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ease <br /> Tanksology Inc. — Policy 100-29-A <br /> era Suite 400Aaw(a•TX79759 (1100064-0010 R',D <br /> 8501 N. JO EatC y CE FORM& Revised:a/o4nooa <br /> JOB CLEARAN <br /> S CHECKLIST—OVF <br /> W. .. <br /> t Address: - a13 0 3 a- <br /> / C G ` �� � Is el Time: <br /> s53 v/ V ate- 1J-r3 <br /> el stte � <br /> �t �; <br /> asks Ofl0rrn00 JSA s must be available or as tasks): <br /> wDa o a w� <br /> R Dat to 9 Pmenl or arta Provided: A606 44 , /a ,B'd '`'��y v l� �� <br /> 1 <br /> Fol ow_W achona required:equipment twist :comments: <br /> ttle <br /> ppE.PERSONAL PROTECTIVE EQUIPMENT REQUIRED Hems used Or mark u leering protection <br /> Safety Vast K Safety Glasses I I Hard Nat ❑ Omer <br /> Steel Toe Boole C] Splash Goggles <br /> e/ PRE TEST PROCEDURES !Check each Hem completed rmark r�1pol`� <br /> I Discuss safety procedures with site personnel. Nearest hospital. <br /> 2 pennant flags,or other perimeter guard). <br /> Prior to fuel deliveries the UST system must be placed back into working or er. <br /> 3 Secure entire work area with barricades(cones.flags,and caution tape. <br /> q place fire extinguishers and'No Smoking'signs in the work area. i n during tasks) <br /> 5. ❑ Implement LockoutlTagout per API 1646(when accessing product the it brneaker(s)with lockout devices and tags. <br /> ❑ As applicable equipment disabled during testis). m <br /> ❑ Secure noz6as with-out of Service-bags and nylon ties. ❑ Verity LOTO is complete by trying <br /> t� top�a�rWthe S�e. <br /> ❑ Close bM valve of checll Va1V9a erl Ypt ❑ Disconnect eiadricai roayone en ruNna <br /> GerNesi shtyel haw been Informed. <br /> All she personnel to <br /> Fuel delivery nay been <br /> L informed. <br /> , fuel delivery due today? <br /> OTO procedures have been dl and agreed. cieerartcefprnn with teGsdclen." - <br /> work areas barricaded to protect workers,staff&public. I Nevi dlabuea <br /> ./ POST-TEST PROCEDURES Check each Item completed or mark " If nota llcable <br /> 1. ❑ Remove all'Lockout/TagouP devices. , Impact Valve Test Ports under dispensers <br /> 2, ❑ Run all pumps and verify there are no leaks: <br /> ❑ Leak Detector Threads on STP's ❑ Functional Elements&Relief Screws <br /> 3. G Install lead wire seal on all test plugs&leak detectors that were serviced. <br /> Count LD threads: L1 _ L2_ L3_ L4_ L5_ L6_ <br /> T <br /> 4. Check following components operational: AG probes,sensors, &caps0 Cathodic protection operational <br /> Baa floats, dry breaks caps <br /> Containment sumps are dry Dispensers 8 POS operational <br /> Drop tubes,fill adapters&Caps <br /> Z< Dispenser panels are replaced Manhole covers and sump lids <br /> Leak detectors&vent tubes Shear valves are open <br /> Monitoring system is operational <br /> Siphon lines and manifold valves Siphon lines and manifold valves <br /> STP strings and bayonet connectors Vents(not capped.plugged or isolated) <br /> 5. 116 Remove barn tides. end . e time ease <br /> .General safety Checks: 6 r„Ct,-tt <br /> work area has been left tidy&safe. p v. <br /> Site staff are aware of work status inciuding any remaining isolation. <br /> Changes to equipment are documented and communicated. <br /> All incidents,near Incidents,and unsafe situations reported. <br /> e <br /> COMPANY CONFIDENTIAL O Tankwlogy Inc..2011.All Rights Ressrved. <br /> ted opites of this document ere tmcontrolled. The c vcrsion is available in the Tankno On-Line Document Conavi 5 <br />