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Home My WebLink About20182553.tiffUSE BY SPECIAL REVIEW (USR) APPLICATPN DEPARTMENT THE f T OF PLANNING ERViCE * 1555 Tw www.weidgov.corn *970-353-6100 EXT 3540 FAX 970-3044498 FOR PLANNING DEPARTMENT LISE DATE RECEIVED: Phone #: (720) 410-8500 _ Email: Street Address: 1801 California St., Ste 2500 City/State/Zip Code: Denver, CO. 80202-2538 Name: Company. Phone #: Street Address: _ City/State/Zip Code: Name: _ _ Company: Phone #: Street Address: _ City/State/Zip Code: Email: Email: I AMOUNT $ CASE#A LAPPLICATION RECEIVED BY PLANNER ASSIGNED: Parcel Number*: 1 4 6 9, 2 8 . 4 _ 0 0 a 0 0 4 Address of site: 1246 CFA 19 Legal Description: PT SE4 28 1 67 LOTS AMD REC EXEMPT Section: 28 tin. Zone District: Agricul turn reage . 10 Floodplain: CJN FEE OWNER s3 OF THE, PROPERTY: Name: Crestone Peak Resources Holdings LLC Company: Crestane Peak Resources Holdings LLC Attn: DJ Lan d Department (*A 12 digit number on Tax 1.0, information, obtainable at v ,wet gov_Com). Township: 1 N Range: 67 IN eological Hazard: YCN Airport Overlay: Y +J APPLi AN OR AUTHORIZED AGENT: (See be/ow: Authorization - -io1'1' must accompany all applications signed by Authonizad Agents) Name: Matthew T. Berghorn Company! Discover ► DJ Services, LLC, Phone #: 303-495-4853 Email: MBer�harp 'i � s►verymidstreairn. eom Street Address: 7859 Walnut !-Hill Ln Ste 335 City/State/Zip Code: Dallas, TX, 75230 PROPOSED USE CompressorStation_ In -line compressor station for removing liquids and impurities than pressurizing the gas for transfer in to a central processing / distribution facility. I (We) hereby depose and state under penalties of perjury that �al'1 �t�t ntawneri withinthe applit+cn are true and correct to the best e�ent�, proposals, and/or plans submitted with or t sign this application If an Authorized Agent s� of my (our)knowledge. Signatures of all fie owners of btu e . y signs, a letter of authorization from all fee owners must be included with in if a corporation is the fee owner, rt cta� rrzed evidence must included indicatingth the a or sign for the corporation. that the signatory has to legal Date � Signature: Owner or Authorized Agent� + -- - �Signature: Owner Authorized Agent Date Print Name ii/164-10/1.) _ leole-1,1\pc,‘ Print Name 6-474 Rev 4/2016 DISC o VERY MIDSTREAM PARTNERS November 15, 2017 Mr. Kim Ogle Weld County Department of Planning 1555 North 17th Avenue Greeley, Colorado 80631 Dear Mr. Ogle, This letter serves as confirmation of Matt Berghorn's authority to sign on the behalf of Discovery DJ Services LLC. Per the Company agreement — "The Board may assign titles to particular Officers. Unless the Board decides otherwise, if the title of an Officer is one commonly used for officers of a business corporation formed under the Texas Business Organizations Code (or any successor statute), the assignment of such title shall constitute the delegation to such Officer of the authority and duties that are normally associated with that office} subject to any specific delegation of authority and duties made to such Officer by the Board?' Matt has been delegated by the Board the title of Vice President, Engineering & Construction. Thanks for your time and consideration. If you have any questions, please feel free to contact me directly at the extension 105 via office number listed below. Regards, L Michael B. Davis Chairman Cc Cory Jordan Discovery Midstream Partners 7859 Walnut Hill Lane, Suite 335 I Dallas Texas 75230 1214.414.1980 I DiscovervMidstream.com DEPARTMENT OF PLANNING AND BUILDING DEPARTMENT OF PUBLIC HEALTH A E�'�'I��NNMENT 1555 NORTH 17TH AVENUE GREELEY, Co 80631 to apply for anq at: Panning, Building or Health Department permits or services on our behalf, for the property located l245cR 19, Brighton, CO Parcel # 1469-28a400004 AUTHORIZATION FORM FOR BUILDING, PLANNING PERMITS AND SERVICES 1, (We ! +firestone Reek Resou ce,H ldin� e, LILL (Owner -- please print) - - , give permission to _ iscovery DJ Services, LLC. (ApplicentiP ) Legal Description; ` 17111rPAW MU, of ---_-- --Section 28 Township an 67 w Subdivision Name: _ Lot Block Property ners Information: .� Phone. 72O frO 2500 Applicant/Agent Contact Information Phone: 303495-4853 Meer ghvrnclscoverymidstream.com Email correspondence to be sent to: Owner Applicant/Agent X Both Postal service correspondence to be Sena to: (choose only one) Owner X Additional Info :Applicant/Agent Owner Signature: Owner Signature; Date: Date: DISC o VERY PROJECT DESCRIPTION Proposed Facility: West Brighton Compressor Station Discovery DJ Services, LL (Discovery) is in the process of expanding operations in Weld County, Colorado. This project will include a compressor station and interconnecting pipelines for the purpose of compressing and the transportation of natural gas through gas pipelines. The proposed West Brighton Compressor Station is located between Weld County Road 6 (approximately 2,730 -feet south of WCR 6) and Weld County Road 4 (approximately 2,600 -feet north of WCR 4). Access to the compressor station will be located off of Weld County Road 19. A Portion of Parcel Number: 1469-28-4-00-004. The site address is: 1245 CR 19, Brighton, CO The compressor station is an unmanned facility. The station will operate 24 hours a day, 7 days a week, year-round. Sewer and or water are not proposed as this is an unmanned facility. Following Weld County Health Department policy, temporary construction personnel will use bottled water and portable toilets. After construction is complete, traffic to the site will be limited to a short daily site visit. Up to 2 operators will make a daily visit. However, up to 8 employees could be on -site for projects or emergencies. Site fencing will be chain link fence with desert tan fire resistant privacy slats with a minimum of 80% opacity. Less than 10 construction trailers and less than 10 Conex storage containers will be required for construction. All items presented in this application are preliminary and are subject to change until final design is complete. PROJECT OVERVIEW This compressor station enables natural gas to travel through pipelines which is crucial to the natural gas transport system. They also allow the gas to be rerouted into storage areas during periods of low demand. The West Brighton Compressor Station will expand the capacity and will enhance the efficiency of moving natural gas to a central processing plant. The West Brighton plant will remove any liquids and impurities using dehydration and a slug catcher then compress the dry gas for transportation in pipelines to a central processing plant for distribution. Any produced water and condensate will be separated and trucked off -site for sale or subsequent disposal in accordance with Federal, State and Local regulations. DISCOVERY Planning Questions Proposed Facility: West Brighton Compressor Station 1. Explain, in detail, the proposed use of the property. To transport dry natural gas in pipelines, the gas requires pressurization to efficiently transport this gas. This station is an in -line station that intakes low pressure gas and outputs high pressure gas thereby allowing gas to continue traveling along pipelines. The West Brighton Compressor Station will include up to 8 compressors, a slug catcher, metering, dehydration, a process flare and process vent flare, MCC building, a fuel gas skid, small tanks and a pump skid. Emissions from the dehydration process will be routed to a vapor combustor, Its anticipated maintenance will be needed once a month. The vapor combustor will be smokeless (i.e. not open flames). Most of the equipment will be horizontal or close to ground level, The exceptions to this are the flare and dehydration tower at 65' each. The process flare at 65' tall will operate only during maintenance procedures or during an emergency. It is anticipated maintenance will be needed once a month with the flare operating for 30 minutes. The process vent flare at 25' tall will operate continuously for the dehydration units at a low volume. The flares will be enclosed (i.e. not open flames). A Recorded Exemption for Lot A will be applied for with this USR permit. 2. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 22 of the Comprehensive Plan. Section 22-2-10(D) of the Weld County Code states that "extraction of natural resources is an important part of the economy of the County." The proposed compression facility will contribute to the expansion of the county's industrial economic base by providing increased capacity for future marketing of oil and gas production in Weld County. Additionally, Section 22-5-100(A) states that a county goal is to "promote the reasonable and orderly exploration and development of oil and gas mineral resources." The proposed facility is consistent with this section in that the proposed site is within agricultural land and is clustered close to other oil and gas facilities. Per Chapter 22, oil and gas facilities are allowed as a use by right in the A (Agricultural) Zone District. However, oil and gas storage facilities, oil and gas support, and associated services require a Use by Special Review (USR) permit in Weld County. Section 22-2-20. G.2.A Policy 7.2 states "conversion of agricultural/and to nonurban residential, commercial and industrial uses should be accommodated when the subject site is in an area that can support such development and should attempt to be compatible with the region." The land that Discovery DJ Services, LLC is proposing to utilize for the gas compression is on dryland grasses that is located in a semi -rural area where there is a significant amount of oil and gas activity already occurring. DISC 0 VERY Proposed Facility: West Brighton Compressor Station Section 22-b-1 OO. B . O . Goal 2 states ''Ensure that the extraction of oil and gas resources conserves the land and minimizes the impact on surrounding land and the existing surrounding land use. 3. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 23 (Zoning) and the zone district in which it is located, section 23-3-10 indicates that uses that are "more intense and have a potentially greater impact" are permitted within the A (Agricultural) zone district. The operation of a compressor station for oil and gas operations while minimally intrusive is more suited for less densely populated areas such as the proposed site. In addition, oil and gas infrastructure is within close proximity to this property. Section 23-3-40 also indicates that oil and gas support and service facilities are acceptable as a Use by Special Review within the district. 4. Describe what type of land uses surround the site. Explain how the proposed use is consistent and compatible with surrounding land uses. The surrounding parcels can be classified as mixed use with agricultural and commercial, properties. 5. What are the hours and days of operation? (e.g. Monday thru Friday 8:00 a.m. to 5:00 p.m.). The hours of operation for the facility will be 24 hourslday, 365 days/year. 6. List the number of full time and/or part time employees proposed to work at this site. There will be no permanent employees working on site. Up to 2 operators will make a daily site visit. However, up to 8 employees could be on -site for projects or emergencies. 7. If shift work is proposed include the number of employees per shift, No shift work is proposed. 8. List the number of people who will use this site. Include contractors, truck drivers, customers, volunteers, etc, This station is an unmanned facility operated remotely. 9. If this is a dairy, livestock confinement operation, kennel, etc., list the number and type of animals. There will be no animals on site. DISC lIVE 'V Proposed Facility: West Brighton Compressor Station 10. Describe the type of lot surface and the square footage of each type. (e.g. asphalt, gravel, landscaping, dirt, grass, buildings). The proposed site is approximately 10 acres. The site will disturb approximately 5 acres, 217,800 ft2. There will be no asphalt. Gravel will cover approximately 82,500 ft2. The buildings will cover approximately 8,130 ft2. The remaining areas will be reclaimed with native grasses. 11. How many parking spaces are proposed? How many handicapped (ADA) parking spaces are proposed? No parking spaces are proposed. 12. Explain the existing and proposed landscaping for the site. The existing site is a greenfield site with native grasses as primary vegetation. After construction, berms can be constructed as screening and/or landscaping wherever possible. A Landscape Plan can be developed with the request for comments from the adjacent property owners. 13. Describe the type of fence proposed for the site (e.g. 6 -foot chain link with earth tone slats). Site fencing will be a T chain link fence with desert tan fire resistant privacy slats with a minimum of 80% opacity. A Landscape and Screening Plan can be developed with a request for comments from the adjacent property owners. 14. Describe the proposed screening for all parking and outdoor storage areas. Wherever possible the site will be shielded with berms and landscaping. A Screening Plan can be developed with a request for comments from the adjacent property owners, 15. Explain any proposed reclamation procedures when termination of the Use by Special Review activity occurs. If the plant is deemed obsolete, the plant closure will follow all Federal, State and Local (County) regulations. Please see the attached Decommissioning Plan for the West Brighton Compressor Station, 16. Who will provide fire protection to the site? Brighton Fire Protection District will provide fire protection for this site. Discovery DJ Services, LLC will hold a meeting with Brighton Fire Protection District to discuss all requirements needed for this facility. ISC o VERY Proposed Facility: West Brighton Compressor Station 17. List all proposed on -site and off -site improvements associated with the use (e.g. landscaping, fencing, buildings, drainage, turn lanes, etc.) and a timeline of when you will have each one of the improvements completed. No offsite improvements are proposed as part of this project. Onsite improvements will include perimeter fencing for the facility, and gravel roads to the property to access the facility, construction activities are expected to begin following the approval of this USR request and receipt of the applicable Federal, State and Local permits. Construction will last approximately 4-6 months. Restoration of the site and final clean-up will begin immediately following completion of construction. DISC C.VERY Engineering Questions Proposed Facility: West Brighton Compressor Station 1. Describe how many rou ndtri ps/d ay are expected for each vehicle type: Passenger Cars/Pickups, Tandem Trucks, Semi-Truck/Trailer/RV (Roundtrip = 'I trip in and el trip out of site). During construction, semi -tractor trailers will be used to haul equipment and materials to the site, along with passenger cars/trucks for site workers and construction management. Following construction of the facility, during normal operations up to 2 operators will make a daily site visit. A service type of truck will access the site approximately twice per week. Please see the attached Traffic Memo and the attached Haul Route Maps. 2. Describe the expected travel routes for site traffic. The site is approximately 5.07 -miles west of Highway 85 and approximately 1.62 -miles north of County Road 2 (E. 168th Avenue). From the south traffic can access the site from Highway 85 to County Road 2, then north on County Road 19 to the access road. From the north traffic can access the site from Highway 85 to County Road 6, then south on County Road 19 to the access road. Please see the attached Traffic Memo and attached Haul Route Maps. 3. Describe the travel distribution along the routes (e.g. 50% of traffic will come from the north, 20% from the south, 30% from the east, etc.) It is anticipated equal amounts of vehicles will use the Highway 85 to County Road 4 or Highway 85 to County Road 6. 