ABU DHABI COMPANY FOR ONSHORE OIL OPERATIONS (ADCO)

Certificate No. 24810 Date 28 - Jun - 2011

EXCAVATION CERTIFICATE

Please tick a appropriate box

SECTION 1 EXCAVATION REQUEST (JOB ORIGINATOR-JO) / (JOB PERFORMER - JP) As-built drawing marking limit of excavation to be attached Restricted area PTW required Description of Work Excavation Dimension: Width(W) Tools/Equipment to be used Job Performer Name: Job Performer Contact Details: Validity Time: From: Originated By Name hrs ADCO: Phone/Pager To: Sec./Dept. Section: No hrs Date: Contractor Radio Signature Name: Channel No. Of Days m Depth(D) m (W / D) ratio Job Hazards Analysis to be attached Method Statement PTW No. Yes NO

Adco Area: Location of Work:

SECTION 2 DETAILS OF EXISTING UNDERGROUND SERVICES NEAR EXCAVATION (AREA AUTHORITY-AA) Pilot Manual excavation Mechanical

AA Signature

SECTION 3 DEPARTMENT APPROVAL (Departments to be consulted to be specified by the Area Authority)

I have examined the drawings of the proposed excavation, and of adjacent underground services. I confirm that the excavation may proceed subject to comments noted below.
Department
Telecom. Instruments Electrical Flow-Line/Pipline Cathodic Protection

Remarks/Conditions/Observations

Supervisor Signature

Post

Date

SECTION 4 PRECAUTIONS (AREA AUTHORITY- AA) (ISSUING AUTHORITY - IA) A. Worksite Precautions
Barriers at least 1m from excavation Markers/ Lighting Warning signs to be placed Confined Space Entry cert. (excavation more than1.2m deep) Cable detector to be used Proper access and egress Expose underground services byhand digging Shoring/Sloping (excavation more than 1.2m in depth) Excavation by mechincal means after pilot trenches (min. 3m from serv.) Banksman to be provided Information Safety & Loss Prevention ( in case of blocking roads) Establish & mark out position of underground services Barrier off areas restrcited for excavation Book Out/Book In Standard PPE (Saftety helmet, boots & coveralls) Communication means Welfare facility (watersalt-shaded area)

Yes

No

IA Check

B. Personal Protection Yes No

IA Check Gloves Goggles Safety Glasses Dust Masks Hearing Protection Others specify

Yes

No Check

IA

C. Other Precautions

SECTION 5 AUTHORISATION (AA / IA) I, AA authorise the excavation work specified above to be carried out subject to the nominated safety precautions and conditions being maintained during validity period specified in Section 1 of this certificate. Name Date Time Hrs
Day Date Time AA IA Sat

SECTION 6 VALIDITY OF CERTIFICATE (AA/IA)

Sun Mon Tue Wed Thu Fri

I, Issuing Authority have visually inspected the precautions and conditions stated by AA. I approve the work to be started. Name Sign Date Time Hrs SECTION 7 CERTIFICATE / CANCELLATION CLOSE-OUT (JOB PERFORMER / AREA AUTHORITY- JP/AA) I, the Job Performer, declare that the work is completed and the work site has been left clean-clear and safe and the excavation has been backfilled and road blockage cleared. Job Performer (JP) I, the Area Authority , have inspected the work area and found it clean-clear-safe and area came back to normal. Area Authority (A A)