Permit Number Confined Space Work Permit Meraux Refinery

Permit Number: Confined Space Work Permit Meraux Refinery Contractor Name Information to be completed by Permit Holder Company: Meraux Refinery Area/Unit Permit Holder: Equipment # # Persons: Tools/Equipment to be used: Hand tools Lift trucks 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. (MUST BE CHIEF OPERATOR) MSDS Yes Checked N/A Previous Product in Equipment: • Electrically locked / tagged out • Safety Department Notified Y Y -- N External Atmosphere Aspirating / Fans / Air Flow Y -- N Rescue Services Available Trained Entry Attendant Y Y Y -- N • Grounded / Bonded Y -- N • Evacuation Horn • Main Air Supply Valves Tagged Y -- N • Orange Vest Natural Draft Y -- N • Sign in/Sign out log Radioactive Source Secure Y -- N • Contact: • Retrieval System • Life Line • Continuous air monitor Y -- N Field Test / Attempt to Energizestart Blinds Verified & Blind-List initialed • Y -- N Y Vessel Decontamination Y -- N Internal Lighting • • Water Washed N 2 Purged Y -- N • • • Job Hazards Steamed Y Access & Egress Other • Area Preparation Y -- N Done Y Blinded/Disconnected Equipment Opened/Depressurized Valves. Closed/Tagged/Chained/Locked Additional PPE Required? Equipment Pre-Work Lock Box Number: Req’d LOTO Procedures Followed • • • Standard Controls Y -- N Housekeeping, Walkways, Y -- N Stairs Req’d Done Activities of Others Moving Parts Covers, Isolation, & Maintenance Chemical /Fuel Exposure MSDS Review, PPE Overhead Hazards Labelling, Isolation, & Barriers Procedures, Barriers, & Permit Isolation, LOTO Electricity Flammable Vapors / liquid Fumes & Dust Hot Surfaces Slips, Trips & Falls Covers, PPE, & Equipment Inspections Housekeeping, & PPE Gas Testing & Isolation Static Electricity Grounding, Respirator / Eye Protection Trapped Pressure Sharp Edges Insulation / Barriers / PPE Toxic Vapors / Liquids Gas Testing & Isolation Specific Hazards: Spillage to Ground Secondary Containment Spillage to Water No Date Containment / Booms Time Oxygen LEL Y Y Y -- N CO Benzene Req’d Y Full Face Shield Goggles Hearing Protection Fall Protection Leather Gloves Venting, Draining, & PPE Rubber Gloves Hi-Vis Clothing, Speed Limit, & Vehicle Traffic Signs Non Permeable Suit Underground Hazards Additional CATControls Testing, Labelling, & Barriers Respirator ½ face and/or Special Instructions: Hot Liquid Procedures & PPE Respirator Full Face Scaffolding & Fall Protection / Working at Height Harness Supplied Air Working Over Water Life Jacket, & Safety Boat, Personal H 2 S monitor Mechanical Lifting Barriers / Lift Procedures Organic/HEPA H 2 S Done Y Low Volt 12 V lights Y -- N 120 V w/ GFCI Y -- N Inert Entry PPE Standard Controls Job. Procedure Hazards (SSP- Y Y -- N Bottle Watch Y -- N 0015) Manual Handling / Lifting Assessment & lifting equipment Confined Space Signs Posted Additional Standby Y -- N Y Standard (SSP-0011) Communications, Barriers, Permit Vehicle Entry Req’d Other Serial # Calibrated? 1 2 3 4 Y Meraux Qualified Person: • Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Holder, the area is 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 necessary. All Signatures are Required PRIOR to INITIAL work. Authorized Start All Signatures are Required PRIOR to EXTENDING permit up to 12 hours Time Start Time End Signature Print Name Date Authorized Continue Permit Holder Permit Issuer Operator Shift Supervisor Confined Space Attendant Permit End Permit Holder Unit Work Complete d Site in Safe Condition Yes No Yes No Print Name Time Start Time End Signature Print Name Signature Date Time Date CSE Permit Review Within 12 months By:

The Permit Holder completes this section of the permit prior to meeting wit permit issuer. Check if Meraux personnel doing work Permit Number will be pre-printed on form Check and indicate Contractor Name for contractor work Person responsible for directly supervising the work. How many Indicate work will be order numbers involved performing List tools & work equipment to The Permit Holder should describe the scope of work to be completed in this area. be used. Must be the Chief Operator Indicate product last in vessel so proper PPE can be assessed. . << Indicate if the MSDS was checked for the previous product in the vessel – then make any relevant comments in this area. 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 ensure area preparation is required and Done for Bottle Watch or Low Energy Work. 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. Based on the work and hazards – specific required PPE should be Identified for the permitted work. 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 any confined space work and must take additional samples during the course of the work. A separate form for tracking confined space entry and other required will also be required. 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, date and time on the form. This area is for the Required OSHA permit Review process and is