Permit Number Confined Space Work Permit Meraux Refinery

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Permit Number: Confined Space Work Permit Meraux Refinery Information to be completed by Permit

Permit Number: Confined Space Work Permit Meraux Refinery Information to be completed by Permit Holder Contractor Name Meraux Refinery Company: Area/Unit Permit Holder: Equipment # Date: Work Order # (s) # Persons: Scope of Proposed Task: Information to be completed by Permit Issuer. (Must be Chief Operator) Work Description: MSDS Yes Checked No Previous Product in Vessel: Req’d Comment: Equipment Pre-Work Lock Box Number: Done Y LOTO Procedures Followed Req’d Area Preparation Done Y Y Y • • • Blinded/Disconnected Equipment Opened/Depressurized Valves. Closed/Tagged/Chained/Locked Aspirating / Fans / Air Flow • Grounded / Bonded • Main Air Supply Valves Tagged Rescue Services Available Trained Entry Attendant • Evacuation Horn • • Electrically locked / tagged out • • Orange Vest Radioactive Source Secure • Sign in/Sign out log Internal Lighting • Contact: • Retrieval System • Life Line • Continuous air monitor Field Test / Attempt to Energizestart Blinds Verified & Blind-List initialed Y Vessel Decontamination • Water Washed • N 2 Purged • Job Hazards Steamed Y Access & Egress Activities of Others Chemical /Fuel Exposure Standard Controls Housekeeping, Walkways, Stairs Communications, Barriers, Permit • • • Low Volt 12 V lights 120 V w/ GFCI Inert Entry Procedure • Y Job Hazards Confined Space Signs Posted MSDS Review, PPE Electricity Fire & Explosion Fumes & Dust Procedures, Barriers, & Permit Isolation, LOTO Gas Testing & Isolation Filter Mask, Eye Protection Hot Surfaces Procedures & PPE Vehicle Entry Natural Draft Covers, Isolation, & Maintenance Overhead Cables Labelling, Isolation, & Barriers Date Time Covers, PPE, & Equipment Inspections Housekeeping, & PPE Grounding, Venting, Draining, & PPE Hi-Vis Clothing, Speed Limit, & Signs Y Full Face Shield Goggles Hearing Protection Fall Protection Chemical Gloves Chemical Suit Working at Height Working Over Water Life Jacket, & Safety Boat, Hot Liquid Req’d 0011) Respirator ½ face Respirator Full Face Air Supplied Procedures & PPESpecial Instructions: Hood/Line Hand Rails, Harness, & Life-Line SCBA Underground Cables No Y Moving Parts Vehicle Traffic Additional Controls Required: Environmental Yes No Y Manual Handling Slips, Trips & Falls Static Electricity Trapped Pressure Done Y Bottle Watch / Additional PPE Standard Controls Standby Y Assessment , & Equipment Standard (SSP- Sharp Edges Can product contaminate soil/water? If yes, have preventive measures been taken? Is secondary containment required? Req’d Safety Department Notified CAT Testing, Labelling, & Barriers Personal H 2 S monitor Y Other. . %LEL Oxygen H 2 S CO Other Serial No Meraux Qualified Person: 1 2 3 4 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 confined space permit. The Permit is valid for a period of up to 12 hours or may be extended (below) for up to 24 hours. All Signatures are Required PRIOR to INITIAL work. Authorized Start Permit Holder Permit Issuer Shift Supervisor Confined Space Attendant Permit End Permit Holder Unit Operator Time Start Time End Signature Print Name Work Completed Yes No Yes All Signatures are Required PRIOR to EXTENDING permit up to 12 hours Work Site in Safe Condition Yes No Yes Date Authorized Continue Print Name Time Start Time End Signature Permit Holder Permit Issuer Shift Supervisor Confined Space Attendant Print Name Signature Date CSE Permit Review Within 12 months By: Date: