Meraux Refinery Information to be completed by Permit

Meraux Refinery Information to be completed by Permit Requestor/Holder SAFE Work Permit Contractor Name Company: Meraux Refinery Area/Unit Permit Holder: Equipment # # Persons: Permit Number: q Cold Work q Low Energy Tools/Equipment to be used: q Hand tools q Lift trucks q. Double Insulated Work Order #: Scope of Proposed Task: Electric Other: Please initial that the Scope of work is clear and understood. Permit Holder: Permit issuer: Information to be completed by Permit Issuer. Previous Product in Equipment: MSDS Yes Checked N/A Additional PPE Required? Equipment Pre-Work LOTO Procedures Followed • Blinded/Disconnected • Equipment Opened/Depressurized • Valves. Closed/Tagged/Chained/Locked Req’d Done Equipment Pre-Work Y -- N Lock Box Number: Y -- N Decontamination • De-energized Electrical Systems Req’d Done Y -- N • Water Washed Y -- N • N 2 Purged Y -- N • Steamed Y -- N Area Preparation Bottle Watch Additional Standby Low energy work Preparation • 120 V Electrical equip GFCI • Prepared for Vehicle Entry Req’d Done Y -- N Y -- N • Electrically Locked-out/Tagged Y -- N • Other Y -- N • Sumps-drains covered Out Job Hazards PPE Y -- N Req’d Y Y Standard Controls Job Hazards • Field Test / Attempt to Energize • Electrical Connections Manual Handling / Radioactive Sources Secure. Assessment Y -- N & lifting equipment Standard (SSPStatic Electricity Grounding, Y -- N start Taped Y -- N Lifting 0011) • Vehicle Wheels Slips, Trips & Falls & PPE Moving Parts Covers, & Maintenance Full Face Shield Y -- N Blinds Verified & Blind-List. Housekeeping, initialed Y -- N Y --Isolation, N Chocked Y -- N Chemical /Fuel MSDS Review, PPE Overhead Hazards Labelling, Isolation, & Barriers Exposure Goggles Y -- N Vehicle Entry in the Procedures, Barriers, & Covers, PPE, & Equipment Sharp Edges unit? Permit Inspections Hearing Protection Y -- N Communications, Barriers, Electricity Isolation, LOTO, GFCI Activities of Others Permit Fall Protection Y -- N Flammable Vapors / Gas Testing & Isolation Access & Egress Housekeeping, Walkways, Stairs liquid Leather Gloves Y -- N Respirator / Eye Fumes & Dust Trapped Pressure Venting, Draining, & PPE Protection Rubber Gloves Y -- N Insulation / Barriers / Hi-Vis Clothing, Speed Limit, & Hot Surfaces Vehicle Traffic Specific Hazards: Additional Controls and/or. Signs Special Instructions: PPE Non Permeable Suit Y -- N Toxic Vapors / CAT Testing, Labelling, & Gas Testing & Isolation Underground Hazards Liquids Barriers Respirator ½ face Y -- N Excavation Checklist Hot Liquid Procedures & PPE Respirator Full Face Y -- N Scaffolding & Fall Protection / Weather Extremes Schedule, breaks. Working at Height Harness Filter Type: Spillage to Ground Secondary Containment Working Over Water Life Jacket, & Safety Boat, Supplied Air Y -- N Personal H 2 S Spillage to Water Containment / Booms Mechanical Lifting Barriers / Lift Procedures Y -- N monitor HF Alky -- LEVEL “A”: Totally encapsulated • Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Requester/Holder, the area issuit – positive pressure prepared, and each individual has agreed to comply with the conditions of this permit. • The Permit is valid through the end of the current work shift (start and end times below) and may be extended into the next shift if HF Alky -- LEVEL necessary. “B”: Test 1 One piece coverall, gloves w/sealed cuffs, HF boots, positive flow hood w/ air line. Date Oxygen H 2 S Chief Operator (if required) Other Serial # Calibrated? Initial -- Meraux Qualified Person Print Name All Signatures are Required PRIOR to EXTENDING Permit into the following shift. Authorized Continue Signature Date Print Name Time Start Time Expires Signature Date Permit Holder Permit Issuer Chief Operator (if required) Work Safe/Clea Expose HF PPE Comple n Jobd Cleaned te Site? HF Acid ? Y N Y N One Piece Coverall, HF Gloves w/sealed Time Expires Boots, Cuffs/ face shield Permit Holder Permit Issuer Benzene Permit End Authorized Continue LEL CO “C”: All Signatures are Required PRIOR to INITIAL work. Time Permit Holder Unit Time Start HF Alky -- LEVEL Test 2 Y N Print Name Signature Date Time

Please designate if this is “Cold Work” or if Low Energy which includes only Vehicular Entry into a unit or low voltage only work. Please see hot work permit instructions Check if Meraux personnel doing Check and indicate Contractor Name for work contractor work The Permit Holder completes this section of the permit prior to Person responsible for directly supervising the meeting wit permit issuer. work. Indicate work order How numbers many will be involved performi List tools & ng work equipment to The Permit Holder should describe the scope of work to be completed in be used. this area. Permit Issuer is an operator for the area involved << Indicate if the MSDS was checked for the previous product in the vessel and any additional PPE required. Indicate product last in vessel so proper PPE can be assessed. . The permit issuer and Permit Holder also ensure area preparation is required and Done for Bottle Watch or Low Energy Work. The Permit Issuer and Permit Holder work through this section to ensure that: 1 – all Equipment Pre-Work area are checked to indicate what is REQUIRED (Req’d) 2 – to ensure that all REQUIRED Pre-Work is actually DONE The Permit Issuer and Permit Holder also inspect the area for Job Hazards. In this area if a Job Hazard exists the box should be checked. Standard Controls or other appropriate measures should be taken to ensure the area is safe for work. Also – potential Environmental impacts are noted below: Identify any additional or specific Hazards of explanations of certain above information. Clarify additional controls or special instructions for the work. . A Meraux employee (or designated contractor during turnaround events) who is qualified to do air testing must test the work area prior to any Vehicle entry or other low energy work being performed for this permit. These readings are noted here. A signature is required If HF Exposure– indicate and Based on the work and hazards – specific required PPE should be Identified for the permitted work. If HF Alky involved indicate PPE Level These names, signatures and date must be complete and the Start and End time for the permit set (above) prior to work start. If, at the end of the shift, it is necessary to extend the permit, the on-coming Permit Holder and Issuer must review the area to ensure conditions have not changed and re sign the permit with start and end times. When the work is complete the Permit Holder and the Unit Operator should review the work and indicate whether it is complete and the site is in Safe condition – then print and sign their name and date the form.