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p <br /> ITS-As KNOLOG o ' <br /> e <br /> .hMsv A <br /> r <br /> CHNOLOGY FOR TANKS MANDATORY Safety Tag & Lock-Out Pre,-test <br /> t st <br /> O THEIR ENVIRONMENT and <br /> Quality rance Post-test Procedure <br /> Customer: Site #: Service Order : <br /> Address: City/St: Zip: / <br /> 9666 L9Wfl--� <br /> PROCEDURE: <br /> The following items must be signed for prior to starting tank and/or line testing at <br /> site: <br /> 1 ) The station manager understands that PRIOR to FUEL DROPS the Unit Manager <br /> must stop testing and place the complete station back into working order. <br /> 2) The station manager understands that the pumps, dispensers and electrical supply <br /> must stay disabled throughout the test. <br /> 3) All associated power breakers have been turned off for testing. <br /> 4) Magnetic signs have been placed on power breaker boxes. <br /> 5) "Out of Service" bags are on dispenser nozzles. <br /> ) Padlocks are on dispenser nozzles. <br /> 7) Check valve is closed. <br /> ) Bayonet connector is disconnected from pump. <br /> ) All safety procedures have been discussed with all station personnel. The Station <br /> Manager and Tanknology Unit Manager have each confirmed that the Tag & Lockout <br /> procedures are in effect. <br /> The Station Manageragrees that the above items wereexplained <br /> completed rir to the start of tank and/or line testing. <br /> Station Manager Name: Station Manager Signature: Date: <br /> POST-TEST : <br /> To insure that your station is fully operational prior to our test-unit departing from your location, <br /> PLEASE VATNESS the following items: <br /> 1) Each dispenser operates, and all "out-of-service" bags & pad-locks were removed. <br /> 2) There are NO LEAKS in the sub-pump area, even when the pumps are running. <br /> 3) 'Tamper proof wire seals were installed on all leak detectors serviced. <br /> 4) All debris, safety-cones & magnetic signs have been removed from the work area. <br /> 5) All tanks and dispensers were restored to their original state. <br /> The Station Manager agrees that the above items were witnessed & completed following the <br /> completion of tank and/or line testing. <br /> Station Manager Name: St 'on Manager ignature: Date: <br /> ig <br /> nR �i7e� <br /> Unit Manager Name: Unit Manager Signat re: Date: <br /> �i ZX_ )�� ���� Certificate <br /> TAK-27 <br />