Permit Number Confined Space Work Permit Meraux Refinery

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

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. Indicate product last in vessel so proper PPE can be assessed. . Must be the Chief Operator << 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 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. If radios are provided note radio and channel 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. For office use -This area is for the Required OSHA permit Review process and is