Laserfiche WebLink
RECEIVED FEB 0 3 7012 <br /> Tanknology Inc. <br /> 8501 N.MoPse Exprdsway,Suite 400AustSn,77t 78759 (500)960.0010 Pdiry 100-29-A <br /> JOB CLEARANCE FORM & Rev.D <br /> SITE SAFETY CHECKLIST—QVF Re`ISed'9/042008, <br /> rya NBTe/a", <br /> ices: <br /> �"i <br /> � t�. rQ��y �3c.vn• . .« C <br /> ���ai �1lla�d i <br /> Amral IRN: 7'Xiter <br /> acture rma: ravel ime: it on arta: ah <br /> pope o ark and Teaks PeAermed(J A'6 mu,{st be avails le for all recite): TW 22- i—/Z <br /> l✓tAJ/�Gl t'h.Tf /t ill . L�. (l St/ <br /> 0 <br /> epsna t0 uipment or Parts Provided. <br /> v <br /> 000'•'-uP actions required;equipment iaoleled;comments: <br /> l� <br /> POE•PERSONAL PR0TEC77VEEQUrP,wEN1REQUIRED Checkinms used ormadr-Macre rieabre <br /> Safely vest <br /> 'y(BION Toe spots Safety Glasses Gloves C' Hearing Protection <br /> W !Splash Go les 0 Hard Hat L Other <br /> ✓ PRE-TEST PROCEDURES ffiLe2pilliechheal,,alialend or mant <br /> "' if not a licabfe <br /> Discuss safety procedures with site personnel. Nearest hospital: i /-J.% V :/114 4 Cqr ✓ .;� 2. <br /> 2. ri Prior to fuel deliveries the LIST system must be placed back into working order.7- <br /> 3. t <br /> t' secure entire work area with barricades(cones,flags,and Caution to k jt7✓ <br /> 4. Place fire extinguishers and"No Smoking'signs in the work area. �'pennant flags,or other perimeter guard). <br /> S. Y Implement LockouVTagout per API 1646(when accessing product piping during tasks) <br /> l _ <br /> IV."al applicable equipment disabled during test(s). i_i .$*Gere the circuit breaker(s)with lockout devices and tags. <br /> R"Secure nozzles with'Out of service"bags and nylon ties. �Verity LOTO Is complete by trying to operate pumps. <br /> J Close ball valves o check valves oin rotluM piping• 0 Disconnect electrical"Bayonet•connecter from the <br /> SIGN IN Lase Tecemeian Name sad eramoan gnaws <br /> General Safety Cheeks: 1� _ <br /> All site personnel have been Informad. <br /> Fuel delivery has teen informed, roe eprcsens va Name ~ <br /> Is a fuel delivery due today? k eprcsenb4.e sianatre <br /> LO TO procedures have been discussed and agreed. ;`�. �, rA.t1 r 1 <br /> Wnrk areas harricaded to protect workara,staff&public. t\ `-it,^ �.- t `%M..f`t !t , <br /> I Haus discussed oD Wannce brat with technician, <br /> ✓ POST-TEST PRO EDURES!Check car ham enm Herr x ark <br /> t. % Remove all"LodcouUTagout"devices. <br /> 2. %Run all pumps and verify there are no leaks. yGnpact Valve Test Ports under dispensers <br /> 13 Leak Detector Threads on STP's n Functional Elements&Relief Screws <br /> 3. Install lead wire seal on all test plugs&teak detectors that were serviced. <br /> Count LD threads: L7_ L2_ L3_ L4 L5_ L6_ <br /> <. y' Check following components operational: jYATG probes,sensors, &caps <br /> 2 Ball floats,dry breaks&caps 71 Cathodic protection operational <br /> -6 Containment sumps are dry T/bispensers &POS operational <br /> ;��6istlenser panels are replaced —2�Orop tubes, fill adapters&caps <br /> ./Leak detectors&vent tubes .Pi Manhole covers and sump lids <br /> .Yk Onitoring system is operational $hear valves are open <br /> C Siphon lines and manifold valves IJ Siphon lines and manifold valves <br /> 0 STP fittings and bayonet connectors 0 Vents (not cappeo,plugged or isolated) <br /> 5. /Remove barricades. <br /> SIGN OUT& crater Verification of Work OV lead acnnwn roma <br /> General 3lfaty checks: ,,!!--,, 4 V 9natue <br /> work 0100 hos been ICA tidy&safe. t"' t �oa�t'f <br /> Site staff are aware of work status including any remaining isolation. sir RpF aen come ae reser/ira 5gnaaJfn <br /> Changes to equipment are documented and cnmmimicated. Ly-�'s 1 <br /> All inadants,near incidents,and unsafe situations reported. h �,+^ t-C v 'i,t ,SF /� —\ <br /> elle eprcsenreve Cbmmente: 1.� .Ju <br /> COMPANY CONFIOENitAt, - U p�r� � ib c,G.��S• �rd+ kn�al�/MC..2de8:tAi�p .. fy • '�LGj <br /> Primer 's deco I uneaw ion ie lY to .OA-pir <br /> 0fiuol • � . <br /> � <br /> Soo 'd ➢fid WZ0 I89 ZIOZ-E0-839 <br />