SAFE Work Permit  Meraux Refinery  Cold Work Low Energy Permit Number: Permit Review By: Date: Information to be completed by Permit Requestor/Holder Company:  Meraux Refinery Contractor Name  Area/Unit Permit Holder: Tools/Equipment to be used: Equipment # # Persons: Work Order #: Hand tools Lift trucks Double Insulated Electric Other: Scope of Proposed Task: 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 Checked Yes N/A Additional PPE Required? Equipment Pre-Work Req’d Done Area Preparation LOTO Procedures Followed Y -- N Lock Box Number: Bottle Watch Blinded/Disconnected Decontamination Additional Standby Equipment Opened/Depressurized Water Washed Low energy work Preparation Valves-Closed/Tagged/Chained/Locked N2 Purged 120V Electrical equip GFCI De-energized Electrical Systems Steamed Prepared for Vehicle Entry Electrically Locked-out/Tagged Out Other Sumps-drains covered Field Test / Attempt to Energize-start Radioactive Sources Secure Electrical Connections Taped Blinds Verified & Blind-List initialed Vehicle Wheels Chocked Job Hazards Y Standard Controls PPE Req’d Static Electricity Grounding, Manual Handling / Lifting Assessment & lifting equipment Standard (SSP-0011) Y -- N Slips, Trips & Falls Housekeeping, & PPE Moving Parts Covers, Isolation, & Maintenance Full Face Shield Chemical /Fuel Exposure MSDS Review, PPE Overhead Hazards Labelling, Isolation, & Barriers Goggles Vehicle Entry in the unit? Procedures, Barriers, & Permit Sharp Edges Covers, PPE, & Equipment Inspections Hearing Protection Electricity Isolation, LOTO, GFCI Activities of Others Communications, Barriers, Permit Fall Protection Flammable Vapors / liquid Gas Testing & Isolation Access & Egress Housekeeping, Walkways, Stairs Leather Gloves Fumes & Dust Respirator / Eye Protection Trapped Pressure Venting, Draining, & PPE Rubber Gloves Hot Surfaces Insulation / Barriers / PPE Vehicle Traffic Hi-Vis Clothing, Speed Limit, & Signs Non Permeable Suit Toxic Vapors / Liquids Underground Hazards CAT Testing, Labelling, & Barriers Respirator ½ face Excavation Excavation Checklist Hot Liquid Procedures & PPE Respirator Full Face Weather Extremes Schedule, breaks. Working at Height Scaffolding & Fall Protection / Harness Filter Type: Spillage to Ground Secondary Containment Working Over Water Life Jacket, & Safety Boat, Supplied Air Spillage to Water Containment / Booms Mechanical Lifting Barriers / Lift Procedures Personal H2S monitor HF Alky -- LEVEL “A”: Totally encapsulated suit – positive pressure HF Alky -- LEVEL “B”: One piece coverall, gloves w/sealed cuffs, HF boots, positive flow hood w/ air line. HF Alky -- LEVEL “C”: One Piece Coverall, HF Boots, Gloves w/sealed Cuffs/ face shield Specific Hazards: Additional Controls and/or Special Instructions: Signing this Work Permit signifies the job site has been inspected by the Permit Issuer and Permit Requester/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 Test 2 Date Time Oxygen LEL H2S CO Benzene Other Serial # Calibrated? Initial -- Meraux Qualified Person All Signatures are Required PRIOR to INITIAL work. Time Start Time Expires Authorized Continue Print Name Signature Date Permit Holder Permit Issuer Chief Operator (if required) All Signatures are Required PRIOR to EXTENDING Permit into the following shift. Time Start Time Expires Authorized Continue Print Name Signature Date Permit Holder Permit Issuer Chief Operator (if required) Permit End Work Complete Safe/Clean Job-Site? Exposed HF Acid HF PPE Cleaned? Print Name Signature Date Time Permit Holder Y N Y  N Unit Operator

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 work Check and indicate Contractor Name for contractor work The Permit Holder completes this section of the permit prior to meeting wit permit issuer. Person responsible for directly supervising the work. How many will be involved performing work Indicate work order numbers List tools & equipment to be used. The Permit Holder should describe the scope of work to be completed in 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 Based on the work and hazards – specific required PPE should be Identified for the permitted 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: If HF Alky involved indicate PPE Level 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 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. If HF Exposure– indicate and Ensure area Cleaned.