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