Stopple Checklist Form C

To be completed by the Stopple Contractor Prior to Installing the Stopple

Machine support arrangement approved by the TES Engineer? ( ) Y ( ) N

Stopple o-ring material acceptable for service? ( ) Y ( ) N

Expected o-ring life at process conditions: ____________________

Stopple Machine Used Wt lb Max Working Pressure psig Test date__________

Machine support arrangement approved by the Job Coordinator? ( ) Y ( ) N

Completion Plug to be used ( ) Y ( ) N; If yes, elastomer material: ___________________

If an existing completion plug is to be removed, the integrity of the o-rings must be verified before
starting the job.

Signatures

Shift Supervisor
Print Name:
Signature: Date:

Maintenance/Construction Representative
Print Name:
Signature: Date:

Stopple Contractor Representative

Print Name:
Signature: Date:

Job Coordinator
Print Name:
Signature: Date:

Prior to proceeding with the Stopple the above information shall be signed off, and radio
communication established with the Control Room

CONTROLLED DOCUMENT- 24 HRS

8:37 am 12/29/2018
-- UNCONTROLLED THEREAFTER --