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KNOLOGY- 9 0 <br />MANDATORY r & Lock -Out <br />• Quality Assurance Post-test• "` <br />.- <br />iPRE-TEST PROCEDURE: <br />1 The following items must be signed for prior to starting tank and oi� <br />'testing at site: <br />1) The station manager understands that PRIOR to FUEL DROPS the Unit Manager <br />must • •testingand place_ complete . • back into working • • <br />_ stationr moi•understandspumps,dispensersandelectrical supply <br />must stay disabled ' r • - <br />3) All associated powerbreakers-been turned off for i <br />• Magnetic signs- beenplaced f powerbreaker boxes. <br />"Out of Service' bags are on dispenser nozzles. <br />6) Padlocks are on dispenser nozzles. <br />closed.5) <br />7) Check valve is <br />Bayonetdisconnectedfrompump. <br />i AJIsafety procedures - beendiscussedw • ' personnel. The Station <br />s • • • • •Unit Manager • ithat the. • i • • <br />Manager <br />procedures are in effect. <br />aboveut <br />.. explained ais <br />The Station Mgr. agrees that the items <br />completed • • . • `Tank and/orTesting. <br />Station• • • } • <br />r - <br />PROCEDURE: <br />stationPOST-TEST <br />,To insure that your operational priorour fest-uniT <br />departing • PLEASE WITNESS the following <br />1) Each dispenser operates, and all 'out -of -service bags & pad -locks were removed. <br />2) There are NO LEAKS in the sub -pump area, even when the pumps are running. <br />13) AJI debris, safety -cones, & magnetic signs have been removed from the work area. <br />4) AJI tanks and dispqnsers, were restored to their oriqinal state. <br />The Station Mgr. agrees that the above Items were witnessed & completed i F <br />,,following the completion of Tank and/or Line Testing. <br />Station Manager Name: <br />sta. mgr.Signature: <br />+1 <br />w <br />UNI Manager Narne: <br />Unit"Mgr. <br />In,\,,,, <br />