Laserfiche WebLink
4 <br />FROM FAX NO. :2093699162 c. 02 2009 10:20AM P8 <br />Ta fogy Inc: �^ <br />8501 N.1vloFae ixpressway, Suite,?l00'Austia,; TX 78759 (800) 964-0010 Policy 100-29-A <br />Jog C�,E ATCE F'® Rev: D . <br />Revised: 8/04/2008 <br />SITE'SACHECKLIST -- ®VF <br />-Site Name/#: Street Address: <br />W.O. <br />Arrival Time: Departure Time;Tr&vet Time: thers on site: Date <br />Scppe qf. Work and Tasks Perform JA's must be available for all tasks): <br />Repairs to Equipment or Parts Provided; <br />Follow-up actions required; equipment isolated; comments; <br />PPE -PERSONAL PROTECTIVE EQUIPMENT REQUIRED LChreck items used or mark if not applicable) <br />C Safety Vest® Safety Glasses Gloves 13Hearing Protection <br />® Steel Toe Soots U Splash les ❑ Hard Hat (1 Other <br />✓ PRE-TEST PROCEDURES Check each item completed or mark ~ if not aAaNcabW <br />Discuss safety procedures with site personnel' Nearest hospital: <br />2:" ❑ prior to fu'ef deliveries the UST system must be placed back. into working order. <br />3. . l" . Secure entire work areawith barricades (cones, flags, and caution tape, pennant flags, or other. perimetergaard). <br />...4. ®. Place fire extinguishers and "No Smoking" signs in the work area. <br />5. ❑ Implement L.ockout/Tagout per API 1646 (when accessing product piping during tasks) <br />Cl Ali.apptioabte equipment disabled during test(s). Secure the circuit breaker(s) with lockout devices and tags. . <br />0 Secure noz *$ with 'Out of Servioe"'bags and nylon ties. L Verify LOTO Is complete by trying to operate pumps. <br />" <br />'0'' C16se. ball valves or check valves on product piping. FI Disconnect electrical "bayonet" Conn o m the STP(s). <br />iu :a:::.':: " ;'•::'' =SAN 1N' ;•' : '` ::ea a Hasan <br />General <br />Le Technician Signature <br />eneral Safety; Checks: <br />All site personnei have been informed: / r� ((( t. <br />Fuel delivery has been informed. Site Rmr tiV. Narea qep u s nafu <br />IS 2• fuel delivery due today?ool, <br />LOTO procedures, have been.discussed and agreed. <br />Work areas.bitmc tided to protect workers, staff & public. <br />f:h V6,discussedjob ra ref wit11 technician. ` <br />✓ ' PQ$T TEST iPRQCEQURE$ (Check eacfritem completed or merle o if not aaPlicable <br />1. ❑. .Remove all "Lockoutlfagout" devices. ate^ <br />.2..' Fa Run all pump's and 'verify there are no. leaks: ❑ Impact Valve Test Ports under dispensers <br />❑ Leak Detector Threads on STP's LJ Functional Elements & Relief Screws <br />Install lead Wire'seal on all test plugs & leak detectors that were serviced. <br />CountLD threads: L1 L2 L3 L4' L5 L6 <br />4:' .i�f Check -following components operational: LJ ATO probes, sensors, & caps <br />C1Ball floats; !,� dry breaks & caps V �' Cathodic protection operational . <br />t_�. Containment sumps are dry Dispensers & POS operational <br />❑ Dispenser panels are replaced ❑ Drop tubes, till adapters'S. caps <br />C '.Leak detectors & vent tubes (3k Manhole covers and sump lids <br />4• Monitoring system is operational C Shear valves are open <br />❑. Siphon lines and manifold valves ❑ Siphon lines and manifold valves . <br />❑ STRfittings and bayonet connectors Fl Vents (not capped, plugged or isolated) <br />Ri9mov4 barric tides' <br />• .; ";aSl(311 Qit'8e". . '4oi~l old of rNtorlt:. "' Fi <br />n rime �eaa T� n�an .gnawre <br />General Safety checks: fp ,:Work area has n left tidy & safe- <br />Sit® staff.are aware..o .. work status`inf�ua ng any remaining Isolation.pre n si rtspr ve Signansre <br />Ohanges to equipment aro documented and communiicated.`All,lnc'dentsnear incidents,and unsafe situations re orted. <br />COWAXY CoNFID j� L Tanlmology Ina., 1-008. Al.] Rights Ttcserved <br />rincecl <br />)Pies of this documelit are uncontrolled The euTrmt'version is available in the Tankaolo Un-Line Document Control S st <br />