Laserfiche WebLink
'llmknolog� Inc. <br /> Fit <br /> I I .. -11 "1,,, l A m 1A V '' ' ,hnnI 4..1 unW I', I II14 "� A <br /> 1(113 i l 1 ARANC @ FORM & <br /> SI 1�1 SAl 1. 1'V CHECKLIST -- OVF <br /> 9F Sln,el <br /> �i1P 1me;\K <br /> ...__ ._..__�_____— <br /> qn,valmrne epanurP Time' 1'mval Time Other nn Me Dete <br /> t <br /> pe u 1'ort;and asks Perform USA's must be available for all tasks). <br /> I Recarms to Equipment or Parts Provided: -- <br /> I <br /> Fellow-uD actions roquired:equipment isolated;commanls� ._. <br /> �!• /PPE-PERSONAL PROTECTIVE EQUfPMENT REQUIRED Check items used or mark-f/nota rote <br /> Safe! GlassesGloves Hearingg Prot <br /> SareR'Ves! y Other <br /> steel Toe Boots Splash Goggles Hard Hal <br /> ✓ PRE TEST PROCEDURES !Check each item completed or mark — ff not appficabfe) <br /> Discuss safety procedures with site personnel. Nearest hospital: -- <br /> Prior to fuel deliveries the UST system must be placed back into working order. <br /> Secure entire work area with barricades (cones,Flags,and caution tape,pennant flags,or other perimeter guard). <br /> 4 Place fire extinguishers and"No Smoking'signs in the work area. <br /> Implement Lockout(Tagout per API 1646(when accessing product piping during tasks) <br /> All applicable equipment disabled during test(s). Secure the circuit breaker(s)with lockout devices and tags <br /> Secure nozzles with Out of Service"bags and nylon lies. Verify LOTO is complete by trying to operate pumps. <br /> nect electrical connector <br /> Close ball valves or check valves on product PI? UIng. Discon " eaa recohmS <br /> e ae h PIa <br /> SIGN IN Lead echnidan Name <br /> General Safety Checks: <br /> All site personnel have been informed. Ste epresentaove Nana Ste Represontafive Sgnamre <br /> Fuel delivery has been informed. <br /> Is a fuel delivery due today? <br /> LOTO procedures have been discussed and agreed. -- <br /> Work areas bamcaded to protect workers,staff&public. I have discussed bb clearance form with technician. <br /> ✓ PROCED L/RES (Check each item completed or mark if not applicable <br /> POST TEST <br /> 1. Remove all "LockoutirTagout"devices. Impact Valve Test Ports under dispensers <br /> 2 Run all pumps and verify there are no leaks. 1 1 Functional Elements& Relief Screws <br /> Leak Detector Threads on STP's <br /> 3. <br /> Install lead wire seal on all test plugs&leak detectors that were serviced. <br /> Count LD threads: L1 _ 12_ L3_ L4_ L5__ L6 <br /> 4. Check following components operational: I ATG probes, sensors, &caps <br /> Ball floats, dry breaks & caps Cathodic protection operational <br /> Containment sumps are dry Dispensers& POS operational <br /> Dispenser panels are replaced Drop tubes, fill adapters &caps <br /> Leak detectors &vent tubes Manhole covers and sump lids <br /> Monitoring system is operational Shear valves are open <br /> Siphon lines and manifold valves Siphon lines and manifold valves <br /> STP fittings and bayonet connectors Vents (not capped, plugged or isolated) <br /> 5 Remove barric-adcs <br /> ' Load .xhniaen u]nalure <br /> SIGN OUT& for Verification of Work(OVF) loadechnietan Name <br /> vbnieral Safety Checks: <br /> �Z�•rfi area has been left bdy&safe. <br /> L:°+staff are aware of work status including any remaining isolation. Ito epiasonlo IV* arra M10 epresenta I nature <br /> N—' <br /> to equipment are documented and communicated. <br /> (A.r incidents,near rnctdents,arid unsafe situations reported. f i:.'ILr r/ j'/.-Ojz <br /> �. arna$enIHhV6 atlanto —! _- <br /> �S <br /> ` COMPANY CONFIDENT JAL C%'Ttatknulogy Inc.,201 t All ktglus ltiaurved. <br /> Friotad IWQKY of Nis dtaarrrx�rt ore unauurolkd <br /> to:currpet vcreicm is available itr the Tankrwlogy On-Lise D.!curtxm Central S <br />