4. Describe the time of day that you expect the highest traffic volumes from above. There will be no specific time traffic will be heaviest. Traffic maybe slightly heavier in the morning around 8AM. 5. Describe where the access to the site is planned. The access for this site will be across an existing 950 -foot gravel road that passes on the north side of the site. An access agreement with the adjacent landowners will be prepared by Discovery. An access permit will be applied for with this DR application. ISC 4 VERY Proposed Facility: West Brighton Compressor Station 6. Drainage Design: Detention pond summarized in a drainage report is required unless the project falls under an exception to stormwater detention requirements per code section 23- 12-30 F.1. A Stormwater detention pond will be required for this site. The drainage report and detention will follow all requirements of the Stormwater drainage code located under Chapter 23, Article 12 Storm Drainage Criteria, The detention pond will be designed following the above code and Urban Drainage Flood Control District criteria for a Non - Urbanizing Drainage Area and will retain the 1 -hour 100 -year storm with the release rate for the 1 -hour 10 -year storm events. DISC VERY Proposed Facility: West Brighton Compressor Station Environmental Health questions 1. What is the drinking water source on the property? This is an unmanned facility with no potable water needed. 2. What type of sewage disposal system is on the property? This is an unmanned facility with no sewage disposal necessary. 3. If storage or warehousing is proposed, what type of items will be stored? The following or warehousing of materials or equipment on site will be minimal. The following materials are expected for a plant of this type: 1. Lube Oil 2. Solvents 3. Grease 4, Filters 5. Gasket Material Any oils or solvents stored and handled as per the guidance provided on the Safety Data Sheets (SDS). Any liquid waste will be temporarily stored in a container approved for that waste. Any solid wastes (i.e. used oil filters) will also be temporarily stored in containers approved for the waste in question. Clean Harbors (cleanharbors.corn) or a similar third- party waste recycling/disposal service will be used to recycle or dispose of all chemical/oil wastes as required by state and federal regulations. 4. Describe where and how storage and/or stockpile of wastes, chemicals, and/or petroleum will occur on this site. Please see question number 3 5. If there will be fuel storage on site indicate the gallons and the secondary containment. State the number of tanks and gallons per tank. Fuel will not be stored on site in quantities greater than 5 gallons; the facility will operate using a small portion of the inlet gas as fuel for the inlet compressors and for the flare. 6. If there will be washing of vehicles or equipment on site indicate how the wash water will be contained, No vehicle washing is proposed for this site. DISC 0 VERY Proposed Facility: West Brighton Compressor Station 7. If there will be floor drains indicate how the fluids will be contained. Floor drains are not proposed. 8. Indicate if there will be any air emissions. (e.g. painting, oil storage, etc.). Discovery DJ Services, LLC has applied for all necessary air permits. 9. Provide a design and operations plan if applicable. (e.g. composting, landfills, etc.) N/A 10. Provide a nuisance management plan if applicable. (e.g. dairies, feedlots, etc.) N/A 11. Additional information may be requested depending on type of land use requested. DISC a VERY Building Questions Proposed Facility: West Brighton Compressor Station 1. List the type, size (square footage), and number of existing and proposed structures. Show and label all existing and proposed structures on the USR drawing. Label the use of the building and the square footage. Up to 8 compressor buildings are proposed as Arctic buildings and the MCC is a modular type building. 2, Explain how the existing structures will be used for this USR? There are no existing structures on the proposed site. 3. List the proposed use(s) of each structure. To house the compressors and the electrical equipment. DISC o VERY z Boardwalk Project: West Brighton Compressor Station Neighborhood Open House Invitation for Project Landowners and Neighbors Date: Monday, June 5, 2017 Time: 6:00 pm to 7:30 pm Location: Hampton Inn 992 Platte River Blvd Brighton, CO 80601 Purpose Discovery Di Services, LLC is holding an informational meeting for the community to discuss the West Brighton Compressor Station. The proposed compressor station will help transport natural gas to the Discovery Gas Processing Facility. This project is located west of US Highway 85, just North of 168th Ave, between County Roads 17 and 19. Discovery is holding this meeting to Inform neighbors and landowners, answer questions and seek input prior to submitting permit applications with Weld County. This will be an Open House style meeting with experts from different groups across the project. County regulations do not require that Discovery notifies you about this meeting, but we thought you would like to be aware of the project. You are welcome to attend this meeting. Please contact Manya Miller for more information: manya@discoverymidstream.com DISC VERY Boardwalk Pipeline Project - Brighton West Compressor Station Neighborhood Open House Monday, June 5, 2017 - - Phone # E --Man Name Address py° At ) risme /Cfp P 2 J''-_ ..„ - +�. r, to ,).• l Y _ SA, a P J_ - t p rye rfl/ A 1Ti 2 CyThic We& 0.7)0.7)i YL. il,af_ i n � r r � � I t,I 4:.J a k . ..: _ (tea: thi f � ail a ar I.• 1 •1 " iirI..1.IR "yX -1 r 'I• /yam it f9 sY 4l knit) /r 1 J C C n .. .... an f r Lt- " P• ,_. t- �.. • .. , a V i& i � ;Lee n �≥ ► P . �` - ..� nun }n -43 i� < �Ir �j +�-.�) (IMRE _ y mo d. �.. '�� . t - 4 r i ..ere Y� �. _ _ _ .Y' _ XI ./ rA 1 P f _ 1-11:3 C. 3 liniti. • It 'ib � 1 f �. . _ I' G der,,,, � � l� r � � r mow- � � l C e PiA14r ,ff dye ° ty f ,� � .. r _ _ ! � ,. 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''- a '� r +Ti � J ea _� � R~ � _ 1 =tea .�.'� .l' _ +4 f 1 ! t to, ?"\ r 1r .., r=L-Cia ' ,yam .' Il .� f0 ISM �rrl i * ' -. 1,. s T"; c i,s �./ �'c la r" EI t 4l rir i � r 1 �1 .i te+ J •' �"',-' ., 6d) �'' 'I -w f '�' . i.e� i '1� �,"'= • ! - � a} !� ht. ,f ce r • r—' P }l r d9 a rc, .-' ePt %_..- ekes;� �' ' •n. Fr Mate L � X P ,�9a�, 1.0,f•-.�� -y��+�^ Z` (la Y 1� �+L'i .:L ''j.d. r�-li.'� L7 w -may AAlmac �,�q f 4 0 r• 1.. Yom.' �� ' r ,i 41 a% it _673 i •-- a , 7 .� I- LA -6 e .' /4. it �9 (7e, ( d' mil; r•" ea ' �` - r e' I ri Is El , -iri e÷ _a. DISC VERY Boardwalk Pipeline Project - Brighton West Compressor Station Neighborhood Open House Monday, June 5, 2017 Address Phone* E- Mall Name t ` ' "` '`C UU -3 -e s f" Slo r't 7.20-47.16 _ 005.1 Is a r etee � I r Weld County Public Works Dept. 1111 H Street P.O. Box 758 Greeley, CO 80632 Phone: (970)304-6496 Fax: (970)304-6497 ACCESS PERMIT APPLICATION FORM Property Owner Authorized �A�ent/Applwcant (if different from Owner) Name Matthew T. Bergorn Name company Crestone Peak Resources Holdings, LLC company Agent of Discovery DJ Services LLC Address 1801 California St., Ste 2500 Address 7859 Walnut Hill Lane, Ste 335 City Denver Phone Fax 720-410-8500 mail _ _ State CO zip 80202-2638 City Dallas State TX zip 75230 Phone 303-495-4853 E- Fax E-mail MBerghorn@discoverymidstream.com Parcel Location Existing County Road Surface Information The access is on WCR 19 Asphalt Gravel ! Treated Other Nearest Intersection: WCR 4 & WCR 6 Dist. from Intersection (approx. in ft.) 2,730' Parcel Number(s) 1469- 8-4-00-004 Section/Township/Range S28 / TIN / R 67 W Total # of Existing Accesses to parcel I Proposed Access Information Culvert Size & Type (15" CM P/RCP min.) 15m CMP / RCP miin Materials used to construct access Class 6 Road Base Access Construction Start Date 08/01/2018 Access Construction Finish Date 12/31/2018 Temporary (Tracking Pad Required) (#) ❑ Single Residential (#) at Oil & Gas + # ❑ Small Commercial (#) ❑ Large Commercial (#} o Industrial (#) ❑ Field (Agriculture Only) (#) n Subdivision + # Is this access associated with a Planning or Building Department Process? USR/MUSR USR E RECD SUB} ❑ PIED ❑ WOGLA ❑ COMPLEX (IA required) I Other ROW Planning/Building Department case # PRE1B-0074 Recuired Attached, Documents - Traffic Control Plan (a generic plan can be found at https:/,/www;weldgov.co►rn/departments/public worts permits/) During the review process it may be determined that a right-of-watuse permit will be required as well. - Certificate of Insurance (with "Weld County, Colorado" listed as the certificate holder & as an additional insured) - Access Pictures (from the left, right, into & out of the access — N, 5, F, & W) - Access Authorization Form (Not required if the application is signed by the landowner.) Fee schedule (to be determined by permitting agency) - $75 each access point: Temporary, Small Commercial, Oil & Gas, Single Family Residential - $150 each access point: Industrial, Large Commercial, Subdivisions - Field (Agriculture only): no cost Parcel Sketch (or provide an aerial on an adds' sheet) A= Existing Access A= Proposed Access WCRG T N r U WCR a) ce cep 3 Description of Work or Reason for Permit Permanent Access for the development of oil & natural gas resources, including the development of the proposed compressor station. By accepting this permit, the undersigned Property Owner/Authorized Agent, under penalty of perjurer, verifies they have received all pages of the permit application; they have read and understand all the permit requirements and provisions set forth on all pages. By virtue of their signature the Property Owner/Authorized Agent is bound by and agrees to comply with all said permit requirements and provisions, all Weld County' ordinances, and state laws regarding access construction. Signature zA L 1 ,p N 4L Signature Printed Name Date (In case of multiple Property Owners/Authorized Agents) Printed Name Matthew T. Berghorn Date c'/ • Access Permits are good for 1 year from the date of issuance. Property Owner/Authorized Agent must obtain a new permit or request an extension if the construction of the access point is not completed in that timeframe. • Extensions are subject to approval by Public Works • County regulations on road access can be found in Article V of Chapter 12 of the Weld County Code. DEPARTMENT OF PUBLIC WORKS 1111 H STREET GREELEY, Co 80632 AUTHORIZATION FORM FOR ACCESS PERMITS give permission to Discovery DJ Services, LLC (Owner — please print) lioant/A print) Pp den# — please pr! nt) to apply for Access permits on our behalf, for the property located at(address andparcel numbers): 1245 CR 19 Parcel Number: 1469-284-00-004 Property Owners Information: Address: Phone: City: Zip: E-mail: Applicant/Agent Contact information: Main Contact: Matthew T. Berg horn Company: Discovery DJ Services, LLC Address: 7859 Walnut I i11 I_me? Ste 335 City. Dallas, TX zip: 75230 Phone: 303-495-4$93 E -Mail: MBerghorn@discoverymidstrearn.co erymidstrearn,co Email correspondence to be sent to: Owner ApplicanUAgent � Both Postal service correspondence to be sent to: (choose only one) Owner Add iticnai l nfo: OwnerSignature- Owner Signature: Applicant/Agent Date: west Brighton Compressor Station — Access Road North South ICOOO CORNER ..SEC 1► 28 2-" WV CAP PIS 2.1.59T H 4, e 13-7 rap Row ..,s 1 N.. cosine min mew tentr i .--� /1122:SleATBEKINcragu. S 00.270,6"1 E Jo'.o6' rs r N 0022`0r" W L4 i 8 ;3�`'5r" row. AREAOrd Ate' NE!41 SECTION 2$ R67W6TH fat x dr 1DYLLE x nit ItYP.) IRAnfoRmER ftorRil Row N 89`.3.7154- r leina PADS HPECSVE MARKER (try.) UnttitaRtat, ramie' l4 r Mc RATER Marc sp." OWNER, C ESTOVEPEAK RESOURCE HOLOINGSItC. APt 146I12340000ti SE /Al SECT/ON 29 L 34t, f 90477 3t,co` 0 � 9V1/�L,'u4t; Off iP. �l�f OD � � ^'.4b NY��' '_i� YL! etitin � r 1, 7 i? t k -� ,L N Obi .• F SIONto ilibi2) A Doer C `a 4' IER Amu JI4Y Us. Aim9 M 8f OO at' -O 'Ry re :E7Cyt Ar wan S+`r'DE WM OF tI 7lk Oa y ,. ri rt AMA, «C. A EX� OR ' '5, .#11.2a5 tip PO. ARAVCIS MD 0il'es t ' ram .5,) In total/5� � t�s'� sump'I�r ,011 AiRechriffar E�'T AS :��r i4c 0r ' K MO 6&X an; MANI. fr NE3' A# FT Fit , rim; me NE rcf mtsgefir .082 0110 Met MAkowiar WES e aft 84StuaaM OS OggyavoltS ill leis Now° Fornmec sysrDR AVM PC MK " rPcIMS.,nD :ai)tt' 0L C1ltMairF Iii (Zeite J A• 10 0. Dsf Hat* Aqf tAt tiS Starr Fal r S) now, t ;0 MEMO OW too JAW O3MitecE Ner UPI, SI+ a& CD ' my Derr K.,, you Fr q' SL x . T as . SO ' a:y .A t �'T Mr aD 'tr" mow tl f i+ S wow Pig- er o # ' k hr PETIC qIp .it Wan' , 6) nits EMT Ss mrititaw e it fir_ Pm 37074. ft? caa 117. . PC a Psi FENCE ELECT u(r EXIONG (,gyp PPELME TEMASFORNER ArrE S Raw EDGE or C7 4 Vl itYPERYTEADq 1•( FENCE ' R.0.W 70" RESERVED R. r . W. — -: 2U' PIPELINE t EASEMENT vEssas kivOROC4RBOPJS 1 I #0. 2558857 20' PIR LIME CAZA•frisa viSSELS HVI " ' • RFC_ NO. 2638868 t P `C. NO. 2538869 M r r ! APPROXIMATE LOCA Cdr ,P' ' f rr 9 PAN ANo E :LASuRN PIPE N t CO KC NO. I 523585 & ate _ RFC MI 266(SUM ) I o MO" Acklornt Inc. if1 tcthrile, C„ L ; Ltdvninr. Co. 11420Cial. I 20D' Iler t I p I i t N 4 UI 2.511 ALUM, CAP PIS ie3o7 (SURVEY VIE To '�. 