~~~~ U-9~ Nfkhll~F4C`tE3~~~'~ GA'FA €~~Pt~Ri F(]R P'Ct~~5~~~'~ES~EL~ ~C~~ ~~-̀ ~€ftPs1~~~errrat°see ~ore~. Fg€ Sin~f~ Gh~~nb~r, Gc~[n~ate~efy ShQ~a ~r Fi~fd Fab %~~<~ed F~essefs ~~aky) #~ ~~`« ~„~ ~

As Regce'aret ~:.'~ha Pravis€c~n~ of ghe ~SfVI~ Cade ~ulc~s, ~ecti; :":::~REr E~[Y15Ft?k"Y ; `~ ~ ~ ~

~` ~~"~~

t. Mznv(aclusea snd cerflfted by RAeXPield 3nc. Box 834 1026 WEStern Orive, Grassfie6d, ftlbe~ta TD°n/i o~0~rae,~o ova baa~,es eP m n~t.~eu~a+J

2. idanafactured for hfusky C}i! ~peratians ltd. Ni~way ~[6 East, Upgrader Ro~dtl Lloydminster, 5ask. S9V 1Ns6(Name and ed u~ese of p~iehA CO r~

3. £.otat'ton of Installatfon NW34-48-2°r-W3 Sask. HLU EthanaE Plank~Nemo and Rddrose~

4. Type: FlOf2lZON7RL 38834A P6554.23 2004-0313D ReW E 6~!!~ 20Q5(lSOfti. o~ rotl tank} {M~O~~a ae~lel Ne_) (CRN) (Dtew1~9 No,J {Nnt'i Bd No.} {Yens b~iE lj

5. The chemical and physSCal properties of all parts meet iha requirements of material specifications of the ASME BOILER AhlO PRESSl3RE

VESSEL C6~E. Tt~e design, canstructlon, and workmanship conform to ASME Rules, Section Vfll, pivision 1 2004Year

ro No Addenda NIAAtlCenEY{Dots) Coda Cesu Nea. 3Datia! 6erv1¢e Per US.f 2D(J~

s. snest: SA51S-7d 0.6854" NfL _ S' 0" 48' 9.5"uai't (seen P1o., Gretle) ~NOm Thk. {[n.) eor r.Alfor (In.) Dlam I.D. (it. 6 tn.) Lanpth (av stall) [ft. d In.)

7. seams: TYPE hio. 1 FULL 1U0% 4 f~5 °F fi0 min. TYPE No. 1 *Spot- 7f}°!o 5long (WelAO d,D b{., ft.T.(Spol or Fu117 EfF.j%) H.T- Temp. (°F) 7tme (hr) Girih(W ~Idad,O41.,Sny i„lep,0utt) tt. T.(b pol,Ef((R Jor Full) Mo. of Coure esSn Dl..le P.Bult~

$_ Heads: (s) t~aYl 5A5~6-7~ {bE ~hat'I. 5A546-70(SAac No., Grace) (6pec. No., Gteda~

Losation(Tap,Boriom,Ends

dAinlmumShkkaess

CorrgsionAllowance

CrownRatllus

KnucMeRadius

BlipticetRalfo

ConicalA ax An le

HemispheflcalRadius

FlatDiameter

Sidsio PressuraConvex or Concave

{8} END 4.6848” NIL 2:1 SE Concave

(~) END b.6848" NiL 2:1 SE Concaveif removable, baits used (describe other fastenings}

s. t~a.wP 25Q psi N/A asi et max. lamp.

Min. design mstet temp. -20° °F at 26d psi.

1G. Nozz~es,inspecifon and safekY valve opeaings:

(Rkn ,spec No_C .Strn N a.)

"~$J °F ~IIA °Ff~~l 1~~0

Hydro.,pneu., or comb. test pressure $2$ psi_

PurposeIn4et,0ullet,Drain

No. Diam.of Size

Type M1daYl. Nam Thk_ ReinforcementMa!'1

HowRtieched

Localinn

Liquid Out i 4" CL15~ RFtNN SA'f05/SA1a6B 0.237" 5A51B-70 LfW46.1(d} g~~~jL'€quid lnNapoue 2 3" Ck~950 R~1NN SA10~NlSA906B 0.2'i6" SA515-7Q UW16.1(d) g~ej~#urge/Liquid Bypass!Din

3 2" CLi50RFWN SA4051VI5A1066 0:954" knherent UVV16.1(d} She11

Continued on U~€— -- - __

79. Sup~oRS :Skirt No ~u95 2 ~eqs 0 otner Attached Shell Welded(Yra e~ No) iN o.) (Ke.) fDe cc ribs) [wbor~ end Hox)

52. Remarks: k9anufaeturer's Partial Reports propsrdy tdeniifted an6 signed by Commissioned Inspectors have been furnished .or tha foflowSng itssns oftMe report:

~rv.me or part, ~t=~ n mbeq Mry r'a name e c ~aenarr~~a se.mvy25,304 USVi~G X08° if} Anhydrous Amman+a Storage Vesse[ hAanuiacturet's Drau~ing~2005-0426D Rev 2

Capacity J382 Cu. Ft(9a.8 C€r. M} = UW11{a)=5}{b) tmpaci Tesi: fro, exempt per UG20(f}(1-5)

VesssE for P~os~-Corrosive ~erv[ce

CE%t~'1FkC,~iE QF Sk~€rPfFtEL~ C4~P~r~LIAFdCE

iNe cerfity that the statements raxrla in fi~Is report are carrect and that ail details of design, material, construction, and workmanship of this vesselconform to phe ASME Code for Pressure Vessels, Section Vil6, Division 1, °U" CertEficale of Ruthorizetion No. 13,551 expires July 24. 2fl4

Date t34~ ~ ~ Loyd Co. name MaXfleld tnc. Signed

CERFIFiCATE OF SHOPlF@ELD tNSPECTI6At

Vessel constructed by McXfietd Inc. a[ 1026 iNeafern Qrive,_Grass€ie[d. Af6ertaI, the un6ersignad, holding a valid commission issued by the National Board of Boiler and Pressure Vessel inspectors sad/or the Stale or Province of

Alberta and 6mployad by ~463A

have inspected the component described in this ~Aanufacturer's Data Raporl on ~~'T 'I 7 ̀ ~~I~ , ,and state that, to the bestof my knowledge and belief, the Manufaciutar has constructed this pressure vassal in accordance with ASME Code, SecEiOn VI11, Division 1. Sysigning ibis certificate Walther the Inspacior nor his employer makes any warranty, expressed or implied, concerning the pressure vessel described inih~s Mane#acturer's Data Report. Furthermore, neilhe~ the I specio~ nor his employer shall be liable in any manner for any pa~sonel injury orproperly d{a~m(+age or a~gl~o~s}s of any kind arising fro ar e d with this inspection. -~-iDate tJL~ ~ { y~~g~ Signed Commissions ~~"°~77~~~

ea(A albs Axed In yvaelor) jll et'I Board (inel. endo rsenenla ), S[eta, Arev o~d No.)

~{:~~~~..;~~-4 f~.~~lfSF~CTI~r~~~`~ G~~TP~ ~~~dJF~[ F~€~ ~€e.Fv~''-.~~ ~'ES~~~~,~~ ~ec}c_.....__~. ~y the F°ee~~lsis~ns of ghe fi~~±~ ~~~e Rues, ~ tca '~f}l, ~7€~isicr~ t

S. NanufacYUre6 and Certi'rfed by flf~~`~~EcS lt7C, 16~fil~J ec~ ~3r~~re, ~rsasrfietd, ~(b~e~a i0~ Ct~E1: - -(ltnmc znP edd~e~c of msnutacluror~

z, ruas,~,«cz„red ror Hr~sky iii E~ner~iians Ltd, Nigh~nray 'i5 Easf, U~rad~r Road, Lloydn~inst~e Sack. S9V i~li5(tucme end sears cs oe n~~cLoeo~~

s. Location O~ IRSfslla4fon 1~W30-49-27-tN3 Sask HLU Eeharto6 P4an~tHamE one aaa~e:.~

~. 7ype:. HCAF>!G(3f~AL 38~36fi ~6~54.~3 ~Ql(Bt~=(l3~3I3 l~tev E I~PlA 2005(Horic. or Vor( 7a~k] (Mfy r'a Setf eE }Jo.) ~GRN) {D~awdnn No,) (Nef'1 8u No,) tYoei Bull}

Data RepoY~ MFGR DWG # 2005-0426b Rev 2

Item Number

PURPOSE h10. Dl~+. TYPE PvSAT'L NOAH.TNlt,

REINFORCMENTMAT'L

HOWATTACHED

LOCATION

Pressure Gauge/85°!o OuFa e

'f .750" x .250" Red. Cpfg. SA105N 3004# Ftg. Inherent UW16.1(d) Head

P5V 'f 4" CL30d RFlNN 5A106B/SAg05N b,237" SA516-70 13W16.1{d) Sheli&ridle 2 2" CL3D0 RFWN SA'f06BISA105N 4.154" inherent UW16.1(d) ShellTher~nowell 1 0.50 " FNPT 8A1D6B 0.154° Inherent UW1fi.1(d} HeadManway 1 ~6" INSERT aA618-70N CL150 inherent UW16.1(d} Head

f

k ;

i

CertiGcaleoflwthorizapon: Type: °U' hlo. 13.551

dale ~~ ̀ L f LUQJ Co. Name MaXFletd Inc. Sigrna~„w.~n.a~

Date ~~ ° L ( $"~°' Signed Commissions~nutnort~.e ia,oa«o.~

Expires Julv 24, 2008

(Nara sd {loci_ enaor ~.mo~ial. si.ie. P.or. aye Hn )

MaXf

ield

Inc, ~I~~ REPORT NUMBER: (~~ '~~

Date: S~

~,~

> Pa e

~ of

~~

Job #: ̀ „ ~~

Inspected by

: 'j?

,t=`

vessel Inf

arma

tion

Shel

l Mat'I ~

j~,~ )~'

hlom Thk ~

~'- ~

~ ;'

Storage

❑ Portable

UHT

Nead MaY

I ~'

~

~,+~ ~

?~~,

glom

Thk

. •,"

~ '' ̀

Shel

l Min Thickness

_._.

__

Head Min Thickness

iType of In

saec

tior

a and Epuiament

❑ Dry Visible

❑Contrast

~ Pre

pare

d Sath

❑Wet Visible

Q AC Yoke

❑Contrast

Pain

t

Q WFMPI

❑ DC Yoke

❑Visual

❑ UT

Q Biack Light

❑ UT Sur

vey

Acce

ptance

Sta

ndar

d ASME SEC VIII Div. 1 App 6

Time of Insuection

~ Pre

lim.

Insp.

❑Bef

ore PWHT

❑ A

fiter Indication Removal

❑ Bef

ore Hy

dro

❑Aft

er PWHT

❑Aft

er Repair

❑ A

fter

Hydro

Othe

r@~roceduP~ Used

❑ MPI-

1 Ftev 6 Dry Powder

~ MPI-2 Rev 7 Wet Flu

ores

cent

❑ MPI-3 Rev 4 Wet Vis

ible

Q CGA P-2

6 WFMPI

❑ UT Sur

vey

❑Vis

ible

Liah

t Eauiament

ontensity Gheck

Q Bef

ore

~ Aft

er❑

2 (300) Hal

ogen

❑ 1 (300) Hal

ogen

❑ 3 "D" Flashlight

❑ 3 "C" Flashlight

❑Rec

harg

eabl

e Flashlight

~ Light Met

er

Spot # (or Area # (or)

~2

s4

56

NNo

zzle

Mark # (o

r) She

ll #

DLi

near

Gouge

CAr

c Strike

~

AThickness in

Area

~

TUndercut

Other

p N S

Defect Ground

utscone

Q A

ll Internal Welds (Pads, Nozzles, Cires, Lon

gs)

❑All Ext

erna

l Welds (Pads, Noz

zles

, Cires, Longs)

❑ 100% Int

erio

r surface of heads

❑ 100% Ext

erio

r surface of heads

❑Ext

erna

l welds visibly discernable in

Interior

❑Back gouging /Be

vell

ed Edges Long seams

❑ Bac

kgou

ging

/Be

vell

ed Edges Circ Seam

❑Back gou

ging

Nozzles Listed

❑Back gouging Cat "D" nozzles Listed

❑ Com

plet

ed Cat "D" Nozzles Lis

ted

Acce t

able

Re'e

ct

A C T O N g

Mino

r Re airs Re 'd <50°

l0Ma

jor Repairs Re

q'd >50°

/a~

Fitl &Grind

Blend

Area Marked in Vessel

Comnlent5:

~` «,

~~!~

: ~

r' ~

-~;~',~'

„~~ ~,_

~;~••,

~

~

-~-

` .~

OTHER:

Certification:

,

,

iJ

•

i e

u e

rvis

or

an

ice

ecorde

in Lo

00 <

- -

P

g

Form NEE-001 Rev 31

~, Na

tura

l Resources

Resources

naturelles

Canada

Canada

MAGNETIC PARTICLE

TESTING

~

•~R

~7.11~~

n

CONTROLE PAR

MAGNETOSCOPIE

ENGINEERING MATERIALS &COMPONENTS SECTOR /

SECTEUR DES MATERIAUX & COMPOSANTS INDUSTRIELS

LEVEL 2 NIVEAU

DATE January 2011

this cer

tifi

es tha

t/la

pre

sent

e ~tteste que

BLAKE A. FIFIELD

has successfully met the

req

uire

ment

s set by the

Can

adia

nGe

nera

l St

anda

rds Bo

ard

in Sta

ndar

d Can/CGSB 48.

9712-20Q6,

for th

e Le

vel,

Opt

ion an

d Se

ctor

ind

icat

ed her

eabo

ve. The

validity of th

is certificate is su

bjec

t to the

con

diti

ons

for its renewal and r

ecertification.

Mate

rial

s Te

chno

logy

Laboratory

Natural Re

sour

ces Canada

Ottawa, Canada

NDT Certifying Agency/Organ

a satisfait aux

exigences eta

blie

s pa

r i'

Offi

ce des Normes

Generates du Canada Can/ONGC 48.

9712-2006,

et vis

antl

e Niveau, Option et Secteur indique

ci-dessus.

La val

idit

e de ce certificat est su

jett

e aux

conditions de son

re~

ouveil

ement.

de certification en END

Labo

rato

ire de la technologie des materiaux

Ressources Nat

urel

