PDI

• Site Name

• Delivery Address

• Directions

• Postcode

• Site Contact Name

• Position

• Telephone

• Email

• Manager

• Telephone

• Email

Product Information

• Product

• Concentration

• Storage Tank Capacity

• Minimum Order Quantity

• Annual Consumption

• New

  Yes

  No

  N/A

• Previous

Delivery Point Safety Checklist

• Is there easy access for the delivery vehicle to the site and the delivery point? Check for any height/width/load restrictions.

  Yes

  No

  N/A

• Rigid

• Small Tanker

• Road Tanker

• Can the Vehicle get within 4.5m of the Delivery Point?

  Yes

  No

  N/A

• State the distance from the Delivery Point

• Is the Delivery Point within the site boundary

  Yes

  No

  N/A

Method of Discharge

• Compressed Air from the Vehicle ( Air-pad Delivery) - Tanker (up to 30 psig/2 bar.

  Yes

  No

  N/A

• Mandatory<br>Pumped IBC delivery using pump rig (new sites)<br>

  Yes

  No

  N/A

• What Power Supply is available? Distance to Power Supply?

• On-site fixed pump? <br>Please confirm it will NOT be used in the discharge process. Confirm no onsite pump.

  Yes

  No

  N/A

• Gravity Feed

  Yes

  No

  N/A

Intake Point

• Is the intake clearly labelled to prevent the possibility of a wrong connection?

  Yes

  No

  N/A

• Is the intake locked to prevent the possibility of a wrong connection?

  Yes

  No

  N/A

• Is there an emergency shower nearby?

  Yes

  No

  N/A

• If yes how far away?

• Is it working?

  Yes

  No

  N/A

• Mandatory<br>Is there a water hose available? For emergency purposes in case of spillage for decontamination of personnel (or emergency shower or alternative water source)

  Yes

  No

  N/A
Intake Pipe

• Material

• Diameter

• Length

• Height

• undefined

Connection

• What is the type and size of the intake connection? (refer to PDI Handbook off-loading point table for fitting sizes for specific chemicals) Flange PCD (See attachment 1 of PDI Handbook) Coupling/Adapter (e.g. Quicklock/Camlock) Gender and Size (See attachment 2 PDI Handbook)

• Mandatory: How high is the inlet point from the ground? Must be below 1.5m.

• Will the connection point adequately support a flexible filling hose?

  Yes

  No

  N/A

• Is there an Isolation valve?

  Yes

  No

  N/A

• Is there a Drain/Sample valve?

  Yes

  No

  N/A

Contents Gauge/Indicator

• Mandatory<br>Is there a means of measuring contents?<br>This is to ensure adequate room in the tank for accepting delivery, which is also covered by the authority to discharge process.

  Yes

  No

  N/A

• Is there a separate high-level alarm?

  Yes

  No

  N/A

• Does this Indicate / Alarm / Trip inlet?

Storage Tank

• Is the tank suitable for the storage of this product?

  Yes

  No

  N/A

• Are the contents of the storage tank the same as the product to be delivered?

  Yes

  No

  N/A

• What are the contents of the Storage Tank?

• Verification of Cleanliness (Sodium Hypochlorite/HCL - first fills only – Site Representative must sign)

  Yes

  No

  N/A

• Verification of Scrubber System Operation (For HCL only - Site Representative must sign)

  Yes

  No

  N/A

• Tank Capacity

• Cubic Meters

• Tonnes

• Vent Diameter

• Overflow Diameter

• Is the tank inside a building?

  Yes

  No

  N/A

• Is the tank vented externally?

  Yes

  No

  N/A

Safety & Environmental

• Are there written procedures for offloading including what to do in the event of an emergency?

  Yes

  No

  N/A

• Will the driver be instructed to follow these procedures and any other applicable safety rules?

  Yes

  No

  N/A

• Mandatory Will the driver be supervised during the discharge by a competent person?<br>• A competent person must be made available for the delivery duration to complete the authority to discharge process and forms; this includes supervising hose connection to the customer’s inlet and opening/closing appropriate valves.<br>• It is the responsibility of the site personnel supervising the discharge process to wear appropriate PPE based on the product type being delivered.<br>• During the delivery the Chemifloc Driver should have, as a minimum, the means to be able to easily contact emergency site personnel in the event of an emergency.<br>

  Yes

  No

  N/A

• Is the tank in a bund with at least 110% of the tank capacity?

  Yes

  No

  N/A

• Is the offloading point in a public area?

  Yes

  No

  N/A

• If so, is the public excluded during the transfer?

  Yes

  No

  N/A

• Mandatory - Are the arrangements for preventing spillage from entering surface water drains, foul sewers, and the ground adequate?

  Yes

  No

  N/A

• Drains leading to an effluent treatment system.

  Yes

  No

  N/A

• Drains leading to a containment system such as an interceptor pit.

  Yes

  No

  N/A

• Drains with spillage kits and drain covers are available at the offloading point.

  Yes

  No

  N/A

• Other (describe)

• Is there adequate lighting at the offloading point?

  Yes

  No

  N/A

• Is the bund shared with tanks for other chemicals?

  Yes

  No

  N/A

• Which other chemicals?

• Is there a filling line for another incompatible chemical close by?

  Yes

  No

  N/A

• If there is a filling line for another incompatible chemical, is it fully labelled and segregated?

  Yes

  No

  N/A

Sampling

• Are samples required? See Handbook

  Yes

  No

  N/A

• Where are samples taken from and who takes them if required?

Please use this space to provide any further comments or relevant information.

• Special delivery instructions (for example, particular route to take to access the site due to weight or height restrictions, the specific gate to access the site, location of IBC on vehicle)

  Yes

  No

  N/A

• Contact the site before delivery.

  Yes

  No

  N/A

• Top Fill Adaptor to be used.

  Yes

  No

  N/A

• Comments

• Recommendations

Conducted by:

• Name

• Date

  Date

• Yes

  No

  N/A