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iANI�NCJLOGY _.. UNDERGROUND LEAK DETECTION SYSTEM (V6.21) <br />C.f i VRON,P?6 <br />HOU0495-24-131962 - Apr 10, 1995, 16V <br />Customer: Site 1: Service Order4: <br />CHEVRON USA 94183 131962 <br />Address: City/St: Zip: <br />236 WHAM LN. LODI, CA 95242- <br />W FIT N:::::............r ll:::::::: "':::::, Q.. if.:., llAT C::::1 W 8:;::: W 4, 8:AT ii:::: <br />The following items must be signed for prior to starting tank and/or <br />line testing at site: <br />1) The location rezprasentative 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 r no:zrles . <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 a. •r e 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 ALDGEDGE <br />062 <br />Date: <br />Date: <br />1` <br />