Laserfiche WebLink
A" Line Break Permit <br /> THE WINE GROUP <br /> Section 1: Prior to Starting Work Section 2: Pump Down Precautions <br /> Points of caution before to removing plug/pump down <br /> iPermit Requested by: (Initial that each concern has been reviewed and mitigated) <br /> Date: ?, Z) Work Order: R�� Isolation valves closed and locked out <br /> Solenoid valves,regulators,and actuated check <br /> Affected Location/Area: e� valves are manual) open <br /> Equipment Being Opened: �(, Z All line break personnel are wearing required PPE <br /> Points of caution during pump down (Initial that each <br /> Company performing line break: concern has been reviewed and mitigated if present) <br /> Name t(print) <br /> signat pe erforming line break: % Ice on or forming on desired lines <br /> N non actuated check vaives trapping liquid <br /> Name Signa �eiertenddn; <br /> Defective gauges <br /> Drop legs and low polr. s that couTd rap oil or <br /> ammonia <br /> Estimate Tlme Frame Plant a utha6zation <br /> (in days) of timeframp Plugged service/hand valves <br /> Pump down(vacuum)verification: <br /> Pump Dewn� Name: atJ� L Note:Final reading must be at least 30 minutes after initial <br /> ystem pen I initial Date/ <br /> 4 LIZ) <br /> Dov.n time Title: e- f' //- 3'� <br /> 1S Y vacuum reading: Time: <br /> Evacuation/ Final _ <br /> Ites_ir,/startup ( Signature: , „acuum readine: rlw� Date/ie: 11 Z3 <br /> l._. <br /> Tole Time 71x-t—e�' <br /> Date: , 2 — Section 3: Line Break Approval <br /> slon--�' iest(If required) Section 3 must be signed by a trained and authorized I;ne <br /> break supervisor Prior to irreversible entry. <br /> Tim ITie required Signature: Date: _ Time: 2„03 <br /> lVa_Iv.ju,to be Locked out(Tag ID's): Line BreakApproval <br /> "`Q� •�� �j� l } jConfirmed Isolation and LOFO(supervisor initials) <br /> System will b .aced wit :(Circle) Verification of Vacuum(supervisor initials) <br /> Wafer Suction Tee _�Other: ame(pri tl and Signa ure p ser: <br /> System willed with:(Circle) <br /> 1 � l <br /> Nitrogen Air System stem Liquid <br /> Ga-Pressure Pressure Section 4: Line eak Completion <br /> Checklist(Initial each box to confirm) Prier to reintroducing ammonia,verify vacuum and sign <br /> Nersonne:aware otevacuatlon procedures,eye r <br /> wash locations,and line break procedure(SOP) f .�V !�racuum P,eading Date: <br /> Kirequired line break equipment,satety equipment, t <br /> Na. (print)an re o.p n reek: <br /> I and lockout equ;pmer.t are at line break location <br /> eviewe d assi'gne T roT�s toeach person ;rvo.ved In <br /> nine break - <br /> l otiriet a personre�m area that me urea. Is a .out !Nime(gip^ and signature ine br su _rvi <br /> t <br /> Ito be conducted , l'0>j <br /> In case of emergency ca!! <br /> Fire/Police/Ambulance Dist 91t Name: Number: <br />