les Canada

Otta

wa. Canada

<~ r

-_ - _ _, - _

Issue Dade ~ ,~, - Expiry date: ` " i irr~e: `° =s' ~~:r~. /p.m.}

Specific Unit being Entered: ~->--- ~ ~';•~=

-~ ~ ~-Location: ~°°a?~`~~~ r`:. ?,a°~~Fr~,c°~~- __ ~~,..~`{ ~'s.~-.~:--. ~.-~

Precautions ch~ekec! below have been taken to present any injury to persor~ne9 end permission is

granied for thA~ ur~it entry, this permit is t~ be reneuved on a daily ba~i~ u~tel compl~ti~n of the work.

~nfy trained and c~mpet~nt workers ~hal0 enter aconfined/ restricted spice.

FiEi irs Friar t~ Gc~nfir~ed S~ae~ ~n~ry: vas r~/~

~ . A~niosphere checked °ror oxyg~r~ I~v~f end flammable, topic and inert g~~ses. A po~rvere~

ventilation unii and/or atmosphere testers are to be used vuhere there is any doubt about

the actual or ~aofie~fii~! quality of the ~t~riQSphere.

2. Safe job and entry proced►ares discussed ~~c4 understood by all personnel involved.

3. Safety equipt~ent provided (circlet: _._.___- - - _ ._ ___ __ _ _ ___:.- _ ._ _._ __.. ~ ..~__..G~~~s~~~ _ ----Eye/,_Face Prote~fii~an ~:"' ~~~~ty_~~It/ Li~e._Len~ ..=,_ _ _.. ..___ __Respirat~ __ __.. _ --- ~a~is#er [vl~stc ~: ~~mo~~er~ Tester()

``~ rver ventilation U"m 6t ~ ~- ~._ _ __ _—~ __

4. Trai~~ed attending person with rescue equipment i~ present.

5. Means o~ comrnu~~ication with rrvorker(~) inside the projec'~.

6. fVi~thod of ~tan,rnaning ~merg~r~cy help wi~haut I~~via~~g u~%t (radio, helper, alarm).

7. ~~operly equipped ~r~~ tr~i~ed ~e~c~~ fieara~ is can alert.

~. Hot iN~rk Per~nif in ~;4ace.

9. ~c~;~~~e~ ;.~e~~il~tion snit i~ place.

`~ III ~q~i~~a~~~3 ~~~~~ r~~~c~°a~~~ ~-~~~R~r .

00

oa0

"; ",. E ~i;~ ~~~i"~"3~@i G"~;f~'~CaV~~'a6"~3ii~ ~t~° ~4"1~ i"~a.~9"k'a~~ ~~:~ i~1~1#"3~:FG~1~~4C~ Jg~~§~.~; ~;i~ ~~ ~;I~x~. I~I

1~ 2. serial number of gas detection manifior being used: ; ~~`-

Names of ~ntrant(s : D~si t~at~d V`J~tch [carne: Deli Hated UVatch Si nature._- ._~. -

r `

~~Szrperviso~°'s Name (P~^int): Saspe~viso s Sign~tisrc-:

Section 14 14.08 May 8, 2012

i~ '~

Issue date Cxpiry Date: ~ I irrre ,'(~.~r~. /p.m.)

Specific 9Jnit being Entered: '~''~f~~` ~' ~ ~~-~„`~>

Location: ; ~ ~ L4;~ ~ :~,, ,.~ C. ̀ ~` ~ ~ ~ ;~, ~ ~,'; ' ;mss ~:.~ct ;°--.,

Precaa~tions checked below have been takes t~ prevent any injury to personnel ar~d permission i~

gra~t~d for thus unif entry, phis perrr~ot es to be renewed o~ a daily b~~as until ~~rnpA~tio~ of the work.

Or~l~ tr~ir~ed and ccar~pe~enfi vvork~r~ ~h~19 eater ~ ~or~fi~ed/ r~strict~d spare.

~~19 in Prior to confined Spae~ Entry: - - YES New.

1. F~trnosphere checked for oxygen l~vei and flammable, toxic and inert gasses. A povv~red

v~nti9atian unit and/or atrnospl~~re ~est~rs are to be ~ase~ when there is any doubt: about

the actual or pcst~i~iial quality a~ the atrnosph~r~.

2. Safe job and entry procedures discussed and understood bl` all p~r~o~nel involved.

3. ~afet equipment provided (circle): _~ ~:_...~

Gloves ..__. dye/ ~a~~~r~tecti~n Safety felt/ L~~e-Lime.._ .. __respirator _ ~ _.,. _ ....Canister M~;~~~ ~` _ ._ ._. ~frrt~~phere T~ster(s) ::`

- ~t5r"iver ~e~~.eia~ionr~B~it. ether_._____

4.

......_...

Trained attending persar~ with rescue equipn-~en~ is present.Q__a

5. (Vieans of comt~unicafiion with workers} inside the project. ~a

6. fVlethod of s~mrnoning em~rg~ncy help without leaping unit (Radii, helper, alarm).

7. ~roperl~ equipped ~~d tr~ir~~d re~c~~ ~~~rr~ i~ ~sE s ~ler~.

F~~t Work Fe~-r~~t ire ~E~ce.

~. ~'a~nrered uentil~tiar~ ur~i~ ir, place. ~ -0

1~~a ~!I ~quipr~s~~i~ ~b~~ r~,~o~~i~l~ ~°u~~°ao~~c~.

6 ~'ii5 ¢~C?r~"~~i i~~'tii~~s~~a ~'R"~'r'S3 Riau' ~t'3~a t-~@~3i`~➢G~ ids a"~~~if~~~'~?~~~;~ s::r~s~~'~?, ~G ~~ fl~~~i.

p ~. ~eria9 number o~ gas defi~c~ion ~~~nitar Being used. ~ -

Names of Entr~t~~{~ : ~esi n ted Watch ~1ame. d~ azch ~i nature;

-, .,., .. <

,A~,+ ~e e} Z {i.^~~ ti 5~p. v~-:

c. £ Rk

S ~ ~

~y~/ r x_,16~} g

Supei~visar's Narne {Pratt);. Suer°visor°'s Sig~cttzire:

Section 14 14.08

1

May 8, 2012

4,~.~;~IELC~ E(V~. ~i l E v~~PFF•~tFe`~C;~F~: y~~~4,` °~ ̀~a;~`; .

~LlERITSITSSUf'Cf~if4 C3i=t: ~'~~~?~~ ~` ~~~°"a

;u~~ i ~M~~~~rv~Y CONTAC~f' ~lAfi~E/P~-fO~dE NUMBER: ~~ ~`~,~,~ ~~ ~ t~ ~ "~ ̀ __-_ -.° ~c.~~ — `~ ~

DAILY ASSESS6VIENl S `(E hl0 CC7MMEN I S

1. Initial Client Coy~tact completed, safef documentation completed and work Ian discussed ~

2. Emer enc contact numbers osted

3. Prevalent weather conditions a pro ri~?~e for work tQ roceed

4. MaXfield Inc. office notified work proceedin and location w`~

5. Work area clear of debris, overgrowth which could create hazards V'`

6. Client offiice nofiified work roceedin and location ,~"'

7. Work area identified and client siie personnel informed of work Ian ca

8. Emer enc rescue plan in lace

9. Two ewer ency water tubs in lace, located proper) and filled with clean water ~'°`~.~:~ t ~~~~:.~g~a~

10. Wind socks in place, visible from work area and service unit located u wind ~~

11. Emer enc res irator equi went in lace and readil available for use ~

12. Emer ene PPE in lace and readil available for use <~'

13. All required e uiprnenf in ood workin order

14. AEI AC equi ment properly ~~ounded

15. P,II vessels stable and secure

16. All vessels ro eri b{own clown and ready for inspection where applicable ~ sFR= ` '

17. All hoses ro e~~l blown dow~~ and ready for ins eciion where a licable ~_ ~~ '°~..4

18. All i in properly blown down and ready for ins ectior~ whEre a licable ~ ̀- ~x "t"

19. Vessels to have infernal tnrork confiirmed proper) ventilated end tested g- ~ ~

20. Vessels to have internal wflrk ro~erl isolated firom lumbin and rounc9e~, ~ f ~,., .

21. External ladders and scaffolds stable and secure where ap licable v'~ ~~

22. In4ernal ladders and scaffold stable ar~d secure as possible ~ .~; ~~ -- ~+

23. Manwateh avaifab{e for in~eri7al work ~`

24. Electrical and mechanical equipment locked out and to ed where ap licable

25. Units of issue to ged as work not to roceed until tag removed

26 Toolbax meeti€~g held vvifh crew ors all a~,o~~e as well ~a worl~ plan ~°~

e ~ C,~+ q

~~.:4 ~✓~`~

~. -~''~`4°-~~ `mod ~1 ~'T~r~'4

~. ~" ~-

. t

s

~.

~IUi~~~~~~~ v` ~~~~ ~~~~ ~f~~~F~~i~°~1~6~

~f~~i~~~i~ -~~

Signature

FIRE PHONE NUMBER: `~~ LOCAL h~~SPITAL PHOB~E fV1~6t~I~ER:

Saskatchewan Occupational Health and Safety Phone:.... Regina 1-800-567-7233 Saskatoon 1-800-667-5023

Alberta Occupational Health and Safety Phone :................1-866-415-8690

Manitoba Workplace Safety and Health :............................. 1-866-888-8186 (after hours 204-945-0581}

Saskatchewan WCB Telefile Line :...................................... i-800-787-9288 for W1 and Ei initial reports of injury only

Alberta WCB :......................................................................1-800-661-1993

Manitoba WCB :............................................. ... .~..1.~.` .......~1; 8~D-362- 340 (' ~~ ~~~

MaXfiield Inc. Supervisor Name: ~~'t ~ !~,''~~~ Signature: '"1'~~"J`

Client Representative Flame: °~"'t~ ~~~~ ~ ~?c~~"~`~°r Signature=°~''`~..F~~` '~

POST NEAR PHONE WITH COPY IN SERVICE UNIT

,'L9EN~" GE~NIP~N''t' i~lAM~: €.i~'~° ~i'~--, ~ro

7AXFIELCt If~1C. S6TE ~U{'~€~'•;(I~t~rt: ' ~~'.~ C'~."` ~~C'~

:LIEN° SITE ~UPEFiVI~C3~3: ~~~~ ~-~. x t3~`S c>~€~

;LIEfVi EMERGEiVCY CONTACT' iV,~f~l~/P~IOi~E NUMBER: ~ ~:;.~~ ~ ~` ~ ` ~:~ .°, '~ -`. ~` ~ °^

~iA,ILY ASSESS(~EMTS YES ~!O COMMENTS

1. Initial Client Contact corn leted, safef documentation carnpleted and work plan discussed

2. Emer enc contact nurnbers osted

3. Prevalent weather conditions a ro riate for work io proceed

4. MaXfield Inc. office notified work proceedin and Eocation

5. Work area clear of debris, over rowth which could create hazards

6. Client office notified work proceedin and location

7. Work area identified and client site ersonnel informed of work fan

8. Emer enc rescue plan in place

9. Two emer enc water tubs in lace, located ro erl and filled with dean water ~ ~~- ~ a

10. Wind socks in lace, visible from work area and service unit locafied upwind

11. Emer envy respirator equi meet in lace and readily avaiEable for ease

12. Emer ency PPE in face and readily available for use

13. All re wired e ui ment in ood wc~rkin order y/

14. All AC equi meet properly rounded

15. All vessels stable and secure r,€'

16. Ail vessels ro er! blowm down and ~~ead for inspection where applicable ~; ~ `~,1 ~ ~a:~. °~",_`~~

17. All hoses ro Erly blovun aown and ready for ins ectian where applicable

18. All pi in pro erly blown down and ready for ins action where a pficable

19. Vessels io have internal work confirmed pro erf ventilated and tested t~~•. ~,,,, . = .~ r

20. Vessels to have internal work pro erl isolated fram lumbin and grounded

21. external ladders and scaffolds stable and securE where applicab{e

22. Internal {adders and scaffiold stable and secu~~e as passible y'`

23. IVianwaich available for internal ~,~ork ~1"

24. Electrical and mechanical e uipment locked out and to gad where applicable

25. Units of issue tag ed as work nos to proceed unti► to removed26 Tool~aox meeting held with creuu on all above as well as work pia s~

~igrt~tu~'2

~ign~~ure

uignaiur~

i(~E1~fUi'2-

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~M~~GE~'~~~ ~~~'~`~~~~" 8~~~~~atl~i~~~~x6~9

--~ ti

AM~IIL~G.~~~ F9F9~€V~ G~~~~~~e '~. ~~LI~~ ~~°IC1~V~ i~➢4~~U°V~~~a:

FIRE PHONE NUMBER: ~'t ~~ LOCAL ~IOSPITAL ~E~~i~~ F~l~~Ii~ERe ~

Saskatchewan Occupational Health and Safety Phone:.... Regina 1-800-567-7233 Saskatoon i-800-667-5023

Alberta Occupational Health and Safety Phone :................1-866-415-8690

Manitoba Workplace Safety and Health :............................. 7 -866-888-8786 (after hours 204-945-0581)

Saskatchewan WCB Telefile Line :...................................... i-800-787-9288 for Wi and Ei initial reports of injury only

Alberta WC6 :......................................................................1-800-661-1993

Manitoba WCB :............................................................ ..... 1-800-~2-3340 °~-

MaXfield Inc. Supervisor Name: ~~,e, -~ ~,4^i r~ ~ Signature: ..~°'d~~°c

Client Representative Name: ~.n~ ~s~"~ ~3e~.~t"~ Signature: ~;..~-~"'` %=

ROST NEAR PHORlE WITH COPY IN SERVICE UN~~~~

1

~.~.YFI~LQ li~lc~. SITc ~l.1~='~R1i15~F~: =~'';~,~.~ d__..r

~-.~_.,._.-

;~I~f~lT SITS 51J~ERV9~C~E=i: ~ :~,-~~ ~,E`3,`°S ~:~~=~~~

;LfENT EMERGENCY CONTAC`f hJAME/PHC3iVE iVUii~BER: ~'u~r~~ ~~C:"~~~~~

DAILY ASSESSMENTS VE Na COMMEN i S

1. Initial Client Contact corn ieied, safet documeniatian com feted and work plan discussed J

2. Emer enc contact numbers osted s

3. Prevalent weather conditions a ro riate for work to roceed i,%`

4. MaXfield Inc. office notified vuork roceedin and iacation

5. Work area clear of debris, over rowth which could create hazardst

6. Client office notified work proceedin and location ~`

7. Work area identified and client site ersonnel infiormed of work Ian

8. Emer enc rescue plan in place ~

9. Two ewer enc water tubs in place, located roper) and filled with clean water .~` ~~ ~g .~ ~s,~ °-

10. Wind socks in lace, visible from work area and service unit located a wind ,s"

11. Emer enc res irator e uipment in lace and readil available fior use ~f~

12. Err~er enc PPE in lace and readil available for use ''A13. All re wired e ui rnenfi in ood working order <.~

14. All AC e ui menf pro erl grounded

15. Ail vessels stable and secure

16. All vesse{s ro er{ blown down and read for inspection where ap {icable }

17. Alf hoses properly blown do+ivn ar~d ready for inspection where applicable ,t~

18. All i in roperly blown down and y~eady for inspection where applicable ~>

19. Vessels to have internal work con#firmed roperly ventilated and tested ~`

20. Vessels to have internal work pro erly isolated from lumbin and rounded ~i~

21. External ladders and scaffiolds stable and secure where ap licabie ~;

22. Internal ladders and scaffold stable ar~d secure as ossible

23. Manwatch available for internal work ~`'

24. Electrical and mechanical equipment locked out and is ged where applicable ~,~

25. Units of issue fag ed as vdork not io proceed until to removed d

26 Toolbox meeting held with creuv on all abavc as well as v~Fork plan ~'F

1. ~ ~ ̀i ~'~.~=

2. .. ~~.

~. ~ --

~_

4

6.

s~k~~ E`d~tlNl ~!!-4d LPe ffB~~~~4~~. ~

~'° ~~~; f

A~v~~ULAN~~ ~~9~~~ 6af~~~~

Signafii.~~~e ~~~ ~~~-~ ~ ~.-:

~ign~tu~::-~~~,.~, ~,r: _ :.~ignaiur~ ~ ~, ~` ~ .____._

~6f~Yidi~aP~

Signature

~~~E~~ ~~a~~~~ ~~~si~~~~~

FIRE PHONE NUMBED. <<-~i, b~ LOCAL HOSPITAL ~IiON~ ~~l1MBER: ~t

Saskatchewan Occupational Health and Safety Phone:.... Regina 1-800-567-7233 Saskatoon 1-800-667-5023

Alberta Occupational Health and Safety Phone :................1-866-415-8690

Manitoba Workplace Safety and Health :............................. 1-866-888-8186 (after hours 204-945-0581)

Saskatchewan Wi;6 Telefile Line :......................................1-800-787-9288 for W1 and Ei initial reports of injury only

Alberta WCB :......................................................................1-800-661-1993

Manitoba WCB :................................................................. 1-800-362-3340 -~° '~z _~~,~,~,..~ ;~- f , r~~ ~ Si nature: ~~~-~- ;~-._

MaXfield Inc. Supervisor Name: ~- ~= g t

G(ient Representative Name: ~s ~~~~'~ ~ Gc~+`-t Signature: { ",.POST NEAR PHONE WITH COPY ICJ SERV{CE l! °-

` el 9~~--

,_ }..Issue i~~f~ ~~k~~` Exp;ry C3ate: ~ ̀% t' ~%~~ °i"ime: r -- (a.rr~. f,~_~~a~)

Specific Unit being Entered: ~ ~ r~~ . ~ ~"~ ~~.,. ""

Pr~c~sations ~h~cked blow have b~~~ taken f~ prevent ~n~ injury t~ personnel ar~d p~r~~~soon i~

granted for this unit ~n~ry, this permit is to be renewed orgy a daily basis until compietio~ of fh~ work.

Only t¢-ained arool competenfi vu~rke~s shalfi enter ~ confi~~d/ re~trict~d space.

F f! in Prior to confined space Ertry: Yes ~i~,

1. Atmosphere checked for oxygen, level and flab~nmable, toxic acrd inert gasses. 1~ pe~we~ed

ventilation unit and/or atmosphere testers are to be used where there is any doubfi abaut ~ a

the actual or potential qualaty of 41~e atf~no~phere.

2. Safe job ar~d entry proc~dure~ discus~~d a~~d understt~od by all personnel involved. a

3. Saf~t~, equipment provided (circle): _ ____ _..~-~

__G6o _ ~y~/ F~c~ P~ro~ection '°. Safety, ~elf/_Life_Line~~`-~i~es~rat~r.~~ .. -- - ~: ~a~r5t~r Bask A~mospFier`~~ r~ °°~,

-,~~~r~~V~ntilatior~ Llriit _ C3ther _ ~_. ___._~

4.. Trained at~~nding persa~ ~viCh rescue equipment is ~resenf. ~a

5. ~e~ris of c~f~m~rEica~io~ with worked (s~ in~ad~ 'the ~raa~c~.

6. Mefhod of ~aammoning ernerg~ncy help without leaving unit (9~adio, helper, alarrn~.

7. t~roperly equipped and trained rescue tear► is on alert.

~. g~ic~fi 1f11ork ~'e~-mit ire pl~~~.

~. P~~n!~t°ed ~~~r~~il~~icar unit i~ ~{~~e.

'~ ~. Ali ~r~~ai~ Sri a~~~ r~~i~~i~ls j ~so~r~:~, ~ I~

~~~~E»"'~ ~.~ ~[°"4"$. ~s. Y~~~~4r~f~:A4~:+'...i'~. ~~1" e~l~ ~~i~ ~e'9~ 4~~a~{~~6G~ ~'~a a~i~9E~lc.::!"~~r~..$~~=may' ~.7~~~~~;~~ !3~ ~.8.`~.. ?~yfi~'~y.

12. serial nu~~ber° r~r` gas detectiof-~ ~ aQr~icor being u~~d:

Names cif E~trar~t(s~: ~esi ri~~ecf 1~f~tc~ Name: Deg- r.Lat~d. thatch Si r~~t~re:~.

f:

..sr s,'"

t ~'

~ ~~~i ~ - ~ "~ v

Su~eruisUr's Na~a~e (Pt°int):

,~._ .';E

Sa ervisor~'s. Sig»afurRe:

Section 14 4.08 May 8, .'~~ i?

_ Na[ural Resources

Resources naturelles

Canada

Canada

N~^~

Blake A. Fifield

Nom

~

_`fr

Rce. No.

16134

'~..

Nu. ma~ricvle

`~~,

I.v~c lYaW

°. ~

Datc danissm

2011/01/26

~

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Carcclivc Irnvcs fi

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V area c«reaifs pour la vision eel 1 p'~ I

I di9me.

u'.

_.Signriure

~ .

Natural Resources

Canada

~..sl~,;.cro i>GAn/case-ae.=>t3

..1 iso zexo'~

r wimp .~:~1~,

Me~hucl

Levd

Secxor

Cert.lhte

,~k'Aefhale

Niv.au

Secteur

IJatecert.

MT ~

2

EMC

201110727

...

Ressqurces naturelles

;''~

.Canada

16134

i

lYatc rtro~n.

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Dale rocert. -

Fxpiretion

20 7 417 2

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