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Common User Facility

Refuelling Permit Application

|Applicant Name: | |Vessel Name: | |

|Vessel Registration No: | |Telephone No.: |( ) |

|Fax No.: |( ) |Email: | |

|Date Required: |/ / |Time Required: |(am/pm) |

| |

|Licenced Supplier: |

|Caltex etc. |

|Shell |

|Puma |

| Other: | |

| |

|Applicant Declaration: |

|I / We have read the Terms & Conditions printed on the reverse and agree to abide by the terms and conditions of this Permit. |

| |

|Name: | |Signature: | |Date: |/ / |

| |

|RETURN TO: |

|Port of Townsville Limited |

|Attention: Company Secretary & Legal Counsel |

|PO Box 1031 |

|TOWNSVILLE QLD 4810 |

| |

|Permit to Proceed (Office Use Only) |

|The General Manager Infrastructure & (“GMIE”) Environment (or delegate) is the approving authority for all land-based refuelling at the Common User Facility |

|located at the Townsville Marine Precinct. |

|Name: | |Signature: | |Date: |/ / |

|Decision: | Approved | Not Approved |

|Remarks/Conditions of Issue: | |

| |

| |

| |

|Refuelling Permit Checklist to be completed by Permit Holder: |Yes |No |N/A |

|Do the relevant parties have Port Inductions and a valid JSEA? | | | |

|Is the area cleared and/or free of all readily combustible materials e.g. rags, leaves, paper etc | | | |

|If unable to remove, have such items been covered or protected by non-combustible material? | | | |

|Has a responsible person been designated to conduct a periodic fire watch while work is being performed and for a period of at least | | | |

|30 minutes after work is completed? | | | |

|Does the vessel/refuelling vehicle have appropriate firefighting equipment? | | | |

|Note: Please liaise with QFRS as to acceptable number and type of portable extinguishers | | | |

|Is there any other fire fighting equipment (e.g. hose reel) in the area accessible and its location known by the person/s performing | | | |

|the refuelling? | | | |

|Is the Permit Holder and Licenced Supplier aware of 9 tonne load limit on the wharf? | | | |

|Conditions of Permit Issue |

1. This permit is issued subject to the Terms and Conditions printed below.

2. This permit is only valid for the period specified on the application.

3. This permit is only valid for the scope of works described and approved in this application.

4. This permit is to be retained at the worksite at all times whilst work is underway.

5. Each and every item listed on this permit shall be complied with by the Permit Holder at all times during the carrying out of the permitted works.

6. Delivery of fuel to the site will be by an approved supplier.

7. Fuel tankers shall be operated by a competent person (attendant).

8. The attendant must be aware of proper fuel handling procedures to minimize the risk of a spill and shall continuously scan the area adjacent to the fuelling operation for possible leaks or spills.

9. The attendant must ensure that a site-appropriate spill containment kit is readily available.

10. The transfer of fuel must be stopped prior to overflowing, leaving room for expansion.

11. The operation of moving equipment in the immediate area of a refuelling operation shall be suspended.

12. Welding/burning operations must be stopped while refuelling is in progress.

13. The attendant must maintain regular inspections of fuel systems and their components. Check for leakage, deterioration, or damage, in accordance with the construction regulation.

14. Product shall not be dispensed to fuel a watercraft while the engine is running or any source of ignition is present.

15. Portable containers shall not be filled while located on a watercraft.

16. The vessel must be secured with proper marine lines.

17. Any spills or suspected spills on land or water, regardless of size, will be reported to immediately to the supervisor. The supervisor will report the spill immediately to their manager who shall ensure notification to the appropriate authorities.

18. Smoking will not be permitted in the area.

19. Where works are to be carried out within a Landside Restricted Zone, Port Control must be notified not less than 24 hours prior to commencement.

20. This permit does not detract from the Permit Holder’s responsibility to work safely and in accordance with Work Health and Safety Act 2011 (Qld).

21. Appropriate personal protective equipment must be worn at all times by all people in close proximity to the work area.

22. Barricades and Warning Signage must be displayed at all times when conducting refuelling work.

23. Auditing of Permit Holders may be conducted by POTL’s Safety Manager / or delegate, and unless personal injury or property damage is suspected, issues regarding non-compliance of the Permit Holder with the permit conditions will be directed through the Permit Holder’s company and not to the Permit Holder directly.

24. The Permit holder is liable for and indemnifies POTL (including its officers, and employees) against all claims and losses sustained or incurred, in connection with the scope of works described and approved in this application:

a) by any person in respect of personal injury or death; and

b) by any person in respect of loss of, or damage to, any property, arising directly or indirectly out of or as a consequence of a default or act or omission of the Permit Holder (subject to a reduction to the extent of any contribution by POTL).

25. In the event of any Emergency, the Contractor shall comply with the directions of POTL.

26. In case of an emergency, contact 000 and then Port Control on 4781 1684 or VHF Ch 16.

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