Title Page

  • Prepared by

  • Payzone personnel on location

  • Lease:

  • Customer:

  • Job #

  • Location
  • Select date

  • Asset Number

  • Wind Sock

  • All Valves Function Correctly

  • Plugs in Valves

  • Bolts in Flanges

  • Hatch Seals

  • Hatch Bolts

  • Piping Certification

  • Date of Certification

  • Ladder

  • Valves Operate Freely

  • Handrails

  • Ground Rod and Cable

  • By signing, I agree I have completed this inspection as a competent representative of Payzone Completions.

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