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FROM : CSI#1506 PHONE NO. : 209 333 1740 Apr. 03 2003 10:19AM P1 <br /> J'PP Tanknology <br /> SITE SAFETY CHECKLIST; SERVICE AGREEMENT& OPERATOR VERIFICATION FORM <br /> Site Name: Address: 11j W.O,fhnao� #: <br /> N ;ilk., 1 <br /> s,#. City/STOp, Date: <br /> Scope of work: t <br /> Parts Ma Is vi <br /> &' ded'. t),Ail 4-4,rgrg_� r <br /> £ s 4+ t/ l lo <br /> Arrival yat sitrsc Departlir�e i `Fro <br /> lme m ' owl: vel. m w <br /> f <br /> H <br /> ✓ <br /> PRE-TEST PROCEDURES ✓ POST-TEST PROCEDURES <br /> 1_ Di,Scuss,safety procedures.with site personnel. 1. Remove all"LockoutIT.7gout"devices: <br /> 2. Prior to-fuel deliveries;the complete tank 2. Run all pumps and verify there are no.leaks under.dispensers, <br /> system must be placed back into working or in STP sumps. Aust be witnessed by site representative. <br /> order. ❑ impact Valve Test Port <br /> 3. 'All pumps,dispensers,and electrical breakers 0 Leak Detector Threads <br /> of.the.products)to be tested must be disabled ❑ Functional Element&Relief Screw <br /> during the test(s). - 3. Install a lead wire seal on all test plugs&,leak detectors that, <br /> 4. Secure entire work area with barricades, were serviced. Count LID threads: <br /> cones`andlor caution'tape. L1 . L2 . L3 L4 L5 <br /> S. Place fire extinguishers and"No Smoking" 4. Ensure that all tank system components are restored to their <br /> signs in the work area. original state(including):' <br /> S. Tum off and secure the circuit breaker(s)of - ATG probes,sensors,&caps <br /> the product to be tested with lockout devices - Balt floats,dry breaks&caps <br /> and tags. - Cathodic protectionsystem is operational <br /> 7. Place"Out of Service"bags,on the dispenser <br /> Containment sumps,a,pa"Gtry <br /> nozzles of the product(s)to be tested. - Dispensers&POS system <br /> Dispenser panels are replaced <br /> Verify.proper.Lockout/i agout.procedure is - Drop tubes;Tilt adapters&caps' ` <br /> complete by trying to operate pumps. = Leak detectors&copper vent tubes <br /> 9: Close ball valves or check valves on the - Manhole givers and sump)ids <br /> product piping to be tested_ - Monitoring system Is operational <br /> E. z.o. Remove the electrical"bayonet"connector Shear valves at the dispensers. <br /> 1. Srom,the.STP(s). - Siphon lines and.manifold.valves <br /> Spill containm&drain valves <br /> - STP fittings and bayonet connectors <br /> '5. Remove cones,signs and mution to e_ <br /> i <br /> �Tanjjn�ologyeehnlcla a Pr®-T Signature P - st Signature <br /> Signature below confirms that the i it is in a v 6ipresentative.. <br /> site Representative Name Pre-Test Signature. Post-Test.Signature <br /> U. <br /> Ale <br /> 1 ( ! <br /> j Gnmvea�ts: L,1 <br /> • <br /> s <br /> Tanlmobgry-N.. " ntemational Revised 4/23/01 <br />