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■Yes ❑N/A <br />Training has been completed for all employees involved in <br />maintaining the equipment in the process <br />■Yes ❑N/A <br />Training has been completed for all employees that are <br />required to respond to emergencies involved in the process <br />Visual Inspection Results <br />■Yes ❑N/A All valves closed or in shut-off safe position <br />■Yes ❑N/A Any extra openings capped or plugged - Plugs and caps are tight <br />❑Yes ■N/A Excess flow valves (if any) tight and installed in proper direction <br />❑Yes ■N/A Back checks installed in proper direction and tight <br />■Yes ❑N/A Drain valves installed, closed and plugged if necessary <br />■Yes ❑N/A All valves and trim are compatible with the hazardous material <br />Certification <br />I certify that I have conducted the "Pre-Startup Safety Review" for the above described hazardous material and <br />process using the "Pre-Startup Safety Review Verification Report" above; that the items have been each <br />inspected and determined to be satisfactorily completed; and that the equipment process is ready to receive the <br />covered chemical. <br />Date Originator Manager Contractor <br />5/22/19 Ben Schlegelmilch Ben Schlegelmilch Stellar