1,0 Change Request: 1.1 Change Request Description Section: Change RequestNo: BY-APR-11-O01 Field/Facility BYGP Date: 27-April-11 Name of Requestor Abul Kalam M Sumon Requestor Job s-. operations Specialist, Change Request Title: fabricate & Install Walk way with guard rail BYGP API Description of Change: (Provide Reason/Justification for Change): To Keep API Separator clean from any floating objects or any insects or any floating sludge, Operation crew needs to clean API separator. Presently API separator has walk way towards API separator width wise (East-West Direction) not in length wise (North -South Direction). The walk way at middle towards the Length wise, which will make ease to clean API separator. Please Describe Any Concerns/Issues that the Requestor /Operations May have With the Change Request: 1. Lots of bugs deposit on API Separator water which create obstacle for free movement of Hydrocarbon of the API Weir. List attachments included in package (i.e. Proposed Drawings/Diagrams, Marked up P&ID, Photos & Other Pertinent Documents). It is requestor’s responsibility to provide necessary backup documents/info with package. 1. PaID a. PROPOSED CONERETE DESIGNS Key Business Driver Support by Work Request zation [(] Production Gain] Reliability/Base Business [] Oth Proposed Completion Date: 1.2 Field Review & Approval Section: Requestor: mee Supervisor Name: caren es Abul Kalam M 2 Siddique, Ferdous Bin \ approve = éRecycte Hold 0 cancel Comments: John Russum 1.0. MAY 2011 |Approver (i.e. GPS) should proceed to next page (i.e. ‘should follow Management of Change Process. ‘+ If Change Request receives Field Approval, Office that an appropriate Change Request No. has ‘been assigned to the Change Request & included on the form. Chewron Bangladesh MOC Form doc Page T of?1.3 Management of Change (MOC) Screening Section Initial MOC Determination Review By GPSiFiold Approv It you answer YES to any of the following questions, an MOC is required. Does this change require: Installation of equipment other than “an equivalent replacement"? Dyes NO ‘Operation ofthe unit ouside its recommendedidesigned operating range? [Yes GANO Specialized training (HES andlor operations) for equipment operator(s)? [Yes GNO Modification of existing andlor developing new procedures? C]Yes {NO Change in structural, process flow, utiity piping, system, equipment, building, road or its relocation? L]Yes [NO New or modified control systems? Ces f4NO Use offre protection and detection devices, e.g, alarm, chemical? ClYes G4.NO Tie-in to facility uty systems? (Yes {NO A safety device setting that places the unt outside its ecommendedidesigned operating range? L]Yes [BNO [New chemicals or cause chemical reaction resulting in operation outside recommended operating range? [] Yes [JNO Moc Required? ClYes [No Comment: Classification of MOC Category/Sub-Category (If MOC is required complete the following section) Moc category MOC Sub-Category a Standard (Permanent a Emergency Temporary For Emergency Category Only: 7 Has this change already been made? Shvde eae Hype = Emergency then hs elds atm Iso, what date was the change made? ASAP 1 answer to question above i Yes, date must be provide For Temporary Sub-Category Only (If MOC classified “Temporary” please complete following section): Duration of Temporary Change: N/A Justification for Temporary Change (Provide Reasoning for MOC being Classified as “Temporary”): 1.4 GPS Approval to Submit Approved Change Request/MOC Screening form to FE Manager GPS/Field Approval Name: signatu hn Russum John M, Russum / Gary V. Sims pate: 10 May 2011 + Please forward “signed” form one of to ways: 1. Scan completed & signed form including backup attachments & email as an attachment to the following email address: BangladeshMOC@chevron.com 2. Send “signed” hard copy of form including backup attachments to the Facility Engineering Manager. (Chevron Bangladesh MOC Form doc Page 2 of 2