Pad Site Inspection

• Site Name

• Field Inspector

• Select date

  Date

• Property Number

• Last H2S Results

• Field Office

• Route Foreman

• Route Pumper

General Location Condition

• Is lease road in good condition?

  Yes

  No

  N/A

• Is tank battery and outer perimeter berm in good condition?

  Yes

  No

  N/A

• Are property and H2S gates locked?

  Yes

  No

  N/A

• Is pad free from surface stains?

  Yes

  No

  N/A

• Is well pad free of vegetation?

  Yes

  No

  N/A

• Is Site if free of trash?

  Yes

  No

  N/A

• Are water gates closed?

  Yes

  No

  N/A

• Is site free of unused junk equipment, fittings, or pipe?

  Yes

  No

  N/A

• Is fencing in good condition and secured?

  Yes

  No

  N/A

• Are cattle guards in good condition?

  Yes

  No

  N/A

• Additional comments.

Facility signs

• CHK signs are accurate and present ( please see signage sheet )

  Yes

  No

  N/A

• Is there a lease sign at location gate, wellhead, tank battery, and Y's in the road?

  Yes

  No

  N/A

• Are RRC # present for tank battery, and entrance to location?

  Yes

  No

  N/A

• Are wind socks present at 100 PPM?

  Yes

  No

  N/A

• Additional comments.

Well Head

• Does wellhead cellar filled in?

  Yes

  No

  N/A

• Does the grating over cellar in good condition and without holes or gaps?

  Yes

  No

  N/A

• Does the wellhead have a fence around it?

  Yes

  No

  N/A

• Can operations on wing valve be performed at ground level?

  Yes

  No

  N/A

• Is a proper stand or ladder present?

  Yes

  No

  N/A

• Are ESD features present at wellhead?

  Yes

  No

  N/A

• Are well head gauges the right size? I.E. Sweet or Unsweet Gauges

  Yes

  No

  N/A

• Additional comments.

Chemicals Around Wellhead

• Is adjustable choke free of leaks?

  Yes

  No

  N/A

• Is 2nd containment for chemical tanks sufficient?

  Yes

  No

  N/A

• Is needle valve open when pumping chemicals?

  Yes

  No

  N/A

• Are all chemical tanks labeled correctly?

  Yes

  No

  N/A

• Additional comments.

Pump Jack

• Are automation shut downs in place for pumping unit?

  Yes

  No

  N/A

• Are there "Unit starts Automatically and Lockout / Tag out" warning signs on pumping units?

  Yes

  No

  N/A

• Are controls labeled?

  Yes

  No

  N/A

• Is containment present under engine of pumping unit?

  Yes

  No

  N/A

• Is a counter weight guard in place?

  Yes

  No

  N/A

• Is there a horse head guard on the pumping unit when below 7 ft.?

  Yes

  No

  N/A

• Are belts and pulleys totally enclosed?

  Yes

  No

  N/A

• Is pumping unit at least 1/4 mile from the nearest house?

  Yes

  No

  N/A

• Additional comments.

Separator

• Is vessel affixed with U1A placard?

  Yes

  No

  N/A

• Are pressure relief devices present, open, and correct size?

  Yes

  No

  N/A

• Are all sight glasses guarded and in good condition?

  Yes

  No

  N/A

• Additional comments.

Heater Treater

• Are lighting instructions posted on fired vessels ( I.e. heater treaters, dehydrators, etc.)

  Yes

  No

  N/A

• Is vessel affixed with U1A placard?

  Yes

  No

  N/A

• Are pressure relief devices present or open?

  Yes

  No

  N/A

• Are all sight glasses guarded and in good condition?

  Yes

  No

  N/A

• Are ladders in good condition and secure?

  Yes

  No

  N/A

• Is area around heater treater free of leaks?

  Yes

  No

  N/A

• Additional comments.

Low Pressure Tower

• Are pressure relief devices present and open?

  Yes

  No

  N/A

• Additional comments.

Tanks

• Are equalizing lines present on multiple tanks?

  Yes

  No

  N/A

• Are load lines equipped with drip pots?

  Yes

  No

  N/A

• Are drip pots pulled down?

  Yes

  No

  N/A

• Is 2nd containment for tanks sufficient?

  Yes

  No

  N/A

• From ground level do seals seem to be in good condition on thief hatches?

  Yes

  No

  N/A

• Are thief hatches closed?

  Yes

  No

  N/A

• Are open ended valves and fittings plugged?

  Yes

  No

  N/A

• Is catwalk in good condition?

  Yes

  No

  N/A

• Are confined space signs present on back of tanks?

  Yes

  No

  N/A

• Are all appropriate HAZCOM signs present? I.E. Sour Crude or Sour Water, NFPA

  Yes

  No

  N/A

• Additional comments.

Flares

• Is the flare stack on?

  Yes

  No

  N/A

• Without smoke

  Yes

  No

  N/A

• Additional comments.

Alarms/Shutdown

• Are alarms and shutdown systems operable & tested quarterly?

  Yes

  No

  N/A

• Are level switches and dump valves operating properly?

  Yes

  No

  N/A

• Additional comments.