Laserfiche WebLink
Tanknology Inc. .._v ._— <br /> Policy 3011-29-A <br /> 8501 N.Mutat:Ecp;v%mvuy,Suite 40O Austin.TX 78759 (800)964-0010 <br /> Re D <br /> JOB CLEARANCE FORM& Revised.&1042008 <br /> SITE SAFETY CHECKLIST—OVF <br /> Site Na street Address: <br /> Ci;� 110S . ) 14A, ata ut" i 3T <br /> Arrivaleparture Time: Travel Time: I Others on site' ale <br /> Scope of worts and Tasksertormed(JSA's must be available for all tasks): <br /> AT& L 01 5 Q .i Nit's 4-0. <br /> Repairs to EAuipment bir Pans Provided: <br /> Follow-up actions required:eaulpment isetaled:comments: <br /> PE-PERSONAL P CTIvE MOMENT REQtIIR Check Items used or mark—If not a plfcabJe <br /> (aty vest Safety Giassas Gfovss Nearing Protection <br /> Steel Toe Boots Splash Goggles kasd Hat other <br /> ./ PRE TEST PROCEDURES fCheck each item completed or mark if not applicable) <br /> I '' Discuss safety procedures with site personnel. Nearest hospital: <br /> 2, nor to fuel deliveries the UST system must be placed back into working order. <br /> 3. Sure 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 /> 5. ... Implement Lockoutlragout per API 1646(when accessing product piping during tasks) <br /> All appltcabts equipment disabled during test(s), Sure the clreuit breaker(s)with lockout dev;ces and tags. <br /> Securo nozzles with"Out of Service bags and nylon ties. Verify t_OTO Is complete by trying to operate pumps. <br /> Close bait valves or check valves on product piping. 'sconnoct electrical'bayonet'ccnneA from the STPis), <br /> Igoaucre <br /> SIGN IN. <br /> General Safety Checks: <br /> All s to personnel have been informed. f° <br /> Fuel delivery has been informed. a oittesentauW Itepr tore S+itnnuue <br /> Is a delivery a today? ` <br /> LOTO procedures have been distussad and agreed. <br /> j <br /> Work areas barricaded to protect workers.staff&public I have discussed job ciddrince form with technicia4JA <br /> ✓ POST-TEST PROCEDURES Check each item com letedormark "ifnota Wicabl <br /> 1. Remove all"LockouVragout-devices. <br /> 2. Run all pumps and verify there are no leaks, ImpactValve Test Ports under dispensers <br /> Leak Detector Threads on STP's Functional Elements&Relief Screws VED <br /> 3. II lead wire seal on all test plugs&leak detectors that were serviced. <br /> Count LD threads: L1_ L2_ L3 L4��5_ L5_ <br /> 4. Check following components operational: i%ATG probes.sensors,&caps ?01 <br /> floats,dry breaks&caps galhodic protection operational <br /> tainment sumps are dry ..,."Dispensers&POS operational <br /> Dispenser panels are replaced p tubes,fill adapters&caps H8 71?D8'YA7kfqWWe§j1,VaW— AL <br /> iWk detectors&vent tubes .��anhole covers and sump lids <br /> I Monitoring system is operational Sheat valves are open <br /> Siphon lines and manifold valves Siphon Eines and manifold valy <br /> STP fittings and bayonet connectors Vents(not capped,plugged is lated) <br /> / <br /> 5. /Remove barricades. <br /> SIGN OUT&operator verifieation.of work.Ov L s^_to wamn a cert nein gnn urn <br /> General Safety Checks: [; <br /> Work area has been left tidy&sate. <br /> Site stat(are aware of ylork status including any remaining isotatten, site Rewesartativa h3.119 a epresen nmute <br /> Changes to equipment are documented and communicated <br /> AO Incidents,near incidents,and unsafe situations reported. U <br /> 4 <br /> SCe Repcesrw'mive wnnWnta. <br /> COMPANY CO\FIDE,1'r1A1, V e Taeknalcgy Inc.,Z01 1.All Rights Rc.rarved. <br /> tont d cupi�5 gf this tWcwne a arc utcnnuolEed. TLc etc YCrt verien is:n tilut is in the Tao!refo w On•t irn Docvnteta Ccrtrri S atcut <br /> tb9tb0t1T5T00# Od :#4ad 4snD £68t1T£Z-TMN #'0'M <br />