8943P.54- it 251.92) G I. Raft LI • 7 MIN _ 2.5 S AC{iw. GAP • as avoi DISCOVERY DJ SERVICES U C £x umr "A ACCESS EASEMENT SEI/4 SECTION 28, TIN 967W 6TH P 1, WELD COUNTY, COLORADO sCALER''Wdelr. aim oLvtaajla N,e town Mit Or t rifisctsbet atanYI InDismocildX16 0&2 NW Trunkthe tl'j1d'Wbaffawkigs\CO_ WESTSR CRESTME_ACCESsallwe, 3'87'20181$4• DRAINAGE REPORT REVIEW CHECKLIST Project Name: USRI 8-0053 West Brighton Compressor Station The purpose of this checklist is to provide the applicant's Engineer a basic list of items that County Staff will review in regards to a drainage report. The drainage design shall meet the requirements of the Weld County Code and commonly accepted engineering practices and methodologies. A detention pond design (or other stormwater mitigation design) is appropriate for projects which have a potential to adversely affect downstream neighbors and public rights -of -way from changes in stormwater runoff as a result of the development project. The design engineer's role is to ensure adjacent property owners are not adversely affected by stormwater runoff created by development of the applicant's property. REPORT (© = complete, ❑ = required) ❑Stamped by PE, scanned electronic PDF acceptable ❑Certification of Compliance ❑'Variance request, if applicable ❑Description/Scope of Work ElNumber of acres for the site 5.22 ❑Methodologies used for drainage report & analysis Design Parameters Design storm 100/10 ❑ Release rate URBANIZING or NON -URBANIZING ❑Overall post construction site imperviousness Soils types B Discuss how the offsite drainage is being routed Conclusion statement must also include the following: ❑ Indicate that the historical flow patterns and run-off amounts will be maintained in such a manner that it will reasonably preserve the natural character of the area and prevent property damage of the type generally attributed to run-off rate and velocity increases, diversions, concentration and/or unplanned ponding of storm run-off for the 100 -year storm. ❑ How the project impacts are mitigated. Construction Drawings ❑Drawings stamped by PE, (scanned electronic PDF preferred) Drainage facilities ❑Outlet details ❑ Spillway Maintenance Plan ❑ Frequency of onsite inspections ❑ Repairs, if needed ❑Cleaning of sediment and debris from drainage facilities ❑'Vegetation maintenance ❑ Include manufacturer maintenance specifications, if applicable Comments: Section C.1 mentions a swale that will be realigned. Who is the owner of this swale? Is permission required? Section B.3 mentions Yoxall ditch. If the pond releases to this ditch, permission is required per USDCM Manual 1. xl ■ ■ 4/11/2018 Weld County Department of Public Works/ Development Review 1111 H Street, Greeley, CO 80631 I Ph: 970-400-3750 I Fax: 970-304-6497 www.weldgay.com/departments/public_works/develapment_review/ Samuel Engineering We Provide Solutions 8450 East Crescent Parkway, Suite 200 Phone: 303. 714.4840 Greenwood Village, Co 80111 FAX: 303.714.4800 PRELIMINARY DRAINAGE REPORT Discovery DJ Services, LLC west Brighton Compressor Station The West Brighton Compressor Station is located in part of the Northwest corner of Lot B, Recorded Exemption 1595 AM and is in part of the NE 1/4 of the SE 1/4 of Section 28, TIM, R67W, 6th PM, Weld County, Colorado CE -102 PREPARED BY: SAMUEL ENGINEERING, INC. 8454 EAST CRESCENT PARKWAY, SUITE 200 GREENWOOD VILLAGE, CO 80111 ISSUED FOR USR PERMIT Project Number 17193 — Rev. C May 2018 Samuel Engineering We Pi ; vid° Solutions 8450 East Crescent Parkway, Suite 200 Phone: 303.714.4840 Greenwood Village, CO 80111 FAX: 303.714.4800 GENERAL LOCATION AND DESCRIPTION A. Site Location The subject project is located in part of the SE 1/4 of Section 28, Township 1 North, Range 67 West, 6th Principal Meridian, Weld County, State of Colorado. The property is located approximately 2300 feet north of Weld County Road 4 and 1000 feet west of Weld County Road 19. No public streets are proposed within or as access to the property. Access to the property will be from County Road 19. B. Description of Property 1. The subject property is a 10 -acre parcel has been purchased for the installation of a gas compressor station. The compressor station, access roads and detention pond will disturb approximately 5.22 acres of the 10 -acre site. The development will consist of two compressor stations, one on the north half of the property and the other on the south half. 2. Vegetation consists of native grasses and some weeds. 3. There is an irrigation ditch northwest of the lease boundary known as the Yoxall ditch. The proposed development will not impact this ditch. 4. The subject property is not located in a floodplain. There is an existing drainage swale that bisects the subject property which drains surface runoff from the neighboring property to the east. 5. The surrounding area development consists of single family residences, barns, well pads, a tank battery and miscellaneous oil and gas related infrastructure. The subject site is divided into a north and south section by existing utility right-of-ways and pipelines. 6. Topographic relief over the leased property ranges from 5020' along the southeastern boundary to 5005' along the northwest boundary and is characterized by flat grades that typically range from 03 to 5%. 7 There are two soil types present on this site, Olney fine sandy loam (1 to 3 percent slopes) with USC rating CL and Olney fine sandy loam (3 to 5 percent slopes) with USC rating CL. The soils have a hydrologic soil group rating of R. C. Existing and Proposed Drainage 1. The subject project site is currently mostly undeveloped, with the exception of a drainage swale that conveys storm water from the neighboring site on the east property line. The contributing flow to this swale will not be altered, however the 2 Samuel Engineering We Novick Solinhons 8450 East Crescent Parkway, Suite 200 Phone: 303.714.4840 Greenwood Village, CO 8O111 FAX: 303.714.4800 swale will be re -aligned to allow for adequate space to construct the compressor station. The remainder of storm water falling on the site sheet flows across the site from the southeast to the northwest draining into adjacent fields and eventually being captured by the Yoxal I irrigation ditch. 2, After construction storm water will be directed to one of two proposed detention facilities. The north compressor pad will drain to a 10,200 cubic foot detention and water quality pond before discharging to the natural drainage patterns. The south compressor pad will drain to an 8,500 cubic foot detention and water quality pond before discharging to the natural drainage patterns. The regulated release will be channeled to a pipe and gravel spreader before being discharged into the natural drainage. 3. The detention pond will be designed to hold the 100 -year 1 -hour event and release at the historic 10 -year 1 hour release rate following Weld County Drainage requirements for Non -Urbanizing Drainage Areas. The release will be channeled to a spreader before being discharged into the natural drainage. CONCLUSIONS 1. The proposed detention will provide water quality and detention for the current and proposed site development and releasing stormwater at the historic rates, 2. A full drainage report will be prepared and submitted with grading plans and construction drawings. Samuel Engineering We Provide Sob,,(10n5 8450 East Crescent Parkway, Suite 200 Greenwood Village, CO 80111 Vicinity Map a aaa i .aa.Naaaaaaaa.� ors a iie aaiaaa� aaa�u ari�� ate- • a aa: SIM_ w ...I. r aaaifaln •ataatii 'Brian terns taQ.sn tr et< r�F _ia 1. t. Phone: 303 7144840 FAX: 303.7144800 tr aaara 81 wan l!.o clon ontr n L a d s s y: 7' 0 Samuel Engineering We P.,1c vid° Solutions 8450 East Crescent Parkway, Suite 200 Greenwood Villager CO 80111 r I I I d C. 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Prownse now NO *WNW LP741 Preliminary NO Fr trifler Ines isvonaite MEP 0 ¢, Document #: I 2.2 I Revision #: J 1 'Revision Date: I 7/21/2017 Discovery Emergency Response Plan (DERP) Document Name: Location: Section 2 — Incident Reporting and Management I 1SC 0'10 17 in erg c noy sp Page 1 of 43 ri { + - Document #: r r 2.2 Revision 1 r '� . . #t l [Revision Date: 7/21/2017 Document Name: Discovery Emergency Response Dian (DERP)! a Location: Section 2 — Incident Reporting and Management TABLE OF CONTENTS Purpose of Plan.. .. DJ Asset Information Incident Response Incident Command System.... Responsibilities Training Requirements of Emergency Responders. * ... Drills and. Exercises for Emergencies �3 }.cad i44!I4F-±44 Ii4 p .... e e ' - - r e «.. , . z 4 e ■ err . 5 6 8 10 12 13 DrilllExercise After Action 14 Media Relations Support Plan 4tttM444PPIEPOPPt14.41Flitt4.10 15 Incident Reporting....., .... 17 Incident Response....,. , 19 Specific Scenario Response 20 Appendix A — Emergency Contact List P , .. 36 Appendix B - Discovery Gas Plant Muster Area Map 37 Appendix — Discovery CDP Muster Area Map r .... • ..P , .. 38 Appendix D — Accident Analysis -Report Example 39 Apppendi. E — Post Injury Treatment Authorization for Preferred Provider Form Example 42 Appendix F — Employees Notice of Injury Fern Example ... 43 Page 2 of 43 Document #: 2.2 I Revision #: 11 Revision Date: 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management L Purpose of Plan The purpose of this Discovery emergency response plan is to establish procedures and responsibilities to all foreseeable emergencies that may occur at Discovery Midstream Dir assets. An emergency is defined as any situation presenting a threat to human life, physical well-being, and company or personal property. The main objectives in any emergency response will be as follows (listed by order of importance): • Protection of personnel and the public e Protection of the environment • Compliance with federal, state, and local laws and regulations • Adhering to safety protocols • Restore normal operating conditions Discovery Midstream works to prevent emergency situations from occurring by implementing and adhering to a culture which values safety and by meeting and exceeding industry best safety practices. Examples include: • Use of all —steel pipe manufactured in the USA for Discovery oil and gas lines Pipelines buried further underground than standard three (3) feet • Use of thicker, stronger, higher Bade pipe than required by standard best practice • Adherence to strict welding standards and 100% -Ray of all welds • Integration of a rigorous pipeline integrity management program This plan is supported by the Discovery Midstream Leadership team. The plan furnishes adequate emergency protection and provides training for the employees, contractors, and visitors at the facility. This plan applies to all employees, contract employees, guests and visitors to the facility during normal office hours, unless otherwise noted below: Employees working outside normal hours will be responsible for carrying out the appropriate actions of this plan. Pre -Planning During pre -planning it is important to remember that no two emergency incidents are alike. Look at all the possibilities surrounding the emergency. This includes the size of the event, community and environmental impact, and the possibility of several types of emergencies which could occur at the same time. Page 3 of 43 Document #: 1 !Div v or: Document Name: 2.2 [Revision #: Discovery Emergency Response Plan (DERP) Revision Date: I 7/21/2017 !Location: Section 2 -- Incident Reporting and Management Site or Area -Specific Planning Measures For all area operations and project work,including testing, construction, commissioning, or maintenance activities, Discovery Midstream personnel will, at a minimum and as applicable to the activities being conducted, initiate a review of the following planning measures: Clarify project / operational parameters / hazard identification; Conduct risk assessments and implement prevention measures as an integral part of company operations, where appropriate; • Identify the residual risk of the operation, and potential emergency scenarios that could happen; Procure or contract resources to respond effectively to emergencies; • Meet with stakeholders (i.e.: government agencies, residents/landowners, emergency agencies) as required, to discuss emergency planning; Compile and distribute site -specific emergency response information for the project or production operation to key stakeholders; • Prepare Site Safety / Evacuation Plan(s) for key job sites (i.e. Gas Plants, Occupied Compressor Stations, etc.); • Ensure company personnel and contractors attend emergency response plan review meetings before major facility modifications are commissioned; • Engage corporate support, as required, to ensure emergency support plans address risks and communications specific to the activities; and • Ensure that plans are compliant with applicable government regulation and, if required, registered and/or approved by regulatory agencies. Plan Administration Discovery Midstream personnel are responsible for the development, review and administration of all components of the plan. The administration of Emergency Response Plans and Programs involves the following processes: • Distribution: Copies of programs and plans should be accessible to all Discovery Midstream personnel and agencies assigned responsibilities under the program or plan. Updating: Programs and plans should be reviewed and updated at a minimum once a year (or more frequently as required) to include regulatory changes, organizational and personnel adjustments, identified operational hazards and recommendations resulting from exercises or real incidents. • Approval: Where required, programs and plans should be submitted for regulatory review and approval to the government entity having jurisdiction. Page 4 of 43 in_"i rilas i Document #: Revision #: I 1 Revision Date: 7/21/2017 v ,. g ' 2.2 I Document Name: Discovery Emergency Response Plan (DERP) pet c Location: Section 2 — Incident Reporting and Management DJ Asset Information Emergency Planning & Response The Fort Lupton Gas Plant, compressor stations and gathering system have various interlocks, relief valves, and alarms which function to alert personnel and/or protect equipment against process conditions exceedingdesign parameters. Many of these process safeguards are critical equipment subject to regular testing and preventative maintenance as defined in facility mechanical integrity program. The safeguards prevent emergency conditions from occurring. The Discovery Midstream Gas Plant and compressor stations also have equipment and systems available for personnel to actively respond to an emergency condition. These include: • Facility Emergency Shutdown System. (ESD) • Portable Fire Extinguishers placed at required intervals • Fixed Gas Detectors with equipment shutdown capabilities • First Aid Station • Portable Gas Detectors • Smoke Detectors in occupied buildings Discovery Midstream personnel are trained in the use of each to