Information
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Date:
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Witness Name:
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Lease Name:
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Property Number:
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Transporter:
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Driver Name:
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Truck #/Trailer#(s):
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State/County/District:
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Pumper Name/Route:
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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 Worn (safety glasses, FRC, steel toed 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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Is hose conductive?
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Grounded hose before loading?
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Tank isolated prior to gauging?
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Properly used ROC for upper and lower gauge reading?
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Is upper and lower gauge reading accurately recorded on run ticket?
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BBLS Loaded:
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Comments:
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Signature:
