1. Job Hazards Y Standard Controls Job Hazards Y Standard Controls PPEReq’d Static ElectricityGrounding,Manual Handling / LiftingAssessment & lifting equipment Standard (SSP-0011) Y -- N Slips, Trips & FallsHousekeeping, & PPEMoving PartsCovers, Isolation, & Maintenance Full Face ShieldY -- N Chemical /Fuel ExposureMSDS Review, PPEOverhead HazardsLabelling, Isolation, & Barriers GogglesY -- N Vehicle Entry in the unit?Procedures, Barriers, & PermitSharp EdgesCovers, PPE, & Equipment Inspections Hearing ProtectionY -- N ElectricityIsolation, LOTO, GFCIActivities of OthersCommunications, Barriers, Permit Fall ProtectionY -- N Flammable Vapors / liquidGas Testing & IsolationAccess & EgressHousekeeping, Walkways, Stairs Leather GlovesY -- N Fumes & DustRespirator / Eye ProtectionTrapped PressureVenting, Draining, & PPE Rubber GlovesY -- N Hot SurfacesInsulation / Barriers / PPEVehicle TrafficHi-Vis Clothing, Speed Limit, & Signs Non Permeable SuitY -- N Toxic Vapors / LiquidsGas Testing & IsolationUnderground HazardsCAT Testing, Labelling, & Barriers Respirator ½ faceY -- N ExcavationExcavation ChecklistHot LiquidProcedures & PPE Respirator Full FaceY -- N Spillage to GroundSecondary ContainmentWorking at HeightScaffolding & Fall Protection / Harness Filter Type: Spillage to WaterContainment / BoomsWorking Over WaterLife Jacket, & Safety Boat, Supplied AirY -- N Mechanical LiftingBarriers / Lift Procedures Personal H2S monitor Y Meraux Refinery SAFE Work Permit  Cold Work  Low Energy Permit Number: Information to be completed by Permit Requestor/HolderCompany:  Meraux Refinery Contractor Name  Area/UnitPermit Requestor/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 Equipment Pre-Work Req’dDone Area Preparation Req’dDone LOTO Procedures FollowedY -- NLock Box Number:Y -- NBottle WatchY -- N Blinded/DisconnectedY -- NBlinds Verified & Blind-List initialedY -- NAdditional StandbyY -- N Equipment Opened/DepressurizedY -- NDecontaminationY -- NLow energy work PreparationY -- N Valves-Closed/Tagged/Chained/LockedY -- N Water WashedY -- N 120V Electrical equip GFCIY -- N Deenergized Electrical SystemsY -- N N2 PurgedY -- N Prepared for Vehicle Entry Y -- N Field Test / Attempt to Energize-startY -- N SteamedY -- N Sumps-drains coveredY -- N Blinds Verified & Blind-List initialedY -- N OtherY -- N Electrical Connections TapedY -- N Radioactive Sources SecureY -- N Vehicle Wheels ChockedY -- N Specific Hazards:Additional Controls and/or Special Instructions: All Signatures are Required PRIOR to EXTENDING Permit into the following shift. Time Start Time Expires Authorized Continue Print Name SignatureDate Permit Holder Permit Issuer Chief Operator (if required) Permit End Work Completed Work Site in Safe & Clean ConditionPrint NameSignatureDateTime Permit Holder  Yes  No Unit Operator  Yes  No 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. Time Start Time Expires Authorized Continue Print Name SignatureDate Permit Holder Permit Issuer Chief Operator (if required) Test 1Test 2 Date Time Oxygen LEL H2SH2S CO Benzene Other Serial # Calibrated? Initial -- Meraux Qualified Person

2. 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 and indicate Contractor Name for contractor work Check if Meraux personnel doing work Indicate work order numbers The Permit Holder should describe the scope of work to be completed in this area. How many will be involved performing work << 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.. Permit Issuer is an operator for the area involved Person responsible for directly supervising the 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 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. 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 Based on the work and hazards – specific required PPE should be Identified for the permitted work. 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. 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. List tools & equipment to be used.