the extent required by authorities having jurisdiction and manufacturer's recommendations. Accountability of Personnel Facility operator will conduct accountability of personnel at muster areas utilizing facility sign -in sheet. Equipment Shutdown Operations Department will be responsible for shutting down procedures, Incident Communication - Radio Use Two (2) -way radios will be utilized as the primary communication devices in the event of an incident. Cellular (cell) phones will be utilized in the event radios are not transmitting receiving communications. Location of Discovery Operation Center (DOC) The Discovery Operation Center is located at 4501 Weld County Road 35 Fort Lupton, CO 80621. Ideally, the Operations Center should be equipped with a radio base, several phone lines, and be centrally located for personnel to be dispatched from. Page 5 of 43 2.2 1 Revision #: Ii I Revision Date: C 7/21/2017 A Document #: Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Incident Response Incident Levels Discovery Midstream incorporates three incident levels as part of the "Incident Notification Procedure," (ref. Document 2.1, Incident Notification.) The Incident Notification Procedure assures an incident is promptly addressed at appropriate level to provide resources and support to control and mitigate incident. Implementation of a three tier system helps ensure notification of State and Federal agencies (as applicable), while enabling Discovery Midstream to evaluate impact of incident on employees, general public, and customers. In order to properly respond to any emergency, incidents should be classified into one of three levels. The incident level is determined by complexity of the incident, risks to company personnel and public, and impact on the environment. The three level classifications will be used and communicated to all personnel within the company. Level I Incident The most serious and highest level incident. Level 1 incidents are usually on going and typically involve at least one of the following: a. Any fatality b. Event requires support of government or Emergency Responder agencies c. A non -incipient fire, rupture or explosion involving a Discovery Facility that requires assistance from Emergency Responders d. Any media attention at a Discovery Incident e. Results in more than $100,000 in estimated Property damage *A Level I. Incident will automatically activate the Corporate Emergency Support Team and Emergency Operations Center. Notification Protocol: a. Immediately notify local Supervision, Discovery Operations Center (IOC), Director of Operations, COO b. Discovery Operations Center (DOC) will activate Discovery local First Responder(s) and local city/county fire/emergency organization if needed. c. Discovery Operations Center (DOC) will telephone local city/county officials, landowners and/or local citizens if off -site impact. d. Discovery Operations Center (DOC) will communicate (text, email or phone call) all Corporate Personnel as appropriate. Page 6 of 43 Document #: 2, 2 I Revision ##: I 1 Revision Date: I 7/21/2017 0..D y. �� 4, /j' tr.' p Document Name: Discovery Emergency Response Plan (D ER P) - Section 2 — Incident Reporting and Management Location: Level 2 Incident An event of moderate impact, usually controllable from the scene. Level 2 incidents may be ongoing and typically involve at least one of the following: a. Any Discovery spill/release from a Discovery pipeline or facility b. Any land slip or "frac out" that impacts a water way or has the potential to impact a water way c. Estimated damage or penalties in excess of $50,000 but less than $100,000 d. An incipient fire involving injury or damage to Discovery Facilities e. Emergency Responder attention f. Motor Vehicle Accident ("MVA") with employee or third party injuries g. A security risk that poses a threat to the Company or the Public Noti fi c ati on Protocol: a. Notify local Supervision, Discovery Operations Center (DOC), and local Safety/Environmental Representatives. b. Discovery Operations Center (DOC) will telephone local fire/emergency organization(s) if needed and complete preliminary incident report (PIR) in the ISR. a Discovery Operations Center (DOC), Local Manager or Designee will communicate (text, email or phone call) to all personnel as appropriate. Level 3 Incident Relatively minor event involving one of the following characteristics: a. Injury Illness that requires onsite or offsite `site First Aid Treatment b. "Good Catch" Reporting a Land slips that do not affect water ways or have the potential to affect water ways. d. Estimated property damage is not expected to exceed $50,000 e. No media or emergency responder attention 1. Event that significantly disrupts operations or deliveries (commercial business impact only) g. Near Miss Reporting h. MVA with no employee or third party injuries Notification Protocol: a. Notify local Supervision b. Local Manager or Designee will communicate (text, email or phone call) to all personnel as appropriate. Page 7 of 43 Document #: 2 2 1 Revision #; 11 I Revision Date: I. 7/21/2017 Document Name: _ Discovery Emergency Response Plan (DERN! R P} Section 2 — incident Reporting and Management Location: Incident Command System Discovery Midstream follows an Incident Command System (ICS) structure when responding to any incident. While most incidents are small enough that only limited incident command will be required, larger incidents may require a full-scale ICS. The ICS is designed to enable effective and efficient incident management by: • Integrating a combination of facilities, equipment, personnel, etc. within a common organizational structure • Enabling response measures to be scaled according to nature and size of incident • Involving only those functions required for level of response (i.e. operations, finance, public relations) • Allowing one person to take charge of incident for the company and determine size of response required • Merging into and working with ICS of responding agencies (most governmental agencies use an ICS) Discovery ICS matrices for Level 1, Level 2, and Level 3 incidents are provided. The formats are for full-scale ICS, while normally only a portion of the ICS will be required. For Level 1 and Level 2 incidents, personnel will assume responsibility for primary duties in ICS. One person may assume various or all responsibilities for Level 3 incidents. The ICS structure is meant to be flexible. The Incident Commander is responsible for establishing the size and strength of the team. Primary jobs are: Incident Commander • Director of Operations (Incident Response Leader) * Operations Lead (Logistics — Calls contractors and field assistance) • Manager of Engineering (Planning — Decides on response strategies/schedules events) • Chief Operating Officer (Executive Lead) • Finance Office (Receives invoices, approves and signs) • Media Relations Officer (Interacts with media, community, etc.) *Note — First on -scene employee is the incident commander until other employees or agency responders arrive with increased training and experience in handling type of incident. Page 8 of 43 i, r I r 1 Document 41: 2, 2 I Revision #: i 1 Revision Date: 7/21/2017 Document Narne: j Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Discovery ICS atrix Level 1 Incident Commander Operations Lead Safety Manager of Engineering First Responders: - Fire Dept. - Police - Medical Discovery Operations Center Finance Director of Operations i Chief Operating Officer Media Relations Environmental Level 2 Incident Commander Safety Operations Lead 1 Discovery Operations Center rflk First Responders: - Fire Dept. - Police -Medical Manager of Engineering Environmental Level 3 Incident Commander i Operations Lead Page 9 of 43 ' 1i (A ; ; f . r / r I f Document #: 2.2 Revision #: 1 Revision Date: 1 7/21/2917 Document Name: Discovery Emergency Response Plan (DERP) Location: and Management Section 2 - Incident Reporting Responsibilities Discovery Midstream Leadership Discovery Midstream Leadership includes the Director of Operations and Management that is part of the leadership team for the facility. Discovery Leadership is responsible for: 1. Identifying and designating the person(s) responsible for developing the DERP for their areas of responsibility and ensuring the DER') is developed in compliance with Discovery Midstream standards and any additional emergency response plan governmental regulations. , Communication of the DERP' to all employees and contractors in their areas of responsibility. 3. Ensuring employees complete required training. 4. Ensuring employees in their areas participate in drills and exercises. Emergency Action Committee The Emergency Action Plan Committee consists of Discovery Leadership, Media Relations, Health & Safety, and Environmental representatives. The Committee is responsible for: 1. Review ew and revision of this plan. . Scheduling emergency response drills. Discovery Operations Center (DOC) The Discovery Operations Center is responsible for: 1. Routing emergency calls to appropriate personnel identified in the Emergency Contact list provided according to incident level. . Gathering information to communicate to Director of Operations or designated Incident Commanders and/or external emergency responders. Operations Department The Operations department is responsible for: 1. Enacting and completing shut -down procedures for the facility. Safety and Health Department The Safety and Health representatives are responsible for: 1. Identifying, providing, or obtaining appropriate Emergency Response training for all employees. . Maintaining and updating written Emergency Response Plan per Discovery Leadership. 3. Coordinating Emergency Response drills with Discovery/ Leadership. Page 10 of 43 1 rmite.c4}e. \ trail Document #: 262 Revision #: I 1 Revision Date: 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Supervisors Supervisors are responsible for: 1. Ensuring their employees are aware of the steps to take in an emergency. 2. Notifying IOC of the location of mobility impaired employees who will require evacuation assistance if a building evacuation is ordered. 3, Ensuring employees in their area of work responsibility are trained on the Discovery Emergency Response Plan. Employees Each employee: 1. Is responsible for their own safe evacuation during emergencies and drills. 2. Is required to participate in practice drills and respond to all emergency alarms. 3. Is required to obtain training over the Discovery Emergency Response Plan. 4. Is responsible for escorting their visitors to an exit or safe area during an emergency or drills. Mobility Impaired Employees Mobility impaired employees are responsible for: 1. Informing their supervisors and Evacuation Warden that they will require assistance during a building evacuation. 2. Positioning near an emergency exit to await evacuation assistance from the Fire Department if a building evacuation is ordered. Page 11 o143 A Document #: 262 I Revision #: 1 I Revision Date: 1 7/21/2017 Discovery Emergency Response Plan (DERP) Document Name: Location: Section 2 -- Incident Reporting and Management Training Requirements of Emergency .Responders Training for emergency response employees shall be completed before employees are called upon to perform during real emergencies. Such training shall include the elements of the emergency response plan, standard operating procedures the employer has established for the job, the personal protective equipment to be worn and procedures for handling emergency incidents. Training requirements for emergency responders per OSHA 29 CFR 1910.120(q) are: Action Training Initiating Emergency Response Only: Notifying authorities First Responder Awareness Level: Sufficient training to demonstrate competencies. First Responder Operations Level: Eight (8) hours of training and specified competencies. Respond in a Defensive Fashion: Protect nearby persons, property, or environment from a safe distance. Hazardous Materials (IIAZMAT) Technician: Twenty four (24) hour of training equal to First Responder Operations Level and specified competencies. Respond in Approach point to stop hazardous plugging, patching, of release or an Aggressive Fashion: of release (Hot Zone Entry) substance release (i.e. or valve isolation at point exposure.) Assume Control of Incident: Incident Commanders assume control of the incident scene beyond First Responder Awareness Level. on Scene Incident Twenty four Responder competencies. Commander: (24) hours of training equal to First Operations Level and specified Skilled Support: Provides inunediate, short-term support work at scene of incident. Skilled Support Personnel: Initial briefing at emergency response site to include wearing of PPE, chemical hazards involved, and duties to be performed. Specialized Support: Assist, counsel, or advises IC on specific hazardous substances at the facility. Specialist Employees: Sufficient training or demonstration competency in area of specialization annually. Clean -Up or Clean -Up Supervisors: Assisting with or directing clean^up efforts on plant property. Clean -Up or Clean -Up Supervisors: 40 -hour HAZWOPER training, plus proper training in 29 CF . 1910.8 (Emergency Action Plans), 1910.134 (Respiratory Protection), 1910.1200 (Hazard Communication), and other applicable safety and health training made necessary by tasks expected to be performed. Page 12 of 43 r ),,,,,,w, � / 4' Document ft: 2.2 Revision #: J 1 Revision Date: 1 7/21/2017 Document Name: Response Plan (DERP) Discovery Emergency '� Location: Section 2 — Incident Reporting and Management Drills and Exercises for Emergencies Discovery Midstream training exercises or drills for emergencies and frequency for each for the Fort Lupton, CO Gas Plant are described. The purpose of any exercise or drill is to reveal planning weaknesses, reveal resource needs and shortfalls, improve coordination within the site, clarify roles and responsibilities, and improve overall performance of all employees. 1. Drills or Exercises will be carried out at least once every 12 months or more frequent if needed or required by Discovery Midstream Operations. . Table Top Exercises — When chosen this type of exercise is best utilized to resolve coordination and responsibility issues through a low stress discussion. 3. Functional Exercises — When chosen this type of exercise simulates a real emergency under high stress conditions by testing coordination among various functions and outside response agencies. 4. Full Scale Exercises — When chosen this type of exercise test an entire community's response capability and involves the use or real world equipment. 