All Signatures are Required PRIOR to Hot Work Start.

Time Start

Time ExpiresAuthorized Print Name Signature Date

Permit Holder

Permit Issuer(Chief Operator)

Unit Operator

Fire Watch

Meraux Refinery Hot Work PermitPermit Number:

Specific Hazards: Additional Controls and/or Special Instructions

Permit EndWork

CompletedWork Site in

Safe Condition Print Name Signature Date Time

Permit Holder Yes No Yes No

Unit Operator Yes No Yes No

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 ElectricOther:

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. (Must be Chief Operator)Previous Product in Equipment:

MSDS Checked Yes N/A

AdditionalPPE Required?

All Signatures are Required PRIOR to EXTENDING permit into the following shift.

Time Start

Time Expires

Authorized Print Name Signature Date

Permit Holder

Permit Issuer(Chief Operator)

Unit Operator

Fire Watch

Equipment Pre-Work Req’d Done Equipment Pre-Work Req’d Done Area Preparation Req’d DoneLOTO Procedures Followed Y -- N Lock Box Number: Y -- N Trained Fire-Watch Y -- N• Blinded/Disconnected Y -- N Decontamination Y -- N • Orange Vest Y -- N• Equipment Opened/Depressurized Y -- N • Water Washed Y -- N • Signal Horn Y -- N• Valves-Closed/Tagged/Chained/Locked Y -- N • N2 Purged Y -- N • Fire Extinguisher Y -- N• Deenergized Electrical Systems Y -- N • Steamed Y -- N Area “Wet Down” Y -- N• Electrically Locked/tagged out Y -- N • Other Y -- N Sumps-drains covered Y -- N• Field Test / Attempt to Energize-start Y -- N Radioactive Sources Secure Y -- N Contained Sparks Y -- NBlinds Verified & Blind-List initialed Y -- N 120V Electrical equip GFCI Y -- N Clean-up Oil in Area Y -- N

Additional Fire Equipment Y -- NAdditional Standby Y -- N

Job Hazards Y Standard Controls Job Hazards Y Standard Controls PPE Req’dStatic Electricity Grounding, Manual Handling / Lifting Assessment & lifting equipment Standard (SSP-0011) Y -- NSlips, Trips & Falls Housekeeping, & PPE Moving Parts Covers, Isolation, & Maintenance Full Face Shield Y -- NChemical /Fuel Exposure MSDS Review, PPE Overhead Hazards Labelling, Isolation, & Barriers Goggles Y -- NVehicle Entry in the unit? Procedures, Barriers, & Permit Sharp Edges Covers, PPE, & Equipment Inspections Hearing Protection Y -- NElectricity Isolation, LOTO, GFCI Activities of Others Communications, Barriers, Permit Fall Protection Y -- NFlammable Vapors / liquid Gas Testing & Isolation Access & Egress Housekeeping, Walkways, Stairs Leather Gloves Y -- NFumes & Dust Respirator / Eye Protection Trapped Pressure Venting, Draining, & PPE Rubber Gloves Y -- NHot Surfaces Insulation / Barriers / PPE Vehicle Traffic Hi-Vis Clothing, Speed Limit, & Signs Non Permeable Suit Y -- NToxic Vapors / Liquids Gas Testing & Isolation Underground Hazards CAT Testing, Labelling, & Barriers Respirator ½ face Y -- NExcavation Excavation Checklist Hot Liquid Procedures & PPE Respirator Full Face Y -- NWeather 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 Y -- NSpillage to Water Containment / Booms Mechanical Lifting Barriers / Lift Procedures Personal H2S monitor Y -- N

Welding Apparell Y -- N

Test 1

Test 2

Test 3

Test 4

Date

Time

Oxygen

LEL

H2S

CO

Benzene

Other

Serial #

Calibrated?

Initial -- Meraux Qualified Person

• Signing this Hot 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.

Permit Number will be pre-printed on form

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

Indicate product last in vessel so proper PPE can be assessed..

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 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.

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, date and time on 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.

How many will be involved performing work

The Permit Holder should describe the scope of work to be completed in this area.

<< Indicate if the MSDS was checked for the previous product in the vessel and any additional PPE required.