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41. <br />TANKM£Jf COYyNRGROI�i� t dd M h <br />k <br />A <br />VRON p?� 199 <br />it1� <br />.• ro x , <br />::' n8 a r..r <br />, <br />4P, <br />"9'y''ri f `a <br />Address: City/St: <br />236 N.HAM,. L -N / L OqI , CA 95242 <br />z <br />t " <br />Tho following items must be signed far rigr ..ter°" -starting tank an(jl+ar� <br />l.i ne -test i'ng at, s'i_te y �s <br />'f Ma'nagz�r must stopwestLng and place the chat PRIOR to FUELDROPS ,��"tt3 l.�l�i �r <br />1_) They location repr sant.at.ive understands t <br />omplete station back int6 work`s <br />or der <br />2;) The location representative understands that tire., pumps , dispensers 'a�, <br />electrical supply must. stay disabled th°roi. hoot the test. r, <br />3 ` All as,M.acxated '`power breakers have b e. r turned"oft for testing . <br />4) Nagrie tic ,.sins have' been placed on power," breaker' boxes. ; <br />r5) Out. of service bags are 'on dispenser <br />, <br />6) padlocks aTe' ori dispenser nozzles. <br />il <br />7)"'Check valVe i closed . <br />8) Bayonet connectoris discont.ec.ted from pump . µ� <br />9,;).A1*1 safety procedures have been discussed with all•wtation personnel <br />"tion Representative and Jankndl,ogy Unit' Hanager- have -each 6onfirm e <br />s' that. the`T6g and 'Lockbut procedures are in effect, <br />. <br />£` Thi yl- cation Representative agrees that ,the *have items were explained -, <br />and completed prior, to the start of- T'arrk-and./nr line Testing. <br />a <br />Lack inn 14pr®aentatii Nape: Lac. Rep. Signature- Date, <br />...... <br />4e <br />Uait`Marraget NaaeE.° unit Mgr. Siguatnie Data <br />S"andy aldr i.doelz <br />k ' <br />a <br />`462 <br />. 3l ....... ,. .. _ ........ <br />Xf <br />44 <br />k 3'- _ a• d .�j4 ^. j` q� <br />t + t afi ti. <br />E t �' <br />