5. Any three of the exercise types are acceptable for testing the functionality of this ERP. . When conducting a drill, an "After Action Report" needs to be completed and documented identifying at a minimum the following: • Type of drill/exercise conducted • Scope and Objectives • Persons involved • Sequence of events • Results/Outcome (i.e. were objectives achieved) • Lessons learned • Action plan, including timelines Page 13 of 43 Document #: 2.2 I Revision #: Ili. I Revision Date: ll 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Drill/Exercise Type: Drill/Exercise After Action Report Scope & Objective: Date & Time: Facility: Participating Agency: Location Alarm Initiated: _ EVALUATION CRITERIA. Yes No N/A COMMENT/ACTIONS Communication Process a. Was Emergency Shutdown (ESE)) audible throughout facility? ❑ ■ b. Are communication tools adequate (phones, other equip)? a Q c, Are lines of communication clearly understood? ❑ f Decision -Making Process and Authority a. Were decisions made in a timely and effective manner? ■ ❑ ❑ b. Are changes necessary to improve decision -making process? ❑ �� ERP Understanding a, Does everyone understand the Incident Command Structure and how it differs from daily operations? ■ ■ ■ b. Was activation response contacts executed properly and did proper emergency receive timely notification of incident? ■ ■ ■ c. Did employees know locations of and assemble at primary or secondary muster area? ■ ❑ r — d. Was accountability for all personnel at the plant taken? ❑ ■ ■ Media Response a. Was media handled in an appropriate manner? ■ ■ ■ b. Was media response pro -active and timely? ❑ ■0 c. Was follow-up to media appropriate and timely? ■ ■ ■�■ Crisis Management Ability a. Were critical issues identified and addressed? ■ ■ r b. Were facilities adequate for level of emergency response? ❑ ©� c. Was overall team effort effective in handling the incident? ❑ ■ f Document Performance ❑ ❑ ,■ a, Was information needed to assess scenario readily available? Notification Performance l a. Were internal notifications made in a timely and effective manner? ■� ❑ ■ b. Were agency notifications made in a timely and effective manner? ■ ❑ Overall Effectiveness of Emer.n eney Res • onse Plan a, Were objectives of drill/exercise achieved? ■ ■ Comments/Concems/Corrective Actions: Review and Sign -Off by: Print Name: Page 14 of 43 rj I e.» # 4) v ,_ at s 4 , r , i " Document #. 2.2 Revision it: 1 Revision Date: 1 7/2112017 , Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Media Relations Support Plan In the event of an emergency involving or potentially involving the news media (TV, radio, newspaper, etc.), Discovery Midstream will utilize a representative from the Ten/ 10 Group whose name and phone number is listed on the Emergency Contact List in Appendix A. The Ten/l0 representative will be responsible for developing, managing, and communicating essential organization information to internal and external stakeholders with the assistance of Discovery Management team. This could include: • Maintaining proactive contact with Emergency Response Team(s), assisting with evaluations, collecting information, and communicating progress and updates; • Liaising with community relations and field personnel; • Developing and distributing public statements and news releases; • Arranging and leading media communications when necessary. In the event members of the news media approach you for comment on any Discovery Midstream emergency situation, tell them a statement is being prepared, and defer any further comments to Director of Operations or other senior manager when Director of Operations is not available. Keep in mind the news media are the company's liaison with the public and the community. They must be treated fairly, with every effort made to cooperate honestly. If a member of the media wants on -the -spot coverage or personal interviews, the following applies: 1. Notify the senior manager on site. 2. Senior manager shall call Discovery Midstream Media Relations Contractor at (303) 507%- 0510. 3. Media Relations Contractor will gather facts of the situation, prepare a statement, coordinate with client as required and return site contacts call to provide instruction. Under no circumstances will the name of any accident victim be released to the public. When the facts become known, a Senior Company employee will, in conjunction with Media Relations Contractor and Executive team, prepare a statement for release to the news media, if appropriate. Media Management "Do" and "Do Not" Do Exhibit a professional, co-operative but firm attitude and remain low-key at all times. • Know the location and telephone numbers of company spokespersons • Know the whereabouts of all media in your party at all times. • Offer to follow up requests for information about the incident, rather than answer questions yourself. Page 15 of 43 f i 1= r A \ / ;: P fit Document #: ! 2 2 I Revision Et: 1 I Revision Date: I 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 Incident Reporting and Management — Don't • Don't try to please photographers by allowing unauthorized photo opportunities. • Don't allow media in "No go" areas. If they insist, request back up. • Don't feel compelled to answer questions. You are not a spokesperson. "I don't know" is a good answer. • Don't getinto a confrontation with the media. It may become the story. • Remember any statements made by company employees' an& or contractors that may in any way deal with root cause, fault or liability have the potential to negatively impact the corporate reputation. Page 16 of 43 Document #: 2.2 I Revision #: 1 1 I Revision Date: 7/21/2017 Lail) 1 . esr e '; 1` F )a, r r Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Incident Reporting 1.0 Application 1.1 Applies to all Discovery Midstream employees. 2.0 Definitions Environmental Incident — incidents with potential to adversely affect environment or violate environmental law or permit. Fatality — Any work related death while engaged in Discovery Iidstream business. This does not include death while traveling to and from work. First Aid — One time treatment and subsequent observation of minor injuries when those and only those treatments are administered and mentioned as First Aid per OSHA (See OSHA 29 CFR 1904.7(b)(5)00(A) through 1 04.7(b) (5)(ii)(N) for what OSHA considers First Aid.) Illnesses — . ,.n abnormal condition or disorder caused from anything other than Instantaneous events. This includes acute illnesses resulting from relatively short exposure tines. Illnesses may be caused in whole or in part, by exposures to chemicals, physical agents (egg. radiation, noise, extreme temperatures), biological agents, and ergonomic factors. Incident — Any event which causes or has potential (Near Miss) to cause personal injury, damage/loss of assets, environmental damage or hazard to health and/or safety of any individual. Injury ury — .An abnormal condition or disorder caused by instantaneous events such as cuts, slips, falls, etc. Near Miss — Any incident where the potential for personal injury, property damage, or adverse environmental impact was present due to an event which occurred, even though there was no injury, damage, or impact due to timing or distance. Stop Work — Authority and responsibility provided to all Discovery Midstream employees, contractors, and visitors to intervene or stop a task without fear of reprisal if any unsafe action or condition at the work site is observed. Vehicle Incident — Event or occurrence involving vehicle owned, operated, assigned, controlled, rented or leased by Discovery Midstream, including personal vehicles while being used for company business or subsidized by company. Work Related Injury of Illness- Injury or illness if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness. Page 17 of 43 Document #; 242 I Revision #: 1 I Revision Date: I 7/21/2017 r Document Name: Discovery Emergency Response Plan (DERP) aSection 2 a Incident Reporting and Management 3.0 Work -Related Injuries, Illnesses and General Incident Reporting Requirements 3.1 The following must be reported to Discovery Midstream Management for classification, input, and investigation within 24 hours of occurrence: • Work -Related Injury or Illness • Reportable Environmental Incidents • Property and Equipment Incidents • Near Misses Any other occurrences deemed necessary by Discovery Management 3.2 Discovery Midstream utilizes a third party company, "Employer Flexible" to manage the company's Workers Compensation Claims Program and Post Injury Support. 3.3 When any of the incidents mentioned in section 3.3. occur, the supervisor or lead person in charge shall complete the following: 3.3.1 Fill out and complete an Accident -Analysis Report (Appendix I.I)) within 24 hours of the occurrence and send to Discovery Midstream Management, Safety Department, and Employer Flexible, 14 Any incident requiring an employee to seek medical attention, will also require employee, supervisor, or lead person in chard to complete the following: 3.4.1 Fill out and complete the "Post Injury Treatment Authorization for Preferred Provider Networks" form (Appendix E) and emailed copy to risltheemployerflexibic.com or call "Employer Flexible Safety & Risk Main Line at 1-888-983-5881 to speak with live person. 3.4. 2 The employee shalt carry the completed form with them to the attending clinic hospital. 343 The employee shall complete the "Employees Notice of Injury" form (Appendix F) after being treated and when able to do so. 3.4.4 The completed form will be faxed to Employer Flexible at 281-377-7029. 3.5 x 11 incidents mentioned in section 3.1. will be investigated by a team of Discovery Midstream employees and EIIS department. Page 18 of 43 I r ; Document #: 2.2 _ Revision #: J 1 Revision Date: 7/21/2017 r Document Name: Discovery Emergency Response Plan (DERP) C Location: Section 2 — Incident Reporting and Management Incident Response General Actions The first person at the scene of an emergency may be faced with a complex situation. A "First Responder" should try to remain calm, exercise decisiveness, and provide assurance. A First Responder should take the following steps and improvise as needed: 1. Scan surroundings to ensure own safety and safety of those who may enter area. A general assessment of situation will help clarify actions required. If person(s) with injuries are present, contact appropriate emergency services (if necessary) and if comfortable, voluntarily treat injured person(s) to best of your training and abilities. 2. Evacuate people in immediate danger or with injuries if comfortable and if movement will not cause further harm. If willing, administer first aid, if necessary, per training. Arrange for traffic control as required. Be firm, explicit, and courteous with the public. Exert positive leadership and give instructions calmly. 3. Isolate and eliminate any sources of ignition, such as running engines, sources of sparks, etc. Check road crossings, public utilities, and overhead power lines for danger from possible fire. Shut down operations as needed. 4. Open or close valves as necessary, if it can be done safely, to eliminate the flow of gas to the affected area. 5. Contact your supervisor and Discovery Midstream Operations Center and give a brief overview of the incident and your actions. Based on Level of incident will determine emergency response plan going forward. 6. Maintain scene control until relieved by a supervisor or more experienced person. Use whatever actions necessary to safeguard all persons, property, and environment only when actions can be accomplished in a safe manner. Page 19 of 43 Document #: 2,2 I R vii ion #: 11 Revi ion Da# : 1 7/21/2017 Discovery Emergency Response Document Name: Plan (DERP) Location: Section 2 — incident Reporting and Management Specific Scenario Response The following specific events are considered pre -emergency guidelines. General Fire/Explosion/Wildfire 1. Activate facility or system shutdown. 2. Perform continuous monitoring and notify Discovery Operations Center 877-614-7183 or Fire Department 911. 3. If, and only if, fire is in incipient stage, personnel who have been trained in the use of portable fire extinguishers may attempt to extinguish fire using these devices. 4. If decision is made to use portable fire extinguisher, an evacuation of the area or building should commence in conjunction with these efforts. 5. In the event of a fire or explosion, personnel shall evacuate the facility. 6. If willing and trained, provide first aid to any injured persons. 7. Request emergency medical services (if needed). 8. If safe to do so, clear area of any persons, vehicles, etc. which may be affected by the emergency. 9. Request additional resources if needed (fire, police, or company personnel) to isolate area. 10. Evacuate using nearest and safest "Exit". 11. Proceed to your Designated Muster Area. 12. Do not return to the building/area until "All Clear" is given by Operations Department. Hazardous Material spill. 1. Perform continuous monitoring and notify your supervisor of the situation. 2. Take actions necessary to prevent the contamination of additional personnel and/or additional area or property. 3. Place barricades to restrict access. 4. Evacuate personnel from area. 5. User personal protective equipment to prevent contamination, 6. Provide first aid if needed. 7. Call additional resources if needed Mire department, emergency medical services, etc.). Tornados / High Winds 1. Perform continuous monitoring of the situation by contacting the National Weather Service, listening to radio, television and/or communicating with your supervisor. 2. When a tornado warning is issued, ensure that employees in the affected area are notified of the warning. 3. Determine what facilities, if any, should be shut in. 4. Determine where personnel should be "stationed". 5. Determine if vehicle traffic should be restricted. Page 20 of 43 I. I r rs V F rj ,, Document #; 2.2 I Revision #: 1 I Revision Date: I 7/21/2017 Discovery Emergency Response Plan (DERPN Document Name: Location: Section 2 — Incident Reporting and Management 6. Determine expected duration of the emergency. 7. Determine if personnel will be dismissed until normal operations are possible. 8. Determine if an alternate interim worksite / office will be used. 9. Address concerns for affected personnel (others in areas of the incident). 10. Have location personnel report to the designated area. 11. Account for all personnel on duty. 12. Be aware of your surroundings. 13. If your facility is damaged by the tornado / high wind, notify your supervisor. Winter Weather (Severe snowstorm, blizzards and / or freezing temperatures) 1. Perform continuous monitoring of the situation by contacting the National Weather Service, listening to radio, television andlor communicating with your supervisor. 2. Avoid unnecessary travel.. 3. Understand the hazards of wind chill which combines the cooling effects of wind and cold temperatures on exposed skin. 4. Blizzard warning include strong winds,blinding wind driven snow and dangerous wind chills, 5. Seek shelter immediately, if needed, and stay in contact with your supervisor. Pipelines Explosion or Fire near a Pipeline 1. Determine is a 911 call is needed. 2. Offer first aid to any injured parties. If the incident is reported by an outside person, the Field Supervisor shall be contacted immediately. The field supervisor or his designee will alert the Operations Manager in order to maximize response and ensure the safety of others working in the area. The Operations Manager will dispatch the Incident Commander and the closest Field Operator, team member, or authorized designee in the area to the site reported and attempt to identify the source of the fire or explosion. If a fire is present, the gas supply shall be shut in immediately, followed by isolation at the nearest block valves on either side of the site. Unless there is immediate danger to nearby personnel or equipment, the fire should be allowed to bum out on its own, unless the decision is made to extinguish the fire. 1. The First Responder / Operator shall: a. Monitor line pressure at delivery and receipt points and station sites. b. Close isolation valves to stop the supply of gas to the affected area. c. Ensure that no other persons enter the scene until it is determined to be safe by the Operations Manager or his designee. Page 21 of 43 r j 1 `'r QA ) i r r r Document #: 2.2 Revision It: I 1 I Revision Date: I 7/21/2017 r - Document Name: Discovery Emergency Response Nan (DERP) Section 2 —Incident Reporting and Management Location: 2. The Incident Commander / Field Supervisor shall: a. Travel to the scene and assume the Incident Commander role. b. Provide assistance in the event of an evacuation. c. Assist the Pipeline Operator or authorized designee with the preparation of a log of incident events and scene photographs. 3. The Communications Center / Operations Manager shall: a. Determine the need for notification of: i. Public utilities. ii. Additional team members if additional lines are to be shut in. iii. Corporate personnel. iv. Regulatory agencies. 4. Site Security a. Once the source of the gas has been shut off and the fire extinguished, the area shall be kept clear of all personnel. Once the area is determined by the operations Manager to be safe for entry by Discovery personnel, an investigation will begin. b. Once the area has been determined by the Operations Manager to be safe for long term entry by Discover personnel and contractors, work may begin on repairing the pipeline. 5. Returning to Service a. Upon completion of the repairs, the line shout be refilled at a rate that will ensure complete evacuation of any air within the line. The amount of time for purging will depend on the pressure used to purge, the location of the repair, and the amount or air allowed into the pipeline during repair. Purging shall be conducted in accordance with the purging procedures in the Discovery Midstream Gas Pipeline System Operations and Maintenance Manual.(eferenee Gas O&M 1501) 6. Investigation a. Once the initial investigation criteria has been met, and the area has been approved to be returned to operation, a thorough investigation of the cause of the incident shall be made and action taken shall be reviewed to ensure the effectiveness and continuity of the plan. Changes deemed necessary should be implemented as quickly as possible. Pipeline Leak / Unexplained Gas Loss 1. Initial Response for a Pipeline Leak: a. The initial response to any leak in the pipeline shall be to dispatch the nearest Pipeline Operator, employee team member or authorized designee to the site reported and to search the area reported for the source of the leaking gas. Responders should be aware of wind direction and low lying areas where product may settle and the respective hazards of each. In no case, will any person approach an area exceeding 10% LEL. b. Once the source of the gas leak has been located, the area shall be kept clear of all personnel other than those of the Company or of a Contractor. Once the area is Page 22 of 43 I``" F 9 Document #: 2.2 - 1 Revision #: 1 Revision Date: 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management secured, the leak shall be stopped by suitable means (i.e., Shut down compressors or isolate the leak through the use of block valves). 2. Initial Response for an Unexplained Gas Loss: a. The initial response shall be to dispatch an operations employee to the site suspected to search the area for the source of the leaking gas. b. If there is difficulty locating a suspected leak, the following steps shall be implemented: i. Shut down the line in question under pressure and watch for a pressure drop. Close intermediate valves to isolate leaking section. ii. Look for signs of damage to vegetation, wilted leaves, etc. iii. Use a probe bar to make holes above the line, taking care not to hit the line itself, and sniff the holes with a leak detector. iv. Using detection equipment, inspect the open end of casing vents. v. Obtain more sensitive equipment to perform a flame -ionization survey. vi. If required, shut down and isolate the line into sections and determine which section is not holding pressure. See the Discover Pipeline tactical Plan for valve locations. 3. Action to be taken a. Determine if a 911 call is needed. If the leak is in the pipe itself, and is escaping from a small hole or pit, the leak may be stopped with a repair clamp. b. After this temporary repair has been made, the line should be permanently repaired when conditions are safe to do so. If corrosion is suspected, a survey of the immediate area should be made to check the effectiveness of the cathodic protection in the area. c. If the leak is too large for a temporary repair, the system should be shut down, isolated from the stations, and the nearest isolation valves closed. The affected segment of line should then be blown down to atmospheric pressure and repairs made by qualified and approved personnel. 4. Returning to Service a. The amount of time required for purging will depend on the pressure used to purge, the location of the repair along the line, and the amount of air allowed into the line during the repair procedure. As each incident may contain unique elements, a plan for returning to service will be prepared for each incident, in accordance with the Purging Procedures in the Discovery Midstream Pipeline System Operations and Maintenance Manual (reference Gas O&M 1501). b. After the line is back in operation, a thorough investigation of the cause of the leak shall be made and action taken to prevent a re -occurrence. This may entail sending a specimen of the pipe from the leak site to an independent laboratory for examination, if the leak was due to failure of the pipe, a weld failure, or corrosion. If the leak was caused by third party damage, analysis may not be necessary. 5. The Pipeline Operator, employee team member, or authorized designee shall: a. Monitor line pressure at delivery and receipt points and station sites. b. Open or close isolation valves as necessary to stop the supply of gas to the affected area. Page 23 of 43 Document It: �;+ r 2.2 Revision #: 1 Revision Date: 7/21/2017 Discovery Emergency Response Plan (DERP) Document Name: Location: Section 2 -- Incident Reporting and Management c. Alert Company and approved Contractor personnel and dispatch necessary personnel, equipment, and material to the scene. d. Ensue that no persons enter the scene until determined safe by the Operations Manager or his designee. 6. The Field Supervisor shall: a. Alert Company and Contractor personnel to ensure the safety of those who may be working along the same system. Dispatch necessary personnel, equipment, and material to the scene. b. Arrange assistance for persons in the event any evacuation is required. a Establish and maintain communications with the Pipeline Operator on site. d. Repair the line and restore service as soon as possible. e. Assist the Pipeline Operator, employee team member or authorized designee with the preparation of a log of incident events and scene photographs. 7. The Operations Manager or their designee shall determine the need for notification of: a. Public utilities. b. Additional employee team members or other company personnel if additional lines are to be shut in. c. Regulatory agencies for incident reporting. Suspected Damage Due to Natural Disaster near Pipeline 1. Action to be taken a Following any natural disaster capable of causing damage to the pipeline or pipeline facility, an immediate check of the pipeline and pipeline facility for any unexplainable pressure loss, gas vapor or gas odor shall be conducted by the a designated Pipeline Operator, team member or authorized designee. b. In addition, personnel shall make a patrol of the entire pipeline route if the natural disaster has been of the magnitude sufficient to cause any local structural damage. e. If any leaking gas is found, the area shall immediatelyhmnediately be cleared of all personnel other than those of the Company or of a designated contractor. Once the area is secured, the leak shall be stopped by suitable means. d. The Field Supervisor or his designee will alert other company personnel as needed in order to maximize response and ensure safety for others working along the same system. e. If the leak is in the pipe itself, and is escaping from a small hole or pit, the leak may be stopped with a repair clamp. After this temporary repair has been made, the line should be permanently repaired when conditions are safe to do so. If corrosion is suspected, a survey of the immediate area should be made to check the effectiveness of the cathodic protection in the area. f. If the leak is too large for a temporary repair, the system should be shut down, isolated from the stations, and the nearest block valves closed. The affected segment of line should then be blown down to atmospheric pressure and repairs made by a qualified contractor. . Return to Service Page 24 of 43 re ...) i w' i Document #: 2,2 Revision #: I 1 I Revision Date: V 7/21/2017 0 i rit= Document Name: Discovery Emergency Response Plan (DERP) ter. Location: Section 2 — Incident Reporting and Management a. The amount of time required for purging will depend on the pressure used to purge, the location of the repair along the line, and the amount of air allowed into the line during the repair procedure. As each incident may contain unique elements, a plan for returning to service will be prepared for each incident, in accordance with the Purging Procedures in the Discovery Midstream Gas Pipeline System Operations and Maintenance Manual, (Reference Gas O&M 15O1) 3. Investigation a. Once the initial investigation criteria have been met, and the area has been approved to be returned to operation by Management, a thorough review of the incident and the responses made shall be conducted. Compressors Explosion or Fire at a Compressor Station 1. Determine is a 911 call is needed. 2. Offer first aid to any injured parties. If the incident is reported by an outside person, the Field Supervisor shall be contacted immediately. The field supervisor or his designee will alert the Operations Manager in order to maximize response and ensure the safety of others working in the area. The Operations Manager will dispatch the Incident Commander and the closest Field Operator, team member, or authorized designee in the area to the site reported and attempt to identify the source of the fire or explosion. If a fire is present, the gas supply shall be shut in immediately, followed by isolation at the nearest block valves on either side of the station. Unless there is immediate danger to nearby personnel or equipment, the fire should be allowed to burn out on its own, unless the decision is made to extinguish the fire. 1. The First Responder / Operator shall: a. Monitor line pressure at delivery and receipt points and station sites. b. Close isolation valves to stop the supply of gas to the station. c. Ensure that no other persons enter the scene until it is determined to be safe by the Operations Manager or his designee. 2. The Incident Commander , Field Supervisor shall: a. Travel to the scene and assume the Incident Commander role. b. Provide assistance in the event of an evacuation. c. Assist the Pipeline Operator or authorized designee with the preparation of a log of incident events and scene photographs. 3. The Communications Center / Operations Manager shall: a. Determine the need for notification of i. Public utilities. Additional team members if additional lines are to be shut in. iii. Corporate personnel. iv. Regulatory agencies. Page 25 of 43 r i I # ! F r Document ##: 2.2 I Revision #: 1 I Revision Date; 1 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management 4. Site Security a. Once the source of the gas has been shut off and the fire extinguished, the station shall be kept clear of all personnel. Once the area is determined by the Operations Manager to be safe for entry by Discovery personnel, an investigation will begin. b. Once the station has been determined by the Operations Manager to be safe for long term entry by Discover personnel and contractors, work may begin on repairing the station. 5. Returning to Service a. Upon completion of the repairs, the line shout be refilled at a rate that will ensure complete evacuation of any air within the line. The amount of time for purging will depend on the pressure used to purge, the location of the repair, and the amount or air allowed into the pipeline during repair. Purging shall be conducted in accordance with the Purging Procedures in the Discovery Midstream Gas Pipeline System Operations and Maintenance Manual. (Reference Gas O&M 1501) 6. Investigation a. Once the initial investigation criteria has been met, and the area has been approved to be returned to operation, a thorough investigation of the cause of the incident shall be made and action taken shall be reviewed to ensure the effectiveness and continuity of the plan. Changes deemed necessary should be implemented as quickly as possible, Plant Explosion or Fire at a Plant 1. Determine if a 911 call is needed. , Offer first aid to any injured parties. The Lead Plant Operator shall be contacted immediately. The Lead Plant Operator will assume the role of the Communications Center and will alert other company personnel as needed in order to maximize response and ensure safety for others working along the same system. Upon activation of the Emergency Shut Down (ESD) protocol, all personnel must report to the pre -determined location for a head count outside of the plant. This head count will be completed by the Incident Commander, or Plant Operator. Log entries of visitors will be utilized to account for all persons inside the plant. Visitors will receive training about alarms and mustering areas. Plant personnel should notify any adjacent operations of the current situation so they can act accordingly with regard to their own operations and the potential effect on our operations. The Lead Plant Operator or his designee should consider the effect of both shut down and continued operations of adjacent facilities. Page 26 of 43 i /r ` X119 \ 1 'ak r Document #: 22 I Revision #: 1 Revision Date: I 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Once the fire department and/or Lead Plant Operator has verified that it is safe for you to enter, employee team members may return to secure the plant and attempt to identify the source of the explosion/fire. 1. The First Responder I' Plant Operator shall: a. Open or close isolation valves as necessary to stop the supply of gas to the affected area. b. Alert Company and Contractor personnel. Alert adjacent operations. Dispatch necessary personnel, equipment, and material to the scene. c. Ensure that no persons enter the scene until determined safe by the Lead Plant Operator. 2. The Communications Center / Lead Plant Operator shall: a. Alert Company and Contractor personnel to ensure the safety of those who may be working along the sane system. Dispatch necessary personnel, equipment, and material to the scene. b. Provide assistance in the event of an evacuation. c. Establish and maintain communications with the Lead Plant Operator. d. Assist the Plant Operator or authorized designee with the preparation of a log of incident events and scene photographs. 3. The Lead Plant Operator, or their designee shall determine the need for notification of: a. Public utilities. b. Additional employee team members if additional areas are to be shut in. c. Operations Manager. d. Regulatory agency. 4. Site Security a. Once the source of the gas has been shut off and the any fire extinguished, the plant shall be kept clear of all personnel other than those of the Company or of an approved Contractor. b. Once the area has been determined by the Operations Manager to be safe for long term entry by Discovery Midstream personnel and contractors, work may begin on repairing the plant. Repairs may commence upon approval of Management. ement. 5. Return to Service a. As each incident may contain unique elements, a plan for returning to service will be prepared for each incident, in accordance with the Purging Procedures in the Discover Midstream Ft. Lupton Plant Standard Operating Procedures or the Operations and Maintenance Manual. b. Once the initial investigation criteria has been met, and the area has been approved to be returned to operation, a thorough investigation of the cause of the incident shall be made and action taken to prevent a re -occurrence. In addition, all phases of the incident, responses of various individuals and organizations, and results of the actions taken shall be reviewed to ensure plan effectiveness and continuity. Changes deemed necessary should be implemented asquickly as possible. Page 27 of 43 5 Document #: 2.2. Revision #: 1 Revision Date: 7/21/2017 ) Discovery Emergency Response Plan (DERP) • . 4 lit Document Name: Section 2 - Incident Reporting and Management Location: Medical Emergency First Person on Scene: 1. Do not move the victim. 2. Call 911 if warranted, 3. Call Discovery Operations Center 877-614-7183. 4. Give the following information: a) Your name and extension b) Name of victim c) Nature and cause of injury (if known) d) Exact location of the victim. 6. Notify Supervisor. 7. Assist victim as needed. 8. Whenever possible, have an employee meet external Emergency Response Services in a nearby area to lead them to the victim. 8. If you are exposed to blood during the emergency, notify supervisor. Note: Employees are not required to render emergency assistance. However, periodic cardiopulmonary resuscitation (CPR) courses will be offeredto employees that would like to learn this life saving pro cedure..n Automated External Defibrillators (AED) and First Aid Kit is located throughout the facility and may be used by trained personnel should they choose to do sot Page 20 of 43 Document ##: 282 J Revision It Jf 1 [ Revision Date:I 7/21/2017 Discovery Emergency Response Plan {DERP) Document Name: r I E r ,iV t Location: Section 2 — Incident Reporting and Management Spill Response and Chemical Release Discovering Party: If the Spill cannot be adequately and safely contained and cleaned up by work personnel 1. Clear all employees from the immediate area to nearest and safest assembly area. . Call Discovery Operations Center 877-614-7183. 3. Report the following information: a) Name and phone number of person reporting incident. b) Exact location of spill. c) Material spilled, d) Estimated quantity e) Cause of spill f) Current action taken for containment 4. DOC will contact Trihydro if spill cannot be contained and cleaned up by employees. 5, Notify Supervisor. 6. Do not return to the area until the "All Clear" is given by Operations Department. If a Chemical Release (Unfamiliar Odor) is detected: 1. Clear employees from the immediate area to nearest and safest assembly area, . Emergency Shutdown (ESD) will occur for whole facility or equipment. . Contact DOC 877-614-7183. . Report the following information: a) Name and phone number of person reporting incident. b) Exact location of chemical release or unfamiliar odor. c) when known provide identity of chemical released. d) Current action taken to contain chemical release or prevent employee exposure to unfamiliar odor. 5. Notify Supervisor. . Do not return to the building/area until the "Alt Clear" is given by Operations Department. Acoyry_Op erations Center: 1. Contact Trihydro if needed 800- 359--0251. 2. Contact appropriate Discovery personnel. Spill Response Personnel: 1. Assess the situation. . Obtain Safety Data Sheet (SIBS) for material spilled. 3. Obtain 90 Gallon Spill Clean-up Kit located at Operations/Warehouse Building (Appendix B). . Contain and clean up spill, if possible. Note: Employees are not required to perform spill response and should not attempt to do so if not properly trained. Page 29 of 43 ` T" IA ll Document #: 2.2 Revision #: f 1 j Revision Date: 1 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Natural Gas Emergency If You Smell Gas: 1. Do not attempt to locate the source. 2. Do not turn on/off electrical switches. 3. Do not use ANY phone inside the building. 4. Do not use an open flame or potential ignition sources. 5. Evacuate the building using Exit. (Do not activate fire alarm system) 6. Call Discovery Operations Center 877-614-7183 or Fire Department 911 after exiting the building to a safe location. 7. Proceed Designated Muster Area. 8. Do not return to the building until the "All Clear" is given by Operations Department. Discovery Operations center; 1. Contact Utility Provider. 2, Contact Director of Operations. 3. When needed contact Fire Department. Page 30 of 43 Document #: 2.2 i Revision #: 11 1Revision Date: I 7/21/2017 Discovery Emergency Response Plan (D[RP) Document Name: Location: -Y Section 2 - Incident Reporting and Management Bomb Threat If you receive a call or observe a suspicious object, Do Not Panic. Person Receiving the Call: Make note of the caller's manner of speech, accent, background noises, etc. Use the Bomb Threat Information form to document your observations after the call is completed. • Call Discovery Operations Center 877-614-7183 and report the threat. • Do not tie-up the telephone line. Stay at your desk so you are available for any follow-up questions. • Direct employees to leave the building and assemble in area that is away from the reported threat. Discovery Operations Center: 1. Notify Director of Operations 2. Dial 911 or Notify Police Department. 3. Notify Operations Lead. 2. Notify facility personnel Determination of Credibility: External Responders such as the Police Department will determine the credibility of the bomb threat based on information obtained during the call, along with results of the bomb search. The Police Department will search the building and make a determination of when it is safe to re- enter the buildin 'area. Page 31 of 43 Document #: 2.2 1Revision #: I 1 I Revision Date; 7/21/2017 Document Name: Discovery Emergency Response Nan (DERP) Location: Section 2 — Incident Reporting and Management BOMB THREAT INFORMATION CHECKLIST INSTRUCTIONS: Be calm, courteous, listen, and do not interrupt the caller. Date: Time: Exact words of person placing the call: Questions to Ask: 1 Where is the bomb right now? 2. What kind of bomb is it? 3. What does it look like? 4. When is the bomb going to go off? 5. Why did you place the bomb? 6. Inform caller that the building is occupied, and the detonation of a bomb could result in the death or serious injury of many innocent people. This may elicit a response as to the actual location of a device. 7. What did you say your name was? Try to determine the following (Circle or Check as appropriate): Caller's Identity: Male l Female Adult I Juvenile Approximate Age: Voice: i Loud ID Soft O High Pitch Accent: ❑ Local S Not Local Speech: ❑ Fast ❑ Slow IDistinct ❑ Deep ❑ Raspy E Pleasant ❑ Foreign S Region E Stutter ❑ Nasal ❑ Slurred ❑ Familiar ❑ Other: ❑ Other: ❑ Lisp IN Other: Manner: O Calm ❑Angry ❑ Rational Language: IN Excellent ❑ Good Background: O Trains ❑ Music Noises i Irrational ❑ Coherent ❑ Incoherent ❑ Fair ❑ Poor ❑ Quiet ❑ Voices O Animals ❑ Deliberate ❑ Emotional ❑ Righteous O Foul ❑ Other: Office Machines ❑ Street Traffic a Laughing ❑ Intoxicated [l Factory Machines ❑ Party • Other: Page 32 of 43 r 1 4,4 r" r 4)1r--. r i I Document #: 21 I'll Revision #: I 1 Revision Date: 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Aircraft Emergency EMPLOYEES: 1. Contact Discovery Operations Center 877-614-7183. Discover erations Center: 1. Contact Director of Operations. , Notify Discovery Leadership Team. 3. If required contact: U.S. Department of Transportation Federal Aviation Administration Northwest Mountain Region Denver Airports District Office 26805 E. 68th Avenue, Suite 224 Denver, CO 80249-6361 Voice: (303) 342-1254 Fax: (303) 342-1260 Page 33 of 43 C E i F. ) ` 1 Document #: 2 2 I Revision It: 1 Revision Date; I 7/21/2017 Discovery Emergency Response Plan (DERP) Document Name: Location: Section 2 — Incident Reporting and Management Inclement Weather (Tornado) 1. The Discovery Operations Center and Facility Operators will monitor weather broadcasts/bulletins on the Internet, Television, and Radio when changing atmospheric conditions may produce inclement weather. . If high winds are expected ensure unsecured items are either moved indoors or secured in some manner. 3. If a tornado is sighted within a twenty mile radius of the facility, Operations will notify employees of the tornado sighting and notify building occupants to move to a an internal room without windows (Le. bathrooms), hallway without windows, or designated shelter in place location. 4. Building occupants will remain in the shelter areas until the "All Clear" is announced by Operations Department. Page 34 of 43 lr s �' r r 4\ / ° ` / . / = Document #: 2,2 I Revision #: I 1 [ Revision Date: 1 7/21/2017 Document Name: I Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting - and Management Workplace Violence, Criminal Activities, Terrorism and Civil Unrest 1. Any employee witnessing or learning of an unusual occurrence that mist endanger personnel or encumber Company operations should immediately notify Discovery Operations Center 877-614-7183. 2. Employees should never take any action that endangers them or any other person. 3. Discovery Leadership will summon law enforcement personnel as necessary. 4. The appropriate course of action in response to civil unrest or acts of terrorism must be determined at the time of the event. Discovery Leadership will notify facility occupants of any directions received from law enforcement agencies, public health agencies, or civil defense agencies. Page 35 of 43 lel \ r I Document 1*: 2.2 Revision #: I. Revision Date: 7/21/20t7 Document Name: Response Plan (DERP) Discovery Emergency Location: Section 2 Incident Reporting and Management — Appendix A — Emergency Contact List re jirirrejy,::: prd ( EMERGENCY CONTACT NUMBERS - Discovery Midstream Operations Center (DOC) 1-877-614-7183 First Response Coordinators Office _ Cellular Cory Kline — Director of Operations (720) 378-6592 (970) 987-2527 Josh Bruce — Operations Lead (720) 378-6592 (970) 776-6851 _ Manya Miller — Manager of Engineering (720) 3 78-65 92 (970) 891-3884 Corporate Office (Dallas) Office Cellular Cory Jordan — Chief Operating Officer (COO) (214) 414-1980 (318) 272-1018 Corporate Finance Office (214) 414-1980 N/A Media Relations Casey Nikoloric — Ten/ 10 Group Office: (303) 433-4397 Cellular: (303) 507-0510 Fort Lupton Fire Detriment Emergency! 911 NonErncr 3en : d: (303 857-4603 Air Quality Division: Hazardous Materials and Waste Management Division: (303) 692-3100 (303) 692-3300 Water Quality Control Division: (3 03) 692-3500 USCG National Response Center Hotline: (8 0) 424-8802 Pipeline Emergency Health, Safety Environmental Law Enforcement Fort Lupton Police Department Emergency: Emergency: 911 Nan -Emergency:: (970) 356-4000 State Highway Patrol Emergency: Non -Emergency: Weld County Office of Emergency Management Office: (970) 304-6540 Emergency After Hours: (970) 350-9600 Adams County Office of Enter cue r Man ►, enle m Office: (720) 523-6600 Emergency After Hours: 911 Coman United Power: (303) 637-1300 E-470 Public jhwa.y Authority Non -Emergency: Justine Brown (3 03) 5 37-3 751 jbrown@e-470.com Chuck Weiss c eiss t ca470.com Emergency: (303) 537-3409 Page 36 of 43 Irr Document it: Document Name: Location: 2.2 Revision it: 1 Discovery Emergency Response Plan (DERP) Revision Date: Section 2 — Incident Reporting and Management 7/21/2017 Appendix $ - Discovery Gas Plant Muster Area Map .111 1111 a -?- i%tit A elu Of al -r Jet w r1 1 • E PIPE ¶I Tf9i•ras, Ziff * .r 6 h S • • • a I - a • 42. Preoritrftry 4rlhlft Mvt r"9a►rrw3 s,, ar**01 sa W Ma tor tirli- r26-4' %MC *I _ -o E ` T r . _t _ r"i-ro C LP' 14J O4tPJ rNIR • r TI ORJM er MI6 Part a - A - z�N . Pr•! *Jr, .*fie.ITTI "a'A. 6r1rt.A PK Firs Estinguisker tCO2 lira ErtincuS i *r `LEGEND Spill kit spin Kit Wind Suck Wawa Musser Arse i a I ref. ah dote i avrt!