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Tanknolov Incl polio 10049-A <br /> N.MOP=Expr�sway,Suite 400 Awti$,11A 78751) (800) utU Y <br /> kev.D <br /> JOB CLEARANCE FORK Revised;8104008 <br /> SITE IST—OVF <br /> Sita Name[#; Stmet Mdrea$. w O <br /> Eli f f <br /> �4rriva imc: I3aparture rme, raval Time. thereon s€t@: Coate <br /> scope of Workan Test Pe ormed(J sA s mint be available fcsr ail tasks): <br /> epairs to ipmen of Part rovidad: <br /> + crl;"rs 92 A, ` 'r� r rim�a 4;; � !'.o"it1 �n� /- C't�t� v 4z' . <br /> FofidW4p codons.required;equipment isolated;comments', <br /> ppE.PERSONAL PROTECTIVE EQUIPMENT R��u w&Li Check items arsstf or a ^knot flog <br /> ble <br /> a safely Vest . Safety Glass C@4 Gloves Cl Pleating Prc4terdan <br /> steel Toe Borate 1,V Splash Goggle@. D Bard Fiat ® t3tfter <br /> �l w chr k eaoh item corn re or,stark "� if not a itcobie <br /> 1. C3iuss sftY procedures with sbe persol�nel. Nerest hospital' <br /> 2. Prior to fuel deliveries the tlST system must be placed bock into e+tPorking order. /fie <br /> 3. Secure entire+nark area wlth barricades(manes,flags,and caution tape,pennant flags,or outer perimeter guard). <br /> 4. CZ9 Place firs extinguishers and'No Smoking"signs in the work area. <br /> 5, i implement LockoutfTa sant per All 164$(when accessing product piping during tasks) <br /> 'All applicable equipment disabled during iest(s)• secure the circuit breaker(&)with lookout devices and tags. <br /> ® Secure nozzles with"Cut of Service'bags and nylon ties. verify LOTO is complete by dying to opwate pumps. <br /> D Close bell ITPvalves or check valves on product piping. ® l?iswnnect electrical*beyonet^conns r f the STF(5)• <br /> .s.:�x`fi.Zw4 74 ia'•`.y:.:.4'�:ev'a�r T 7��,'i.d•'a!:q..:.:: tom$ $ FY $n $lrECa �tlC8661 �n €4�I&5�14� <br /> 1++' <br /> + rPeral safety Checks: <br /> All site personnel have been informed, `' E F <br /> Fuel delivery Peas been informed. s pr nrn ve Ntrrr� "erantaNyorotors <br /> Is a fuel delivery duo today? , <br /> LOTO pro urss have boon disco sed and agreed. `° r qL <br /> Work areas barricaded to protect workors,5talf&public, have disclfssod'4b dearan form�ith.tsehnlclan <br /> POST-TES T$PROCEDURES tCh k each item comalat8d or rtla�°k if rot a ppPt ie <br /> 1. Remove all"Lockout Tagout"devices, <br /> 2. t Run all pumps and verify there ere no looks: Impact halve est Ports under dispensers <br /> 0 Leak Detector Threads on STP°s I J Functional Clements&Relief Screws <br /> 3. Install lead wire seal on all test plugs&leak detectors that were serviced, <br /> Count LD threads: L1— L.2 L3 L4 1.5 L6 <br /> 4, CK Check following components operational. ATl3 probes,sen te,&caps <br /> Wf Sall floats,dry breaks&caps I J Cathodic protection operational <br /> containment sumps are dry a Dispensers&PSS Operational <br /> Ee cispeneer panels are replaced 'Crop tubes,All adapters&caps <br /> ! 'beak detectors&vent tubes � ,Manhole covers and sump lids <br /> Monitoring system is operational Shear valves are open <br /> Siphon litres and manifold valvas Siphon lines and manWd values <br /> STP fittings and bayonet connectors PKVents(trot capped,plugged or isolated) <br /> .GA Remove barricades. <br /> ter~North €s <br /> . ..,� .:� 1G � t17'. � r�ifor�fa lorr•ef• al�c.��f..= <br /> General SaWy Checks, <br /> Work area has been left tidy&safe. BnEa v neo <br /> site staff are aware of work status Including any remaining Isolation. Sloe reran ve None <br /> Changes to equipment are documented and communicated. <br /> All incidents,near incidents,and unsafe situations reported. ; , 0 s O" la.s 4 �. ✓ <br /> Sits PrW,6nW W C ta. <br /> (,d.MPANY CONIFIDENTIAL 9 Tanknology int;.,2011,All Rights rtmerved. <br /> rintrxl cu lett of tip duuuntcnt ore unotantrallad, I be outrs ttt vutviaaa is atvadable it[th®£untCuolo 4 Un LictC I7cu'stt ttt Coned 5 stem <br /> I <br />