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W.O.# NW1-2349708
<br /> Tanknology inc.
<br /> r747� I I1�t10 N AfoPac Ecpnssrta},Suite 5tk)Austin,T\M." (RM19M-tX)10 14tlwly I1N1:V A
<br /> 49 JOB CLEARANCE FORM&SITE SAFETY CHECKLIST-OVF
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<br /> Follow-up actions requinx:equpn,a,t isolated;conunw.:
<br /> PPE-PERSONAL PROTE IVE EQUIPMENT REQUIRE Chock✓Items used or murk-M not w htfeab/s)
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<br /> ✓ PRE-TEST PROCEDURES (Check ✓'each item completed or mark - if not applicable)
<br /> 1. Discuss safety procedures with site personnel, Nearest hospit lz
<br /> 2. -❑�or to fuel deliveries the UST system must be placed back Into working order,
<br /> 3. J? secure entire work area with barricades(cones,flags.and exlenslm bars,caution lupe,pennant flags,or nti„, •: ,,:t; ,,i,
<br /> 4. Place fire extinguishers and"No Smoking'signs in the work arse.
<br /> 5. ❑ Confined Space Entry-If required complete separate CSE Chsck jst. if NO CSE REQUIRED check the following reason;
<br /> ❑No CS's ❑CS's not opened ❑No entry only visual 0No entry-used tools C7Work from prone posidon wWo rlek of falling n,
<br /> 6. ❑ Implement Lockout/Tagout per API 1646(when accessing product piping during tasks)
<br /> ❑ Secure nozzles with"Out of Service"bags and nylon ties. 0 Secure the circuit breaker(s)with lookout devices end t:t„
<br /> ❑ Close ball valves or check valves on product piping, El Disconnent**Arial"bayonet"oonneaor from the STP(s).
<br /> ❑ All applicable equipment disabled during tests). I'! Verify LOTO Is complete by tryln&operate um a
<br /> SIGN IN / i,:r,i t,.on: :n,N;ria ra wctnu�Hwn,ignature
<br /> General Safety Checks:
<br /> All site personnel have been Informed. (�
<br /> Is a fuel delivery due today? rw rexwWwuve anxzsite Ropmeertativo SiOnAturs
<br /> LOTO procedures have been discussed,
<br /> Work areas barricaded to protect workers,staff&public,
<br /> ✓ POST-TEST PROCEDURES(Check✓each!tern completed or nark - If nor applicable)
<br /> 1, ❑ Remove all"Lockoutrf agour devices and nozzle bagsRles,
<br /> 2. ❑ Run all pumps and verify there are no leaks: I i Impost Valve Test Ports under dispensers
<br /> ❑ Leak Detector Threads on STP's l) Functional I laments&Relief Screws
<br /> 3. ❑ Install lead wire seal on all test plugs&leak detectors that were sendcod.
<br /> Count LD threads: L1_ L2_ L3_ L4 w L5_ L6
<br /> 4, 9 Check following components operational; L.1 ATG probe*,sensors,&caps
<br /> ❑fah floats,dry breaks&caps L I Rallfiodic protection operational
<br /> Lrtainment sumps are dry I,'rblapensem&POS operational
<br /> ispenser panels are replaced i ltubes,flapper valves,fill adapters&caps
<br /> /❑ ak detectors&vent tubes nhole covers and sump lids
<br /> Monitoring system is operational ^hear valves are open
<br /> 1 1 Siphon lines and manifold valves open i) Spill containers&drain valves
<br /> STP fittings and bayonet connoctors 1 i Vents&Extractors(not capped,plugged or isolated)
<br /> 5. • Remove barricades,
<br /> SIGN OUT&Operator Verification of Work(OVF) LwdT L"d Tsc9-nMc"ianMgimw,,,
<br /> General Safety Checks:
<br /> Work area hos been loft clean&safe.
<br /> Site staff aware of work status including any remaining Isolation. OPttwwn w ww N411tvl Site ROPMmardativo,gnatuo
<br /> Changes to equipment are documented and communicated,
<br /> All Incidents,near Incidents,and unsafe situations reported,
<br /> Sit*Representarivi,Commen s: - -
<br /> COMPANY CONF1DKN IA1. ®Tanknnlogy Inc,2019,All Rights Reserved.
<br /> need copies of this document aro unconnulktd The currant ver",,r..n.n�.,blr m tri;I.mknnlyW On•Line Document Control S tem.
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