•y: rr.a 1 _• u E _swam • Mh- ?VIVA alSkilirlellY net ia:4120Mr. 2864. 1.S.4-14: art is rb•uy -,q. ON. •d•1� :4• _a a 4-4, Pe -array- a —ate 1 { - DISC 0 VERY r'+•9R'rM - - 11.+O�i r 16J r rrOttI Pa S • tit '4 'r tr, il rain 111.1441 y• aLe d` air i4 IS Loarariryy weir a TillaCniall +i a • mranis a masts e itilaa1►f• E1611a e�r7 r ea' • In al' in ■ r"4 44134.21 V1 ulwa tf_ • +, k • i. j .4. I • •• +a. f VOL 1e P. C, es A Sae 1T r . { a 44 i a i >a�• • a ] sa as Cie rrs as I. .r... woe at a+a Se • i MIS •-aa .i✓t • • ■ a M a"- •�. QI!.. #.T>•— - e ' t e • a i II • wor refillalarbe a •;, - - ea 1�+_ : fiiili 1., 9I 1 IV i r,1r1 Etri 1 1-: I 1t+ I I I I I f 1.1! T '6•:r M P % a' t a••ipl r`t" Cr Sri Ffj{ nt it- e•Cweiworirr 4, r••• • e S a I• • + Page 37 of 43 a. 1+ a A t CatelliFetVireli• ' ari a•a .vim• rrifrlen ssa- Ewer trcrtr MIL.. Cal_ aN • ill y • um_ IT/ i•K4.4•Qe1r41f 7 FtWITiMT, TUT hTT PG IC, o_. - ^ u�.►YaCI^' '• k r, it a ••a0 INCIL •nT rusts- ei gun vs ris G7•s; Ifritrres Srevs, , •r a • SIT Wife 4 a7¢ rr a 4 S 6 r. 4. a, 0-1 Document #: Document Name: Location: 2.2 _ t Revision #: Discovery Emergency Response Plan (DER!) Section 2 - Incident Reporting and Management 1 Revision Date: 7/21/2017 Appendix C — Discovery CDP Muster Area Map • i Pd aa.4,an t —r 1 I i 4..t : caps'k�.l•R r o•aat .a�a4 IllUltpliamstippe 444 •�f — moos — e �. as+a*sn, -a--- a ZIIIPOMPIC aeaa. pales a. —ease fir irai-flaimina • •'-•••• n rot a aeir _-.s- iaresia•i+Vi ••••••••••* ant •ti!•Yi•at ad DISC O VERY a >• s- as ..r, c. S 01/24,41 3 IrleYellanalt W *a 'A V' -s: a �• —r ra iSIMS na-- S10'T --a -sr I\ *V•a anti,.• ---S $ i eleha elela a • ea - an ea_ fie •tie` • Slat Yet runs Cats 411 `4ry1 jl cs i 1l ...: • Imet+4•,a n !MIN •P• Pr Otaroma. ape i ir' t •', tr b. _ •I I a.i+wry!• PiaR r •.1fi•' '•I- Are a2. R a ea r•• a. • .54 II iiiatit. iIMi�r .r. MISS s• s.. • gdftema ass matt S MSS iiyy i } is 6:joy BILVICTIVIC WW"G 14"4— •I t "DS ar'�• ••M.IT elan Wer. WWI L4 .. Sy.. if — Amass Ilet et re -aa;K an Mr' asiar easeffrali lassaltintsgre t1in.s awl DIG O ERN IP* •_ - - : _ o -'1 14.1 re K Piro Extingulaaher tCO2 Firim grankkirobavar LEGEND wn Muster Ara ti ZION ENGINEERING,. LW a•aas Slomm•••w •.r .,c imeimene UGC Y•,. � hn::L ,..I -V" me JJJ SECE 5, i. a1_ 110 PROJET.T ittittrapt 0=-44 OYEAAu. 9-E Fits' %%me v c A �Ord 1604 64-1100 1 Page 38 of 43 Document #: 2.2 Revision #: 1 Revision Date: I 7/21/2017 Discovery Emergency Response Plan (DERP) Document Name: Location: Section 2 — Incident Reporting and Management Appendix D - Accident Analysis Report (Example — Page 1) e Employer Flexible Report Only ■ Impact what matters - Seeking Medical Attention Accident -Analysis Report Workers' Compensation claim number: OSHA 300 caselfile number: PART 1: Identification Information Employee name: Date of accident: Occupation: Department: Time: Shift: Last 4 of Social: a.m. Q p.m. Q PART 2: Supplementary Information Company: Mailing address: City: Telephone Establishment location (if different from above) Accident location If Other, Specify: Employee name: Employee address: Telephone ■ State ZIP code: Same as establishment? Q Other Location? (Check if applies) City: Does the Employee Speak English? ■ Yes fl No State: If nor Specify Language: Was injured person performing regular job at time of accident? Length of service in current position: Time shift started: a_m. Name of Witnesses: Name of physician or clinic: Address of physician or clinic: U ■ p,m, �] Yes ■ No ZIP code: Length of Service in Occupation: Witnesses? • Yes O No City Fatality? ■ Yes • No If yes, date of death State ZIP code Page 39 of 43 ) �! Employer Flexiblee' Document Name: Location: 2,2 1 Revision : 1 Revision Date: 7/21/2017 Discovery Emergency Response Plan (DERP) Section 2 — Incident Reporting and Management Appendix D — Accident Analysis Report (Example — Page 2) Impact what matters" Accident -Analysis Report PART 3: Description and Analysis The description should include important event(s) that led up to the accident, injury or illness. They should describe the nature of the injury or iirness, the body part affected, specific tasks being performed„ what specific equipment or substance was directly involved (include name or brand), where the work was being performed. whet specific task was the employee performing (was time a factor?), and what general type of accident occurred, Include weather/environmental conditions if necessary. Attach photos of accident scene, machinery equipment and/or police report numbers as well as additional description pages as appropriate,. Description: PART 4: Training Did employee receive stiecific training or documented instructions relating to safety and health on the task(s) being performed? ■ Yes DI No If Yes: Type: Instructed by: When instructed: Attach appropriate training documentation. Length of training: Page 40 of 43 u net' 4_)‘,/ Document #: 2.2 Revision #: 1 Document Name: Discovery Emergency Response Plan (DERP) Location: Revision Date: Section 2 — Incident Reporting and Management 7/21/2017 Appendix E — Post Injury Treatment Authorization for Preferred Provider Networks Form (Example - Page 1) Post Injury Treatment Authorization for Preferred Provider Networks e Employer Flexibl& Impact what matters" Injured Employee Information Name: Last 4 of SSN: DOB: Patent must resent photo ID at time of Service Employer Information Company Name: Client Number: Company Address: PEC/Third Part Administrator (TPA): Employer Flexible —WC Iniurq Protocol Authorized by Phone: Date of Authorization: Title: After Hours Phone: Due to the nature of these specific services, only the patient Work Related Physical Examination and staff are allowed in the testing/treatment area, Please Date of Injury: alert your employees so that they can make arrangements for children or others that might be accompanying them to the medical center. Substance Abuse Testing Post -Accident Type of Test Non -DOT -b0 panel Hair Collect BreathAlcohol Page 41 of 43 r 4", ,1 # 4) \ r., I Document : # ' 2.2 I Revision #: I 1 I Revision Date: I 7/21/2017 Document Name: me: Discovery Emergency Response Plan (DERP) Pj Location: Section 2 — Incident Reporting and Management Appendix E -- Post Injury Treatment Authorization for Preferred Provider Networks Form (Example a Page 2) Special Instructions/comments, Company has modified duty available. Please be advised that company prefers over the counter medication vs. prescription medication due to OSHA recordkeeping requirements. Billing: Refer to Employer Flexible WC Protocol Attn: Lynn Dollins Phone: 281.377.7604 Fax: 281.3 77.7029 Employer Flexible Safety Et Risk Risk Main: 1.888.983.5881 riskoemoloyerflexible, com Page 42 of 43 I UfI "" \ r Document #: 12.2 Revision ##: j 1 Revision Date; 7/21/2017 Document Name: Discovery Emergency Response Plan (DERP) Location: Section 2 — Incident Reporting and Management Appendix F — Employees Notice of Injury (Example) Employees Notice of Injury 7850 North Sam Houston Parkway West, Suite 100 Houston, Texas 77064 Phone: 281 a 377.7604 Fax: 281.377,7029 Employee Name ila5t, first., rnsddlef Social Security x: Phone: I Street Address City State Zip Code State where employment agreement vas made: Average weekly wase: Length of employment; Months Years Occupation: Date of Accident of Last Exposure: Time: AM PM Place of Injury: City)County/State Body Parts Injured: Describe in detail haw the injury occurred —I Traatirrg Physician {full namel: Address: City: State: Zip: Job site location: Na:ma of Co -employer Are you a previously impaired person due to prior workers' compensation injury or obvious pre-existing disability caused by accident, disease, birth defect or military injury that may impact the treatment of this injury? if "Yes", please describe: Date; Description: Physician - Any person receiving temporary disability benefits from an employer or the employer's insurance carrier shall promptly report in writing to the employer or Insurance carrier and change in material fact, or the amount of income heishe is rece"ving, or any change in his, her employment status, occurring during the period of receipt of such benefits. 1 declare under penalty of perjury that I have examined this notice and claim, and all statement contained herein, and the best of my knowledge and belief, they are true, correct and complete. Any person who ccmrnits workers' compensation fraud, upon conviction, shell be guilty of a felony. Upon Filing this Notice of Accidental Injury and Claim for Compensation permission is given to the Administrator of the Workers' Compensation Court, the insurance Commissioner, the Attorney General, a District Attorney, the insurance adjuster or their designees authorizes them access to medical records, including waiver of any privilege granted by law concerning communications trade to a physician or health care provider or knowledge obtained by such physician or health care provider by personal examination. The information authorization for release may include information, which may be considered, a communicable, or venereal disease which may include but not limited to diseases such a5 hepatitis, syphilis, gonorrhea, and the human immunodeficiency virus, also known as acquired deficiency yndrome_ Signed this Employee Signature day of - - Printed Employee Name This form constitutes a medical authorization far release or medical records. Nothing shall be constructed to waive, limit or impair any evidentiary privilege by law. Employer Flexibl& impact what matters' Employer Flexibly Copyright 2013, All nits reserved Page 43 of 43 6 VERY PARTNERS Revision 1.0 Revision 3/8/2018 DISC MIDSTREAM Document #: #: Date: I Document Name: Decommissioning Plan West Brighton Compressor Station Location: Decommissioning Plan DISC � VERY West Brighton MIDSTREAM PARTNERS Corn preja r Station_ Preamble Discovery DJ Services, LP (Discovery) is committed to minimizing impacts from current and future operations. In the development standards for the West Brighton Compressor Station UR####, the Weld County Board of Commissioners requires an orderly decommissioning of the facility. Such decision to decommission is only expected in the event long term sustained site operations cease economic viability, as determined by the operating Company. Development Standard No. 22 states! "The applicant shall maintain compliance with the approved Decommissioning Plan." Discovery, as the operating Company, has developed this Decommissioning plan to achieve such compliance through a combination of applicable equipment and structure removal, engineering measures, and site reclamation procedures specified by the CO cc , DISC V RV Document #: Jievision #: � 1. i� �RevisionDate: R 3/8/2018 Document Name: Decommissioning Plan MCDSTREAM PARTNERS Location: West Brighton Compressor Station TABLE OF CONTENTS Preamble . a ... -*44t..4.•i*floiB****.la.i****••* isfil.ile•....efil4P PIDs.a.®i.f.e.a..ierni..s..a.lie***;. 1 Table of ontents ...P....•.......ii..*ai „ii:ii.ii **.4.**PO Purpose•i•..i•...u...itui*�r.....rf..**8 4****..a..a4* **44****4!..939P9994 Scope •...•i••.•i•••iii•• ...■.a a a a.■..alga* 4*°Pi...!**4+6.i..Lf***.5.ii**14*Fiiiiiii**04kiiiiii.ir* suer ..... amass .........i.. Definitions......*•.+*...s.w.wfi........r**.....r..r0........ii** Responsibility•alsiif01**P.5.5if44F@a5i44444}F54444444665iii*4.rt ii6mr..i.it7.+lil.a.i ' uidelines•••••..ii•••i••••i..• Document Management Log ....•.•..m. U 444444`P.4$45144!4lb4}.FFF5ei.#t44FF04444*F44rm 2 3 3 *P.i...a11111tLPass 3 .■•.. uses m r.. a........W■ eel Weir .ifi..ili. 3 1 Mtn 1.0 Revision Date: 3/8/2018 DISC VERY MIDSTI EAM PARTNERS Document #: Revision #: Decommissioning Document Name: Plan Location F West Brighton Compressor Station Purpose Satisfy the Condition of Approval addendum to Weld County U R##-#### requiring County review and approval of the West Brighton Compressor Station Decommissioning Plan. Scope Upon review and approval, this document identifies the minimum acceptable conditions for complying with the referenced Development Standard Weld County USRM4-144/444. Definitions Company shall mean Discovery DJ Services, LLC, the local operating company of Discovery Midstream Partners LP, their affiliates or successors. Decommissioning shall mean the removal of an obsolete facility or site from active service and the return of land conditions to a reclaimed state. Site Reclamation shall mean soil stabilization in such a manner as to minimize erosion of disturbed areas to the extent practicable, including but not limited to such disturbed areas being built -on, compacted, covered, paved, or provided more than 80% native vegetative cover. Responsibility The Company's Vice president of Engineering will have the overall responsibility for ensuring plan implementation following the Company'sdecision for complete facility Decommissioning. Guidelines 1.0 Company Decommissioning Plan • The Company will ensure aboveground piping and equipment are depressurized, purged, drained and removed oved from the site. • The Company will ensure below grade piping and utilities will be drained, purged, capped and abandoned in place. • The Company will ensure aboveground structures and buildings are removed from the site. • The Company will ensure concrete foundations and screw piles that protrude aboveground are cut to grade level and abandoned in place • The Company will ensure paved sidewalks, roads, and secondary containments are removed from the site. • The Company will ensure fuels, lubricants, chemicals, and wastes are removed from the site for reuse, recycling, or disposal by a licensed contractor. • The Company will ensure electrical systems are de -energized; and above grade electrical equipment, panels, wiring, and conduit are removed from the site, • The Company will ensure below grade electrical conduits and duct banks are capped and abandoned in place. The Company will ensure Site Reclamation through the re-establishment of vegetation using native grasses in accordance with local and/or state guidelines. Document #: a Revision #: 11.0 Revision Date: 1 3/8/2018 DISC VERY MIDSTREAM PARTNERS Document Name: Decommissioning Plan Location: West Brighton Compressor Station Document Management Log AUTHORS This document was prepared by: Name Title Compliance Manager Asset Phone Email VERSION HISTORY / CHANGE LOG REVISION RECORD APPROVAL SIGNATURES Version apt Version N Description of Change / Remarks Name #� i of �� Approver Signature 2/7/2018 1.d Initial Draft and Review M Norton DRAFT " Incorporate final draft edits for .L2/ r 12/ 1 1.d publication Al Nor Flo tort DRAFT L 3/9/2018 140 Incorporate __publication, county preamblevr edis for final NA Norton ,rierk__ , r V Hello