SAFE Work Permit Meraux Refinery Contractor Name Information

SAFE Work Permit Meraux Refinery Contractor Name Information to be completed by Permit Requestor/Holder Company: Meraux Refinery Permit Number: q Cold Work q Low Energy Area/Unit Permit Requestor/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. Previous Product in Equipment: MSDS Yes Checked N/A Equipment Pre-Work LOTO Procedures Followed Additional PPE Required? Req’d Done Equipment Pre-Work Y -- N Lock Box Number: Blinds Verified & Blind-List Y -- N initialed • Blinded/Disconnected • Equipment Opened/Depressurized • Valves. Closed/Tagged/Chained/Locked • Deenergized Electrical Systems Y -- N • Field / Attempt to Y Energize. Standard Controls Job. Test Hazards Y -- N start Static Electricity Grounding, Blinds Verified & Blind-List initialed Y -- N Slips, Trips & Falls Housekeeping, & PPE Chemical /Fuel Y -- PPE N MSDS Review, Exposure Vehicle Entry in the Procedures, Barriers, & unit? Permit Req’d Done Y -- N Area Preparation Bottle Watch Y -- N Additional Standby Y -- N Low energy work Decontamination Y -- N Preparation Y -- N • 120 V Electrical equip • Water Washed Y -- N GFCI Y -- N • Prepared for Vehicle • N 2 Purged Y -- N Entry Y -- N PPE Req’d Y Standard Controls Job Hazards • Steamed Y -- N • Sumps-drains covered Y -- N Manual Handling / Assessment & lifting • equipment Standard (SSPElectrical Connections Y -- N 0011) • Lifting Other Y -- N Taped Y -- N Moving Parts Covers, Isolation, & Maintenance Full Face Shield • Vehicle Wheels Radioactive Sources Secure. Labelling, Y -- N Overhead Hazards Isolation, & Barriers Chocked Goggles Y -- N Covers, PPE, & Equipment Inspections Communications, Barriers, Permit Sharp Edges Hearing Protection Y -- N 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 Hot Surfaces Respirator / Eye Protection Insulation / Barriers / Specific Hazards: PPE Toxic Vapors / Liquids Excavation Gas Testing & Isolation Excavation Checklist Spillage to Ground Secondary Containment Spillage to Water Containment / Booms Req’d Done Y -- N Fall Protection Y -- N Leather Gloves Y -- N Rubber Gloves Y -Hi-Vis Clothing, Speed Limit, & Vehicle Traffic Additional Controls and/or Special Instructions: Signs Non Permeable Suit Y -CAT Testing, Labelling, & Underground Hazards Barriers Respirator ½ face Y -Hot Liquid Procedures & PPE Respirator Full Face Y -Scaffolding & Fall Protection / Working at Height Harness Filter Type: Working Over Water Life Jacket, & Safety Boat, Supplied Air Y -Personal H 2 S Mechanical Lifting Barriers / Lift Procedures Y monitor • 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. Test 1 Date Time Start All Signatures are Required PRIOR to INITIAL work. Time Expires Signature Print Name Authorized Continue Oxygen Date Permit Holder LEL Permit Issuer H 2 S Chief Operator (if required) CO Benzene All Signatures are Required PRIOR to EXTENDING Permit into the following shift. Other Time Start Time Expires Signature Print Name Authorized Continue Serial # Date Permit Holder Calibrated? Permit Issuer Initial -- Meraux Qualified Person Permit End Test 2 Chief Operator (if required) Work Completed Permit Holder Yes No Work Site in Safe & Clean Condition Yes No Print Name Signature Date Time N N N

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 The Permit Holder completes this section of the permit prior to meeting wit permit issuer. Check if Meraux personnel doing work 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 work The Permit Holder should describe the scope of work to be completed in this area. List tools & equipment to be used. Permit Issuer is an operator for the area involved << Indicate if the MSDS was checked for the previous product in the vessel – then make any relevant comments in this area. Indicate product last in vessel so proper PPE can be assessed. . 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 to any Vehicle entry or other low energy work being performed for this permit. These readings are noted here. A signature is 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 and date the form.