Information
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Date:
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Witness Name:
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Lease Name:
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Property Number(s):
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Transporter:
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Driver Name:
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Truck #/Trailer #:
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Pumper Name/Route:
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State/County/District:
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Start Time:
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End Time:
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Fluid Removed From Tank #'s:
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Proper PPE (safety glasses, FRC, Steel toe boots, hard hat, and 4 gas monitor)
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Wheel chocks in place?
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Truck bonded and grounded before loading?
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Utilized vapor recovery hose/truck vent hose while loading?
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Tank isolated prior to gauging?
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Proper use of ROC for upper and lower gauge reading?
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Sample taken from truck with hydrometer?
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Is oil put in centrifuge first then solvent?
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Is BS&W recorded accurately on run ticket?
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Is upper and lower gauge reading accurately recorded on run ticket?
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BBLS Sold:
