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2021 12:19:47
Work Order No: 50071975165
DFERRAL REQUEST TEMPLATE
Section 1 - Deferral Request Information
Number of Defferal: [ ] First Deferral [ ] Second Deferral Defferal Reason: [ ] Legally compliant [ ] Warranty not compromised Date of Deferral Request:
Additional Information:
Functional Location (FL): 5A15-018-13PO-21-TK-002 [ ] Spares or Tools not available Initial Basic Finish Date: 30.06.2021
FL Description: REZERVOR, ETALONARE PARC 13 [ ] Manpower or Skills not available
Equipment No / Description [ ] Equipment not availabe or accessible Proposed Basic Finished Date:
Equipment Criticality: NSC / Non Safety Critical [ ] Shutdown required
Work Order Description: INSPECTIE REZERVOR 4A [ ] Adverse weather conditions Maintenance Planner:
Priority: 4 WO Type: [x] PM [ ] CM

Assessment Team:

Name (Lead Assesor): Signature: Position: Name: Signature: Position:

Name: Signature: Position: Name: Signature: Position:

Name: Signature: Position: Name: Signature: Position:

Section 2 - Risk Assesment

[ ] Risk Assesment not required Initial Risk Residual Risk

No Problem / Scenario Description Severity Likelihood Work Mitigation Actions Required Severity Likelihood Work Comments
Priority Priority
S1-S5 A-E 1-5 S1-S5 A-E 1-5

Section 3 - Deferral Request Approval

I confirm that this Risk Assessment considers all reasonably foreseeable risks and reduces the risk to a level that is as low as I approve this Risk Assessment as it considers all reasonably foreseeable risks and reduces the risk to a level that is as low as
reasonably practicable reasonably practicable
Issuing Authority Name: Signature: Date: Level 1 Approver: Signature: Date:
(e.g. Discipline Engineer) (Field Manager)

Technical Authority: Signature: Date: Level 2 Approver: Signature: Date:

(TA shall sign-off if a SCE Assurance (Operations Manager)
Task is concerned)
 Anexa 4 Listă de verificări rezervor in timpul functionării

Listă de verificări rezervor in timpul functionării

Parc/Depozit Nr. Identificare rezervor: Locatie functionala:

Parc 13 Poeni 5A15-018-13PO-21-TK-002

Nr. Comanda: Diametru ext. [m]: Înăltime [m]

50071975165
Produsul stocat:

Tip: [ capac fix [ capac plutitor [ alte tipuri

1 [ spa#iul inelar pentru colectare scurgeri [ OK [ repara#ie

2 [ fundatie beton [ OK [ reparatie [ înlocuire
1. Fundatie si 3 [ fundatie pietris acoperit cu bitum [ OK [ reparatie [ inlocuire

zona de 4 [ robinet de scurgeri pluviale [ OK [ reparatie [ inlocuire

contaminare 5 [ etansare conducte la trecerea prin digul de [ OK [ reparatie [ inlocuire

secundara retentie

6 [ robinet sigilat închis/deschis verificare [ OK [ se declansează securizarea

7 [ piping(interior dig retentie) [ OK [ coroziune [ necesar reparatie
2. Test de 1 [ nivelul minim de lichid atins (Capac fix/flotant: 70/95% ) [ Nivelul de lichid [%]:

etanseitate 2 [ OK [ scurgeri [ retestare la nivel minim de lichid

1 [ izolatie termica [ OK [ reparatie

2 [ izolatie anticoroziva [ OK [ reparatie
3 [ contravantuiri [ OK [ reparatie
3. Manta 4 [ guri prelevare probe [ OK [ reparatie

5 [ manlocuri si racorduri [ OK [ reparatie

6 [ indicator nivel [ OK [ reparatie
7 [ indicator nivel [ OK [ reparatie [ lovituri, deformari
[ reparatie
1 [ capac [ OK [ coroziune [ gauri
2 [ protectie anticoroziva [ OK [ deteriorata [ remediere
3 [ supape de repiratie [ OK [ curatire [ inlocuire
4 [ scurgere capac rezervor [ OK [ curatire
5 [ izolatie termica [ OK [ reparatie
4. Capac 6 [ manlocuri/racorduri [ OK [ reparatie

7 [ pontoane [ OK [ curatire [ reparatii

8 [ etansare capac plutitor [ OK [ scurgeri [ crapaturi/altele:
9 [ supapa de siguranta [ OK [ curatire [ inlocuire
10 [ capac plutitor - impamantare [ OK [ reparatie
11 [ capac plutitor - scara rulanta si cai rulare [ OK [ reparatie
5. Sistem de 1 [ Sistem de protectie impotriva incendiilor [ OK [ deteriorat
protectie
impotriva
incendiilor
6. Paratrasnet 1 [ Paratrasnet [ OK [ deteriorat

7. Sistem 1 [ Sistem de impamantare [ OK [ deteriorat

impamantare
8. Scari, 1 [ Scari, balustrade, platforme, pasarele [ OK [ protejare [ reparatii
balustrade, anticoroziva
platforme,
pasarele
9. Comentarii

10. Semnaturi: