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W.O.# NW1-2309197 Cust Ref# : 0015114456 <br /> ,c. <br /> T r�nkaebg}�a� <br /> % tT Mote k P wweY.SwtuiWA nq Tv"71e 0wh96441P10 Policy 100- 9-A2 <br /> JOB CLEARANCE FORM& Rmv D <br /> ' I Revived.&04,20W <br /> _ SI'[Y+' SAFETYCHECKLIST—O4F <br /> Na. Street Address: :k <br /> Arrival lane, Parr/lore TIMThrAFT <br /> / ime: I.Abars pn ge: 00M <br /> Scope of wank an Tasks Performed 15A's must be availatke for ail tesksi; <br /> Repairs to eq,ipmeftt orPanaP v <br /> Fdww-aP sja9ui , ;2wdPmo isdaeeC:comannronts,s: <br /> PPE-PERSONALI ErgUIPMEM REQUIRED Check/Mme used ar mark'-Rnn! <br /> 5afaty Vast Safety Glasses y�" Glove=_ Heanng P:otae. <br /> Steel TV <br /> ce Boots Splash Gaggles Hurtl Hut Other <br /> ✓ PRE-TEST PROCEDURES rchxk"chimmoometwarmaril —ffmotaoi,ficaft <br /> 1. f�piswss safety procedural with site personnel. Nearest hospitalL- 1 � <br /> 2. ,/�Prior to fuel cieiivenea the UST system must be placed back into working order <br /> 3. ;i/Secunv entire work area with bamcades{cones,flags,and caution tape.Pennant flags,or other perimeter guard}. <br /> 4. Place fire extinguishers and"No Smoking"stgns in thework area. <br /> 5. �impleman(LockoutlTagout per API 1868(when accessing product piping during tasks) <br /> �!/'�A'lapr>I��obtainment drumed baring unst t. $BQIre MSe Errgilt hl'aa al W(th bd[Oet CtaYl dent 5 <br /> xxSecure ncc9 with'Out of Service bags and nylon lies Vemy,t.0TO is complete by fr}eng to opera p <br /> Glpee tsdl valvas nr SAlepk valves nn pmduc^.P'W Dlsmnnade tn.'Im el'cannea[or'romt S1HIs}- <br /> e <br /> (lenend aetety Chatters <br /> M arm parmanet as.been inicalmd. el <br /> _._. Ggaeuasom44 <br /> =n—ri <br /> ntiaFvarytlue been <br /> _ rc <br /> LOTo pro b8mc1avebeenasaiss lf�daf&P, 'r t ' 14 <br /> Waal,areusbanicadetl to protect workers,staff&trirWic h coastal, � � terdal�i6a.-. <br /> ,/ POST-TEST PROCEDURES eche k n tem d red rk —n t ppanbr } <br /> I �"Romova all`LockoutiTagoet`devices. <br /> 2 Run as pumps and verify there are m leaks: Impact Valve Test Pods under dispensers <br /> Leak Detesfor Tnreeds on STP's Functmnal:Elements&Relief^u•crews <br /> 3_ install lead was seal on all teat Plugs&iaak detectors that were serviced. <br /> Count LD threads: 1 1 ._. L2_... L3.__'__ L4 __._._.. L5__.. L8 <br /> .. Check following components operational ATG probes,sensors,&caps <br /> Ball floats..dry,breaks&caps Cathodic Protection operational <br /> Containment sumps are dry Dispansam&PRS operational <br /> Dispenser panels are replaced Drop tubes,fill adapters&caps <br /> Leak cultecfiB&vent tubes : Mannwe covers and sump lids <br /> monitoring systetl is operations' Shear vaivesam open <br /> S Septic n lines and manifold valves Siphon Imes and manifold valvas <br /> STPfitiings and iruyonef crr>pectors encs 4 plugged or tsol d) <br /> $. Removebamfcadee. <br /> Work am has been oaf an, safe Ili; fX <br /> Site staff are aware rk o£vmsatatus rnrwdmg unyrami IN saatwn. T win ire ham caesr+e Omar re <br /> Charges to equipment are 6ocuT6nt0d anti communlow,4d r <br /> AI'inndenis,nearInodetd,and unsab LWlnaair3pona.d- <br /> a <br /> re Re}xaunurve. <br /> COMPA"GONFIDENnAl, 4 Taakvoksy W-,2RI L M Rgha lkue r,a, <br /> 'meed as nfnriv.krem rime nncovlejare nt <br /> Tumavrsuea is avulleacla Tanthklzv Un Linc D <br /> vatM,aaaa CmlmN Svurnti <br />