❑ Install lead wire seal on all test plugs&leak detectors that wile serviced, <br /> Count LD threads: Lt L2 L3 L4 L5 L6 <br /> 4. Check following components operational: ❑ ATG probes.sensors,B Caps <br /> Ball floats,dry breaks&caps ❑ Cathodic protection Operational <br /> Containment sumps are dry ❑ Dispensers&POS operational <br /> Fl Dispenser panels are replaced '7 Drop tubes,fill adapters&Caps <br /> ❑ Leak detectors&vent tubes ❑ Manhole covers and sump lids <br /> ❑ Monitoring system is operational ❑ Shear valves are open <br /> ❑ Siphon lines and manifold valves ❑ Siphon lines and man'dold valves <br /> 1F1 STP fdtings and bayonet connectors ❑ Vents(not capped,plugged or isolated) <br /> 5. ❑ Remove hatimpatles. <br /> SIGN OUT S Ovendrisminerfiffigirtion antitank(ONF) eva learrical xame user dward <br /> Genal Safety Cracks: <br /> We*arca has been left tidy&safe. 1 IIni <br /> Site staff are aware of work status inclutling any mmeining"oetipn. Iw -se're a ve synmrm <br /> Changes W equipment are dacumentetl antl communicated <br /> All indtlents,near incidents,and unsafe situations reported — <br /> SitalripeasulatabConshourro, <br /> COMPANY CONFIDENTIAL O Tallkrlology ldd.,2011.All Rights Reel <br /> 'medCaies ufthis daument arc Snowballed. The current writers is veilable in the Trundle On-Line Traversal Controls s <br />