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11-,1vrr,l`1U1-UUy UNDERGROUND LEAK DETECTION SYSTEM - (V6.21) page <br />CHEVRON H#5-24-131964 - Apr 12, 1995, 16:28 <br />Customer: Site #: Service Order#: <br />CHEVRON USA 99840 181964 <br />Address: City/St: Zip: <br />4400 WATERLOO RD. STOCKTON, CA 95205-- <br />Il�:::a, <br />The following items must be signed for prior to starting tank and/or <br />lane testing at site: <br />.1. ) The locatic;n represent.at:.ive under,,ta.nds that. PRIOR to f=UEL... DROP'S the Unit <br />11 %3 n is q e r rrl l.) ,�-> i S f i� j t: t3 :-31::I. 11'';_:J :,--,i nd t i"1 �w C� O 111 j'=� .1. (? % C station b Ea C i'< into W C� r k .7_ n g <br />>r C!e <br />The loCat1.Gl'1 vr-pre ,ni atxv�- undecstands, tl"1titi.t the p(lmpc,, d s -p nsers and <br />electrical 3Up}.r1y Illl.lSt stay d1isahlt:'d throughout the test„ <br />) All arc:C:)C.,i-,i:.;3C{ Power breaker,,:..., <br />havei:)iuf rl ', turned o`f"�t. f ". )r testing . <br />4) Magnetic signs have been r:).La( t?C.{ on Power breaker bt_,xer:; „ <br />5) Out of SerVi.c:e bags .q.'re c,ri ci.i. .p;; n-s,;r nozzles. <br />6) Padlocks are on di �)e1-I ey— <br />7) Check vat vt`:'.l.: C.�.!) >F-: { „ <br />8) Bayonet connector :.s-; disconnecte(I 1=rola pump <br />9) Al.{. safety p'rc: cediures have bec rl di::t,U.ssed with all Ct.aition personnel. The <br />Location ReprL?:>F3nf:ative and Tankno-J.(.?Wy Unit j -)ave e cf`1 confirmed <br />that the Tag and LackoUt procedure- al-- ir1 <�f f ,,-c:k.. <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 ALDRIDGE <br />062 <br />Loc. Rep. S gnature: Date: <br />19 <br />Unit Mgr. Signature: Date: <br />