HOUSTON -- Documents in a potential lawsuit against BP PLC stemming from a fatal accident at the same Texas City plant rocked by a deadly blast last week offer a glimpse of the fine line between life and death in a petrochemical industry fraught with hazard.

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An internal report compiled by BP after a burst of 500-degree water fatally burned two workers in September said inadequate safety procedures, faulty assumptions and lack of training contributed to the accident caused by a valve left open by just 2 inches.

The company has implemented or is implementing worker training and policy changes to prevent a reoccurrence of the September accident, BP spokeswoman Marti Gazzier said Saturday.

Representatives of the Paper, Allied-Industrial, Chemical and Energy Workers International Union were unsure whether the measures had been implemented.

But BP is contesting a $109,500 fine imposed earlier this month by the Occupational Safety and Health Administration for safety violations unearthed during the agency's investigation of the double fatality.

OSHA also imposed a $63,000 fine on the refinery for failing to protect employees from a nonfatal chemical release and fire on March 30 last year, but the agency agreed to settle for $13,000 for that incident.

BP produced the confidential report of its internal probe of the September accident during a court hearing in Galveston County on Wednesday, the same day the nation's deadliest petrochemical accident since 1990 killed 15 people and left more than 100 injured at the Texas City facility.

Wednesday's accident happened during maintenance work -- a so-called turnaround period -- in an area of the refinery that boosts the octane level of gasoline.

See More Pictures Of Texas City Plant Explosion

"How this relates to the present explosion, we don't know yet, but they were clearly in shutdown mode," said Richard Mithoff, a Houston attorney representing the widow of Raymundo Gonzalez, who died about two months after the September accident left him with severe burns on about 70 percent of his body.

Mithoff is seeking a Galveston judge's permission to conduct depositions in a possible lawsuit against BP and its Texas City refinery.

Officials said it could take months to find a cause for the blast, which is being investigated by various federal agencies and the company. The U.S. Chemical Safety and Hazard Investigation Board said investigators could enter the explosion site as early as Monday.

About 1,100 employees and 2,200 contract workers were on site when the explosion occurred at the 1,200-acre plant near Houston.

About 70 workers and 30 area residents were treated for injuries. Of 12 people remaining at three hospitals Saturday, five were in critical condition and the rest were in good or stable condition, hospital officials said.

The plant processes 433,000 barrels of crude oil a day and 3 percent of the nation's gasoline. Areas of the refinery unaffected by the blast continued to run normally with essential employees; contract workers were to return on Monday.

According to BP's analysis of the Sept. 2 incident, three pipefitters were repairing leaking seals on a water pump when a seal broke loose as one of the men drove a wedge between two flanges. Water under 630 pounds of pressure was released, immediately followed by superheated water and steam from a boiler.

The water severely scalded the three men when a check valve was blown loose from the flange connection.

Leonard Moore Jr. suffered burns on 90 percent of his body and died two days later. Gonzalez died in November, about a month after BP compiled its report. Robert Kemp survived.

The report said the men assumed the check valve was closed, and their view of the two-inch opening was partially obstructed.

The company cited improper decision making and poor judgment as a factor, but also said its policies and training didn't specifically address the potential hazard above valves. A previous rule that had been inexplicably removed called for bypasses around the valve, the report said.

The report recommended an update to policies for rules and equipment procedures, worker training and testing in those procedures and a requirement for bypasses and bleeder valves on pumps like the one the men were working on.

CSB spokesman Daniel Horowitz said incidents involving maintenance work was a common thread between Wednesday's accident at the Texas City facility and two other fatal refinery accidents that prompted major investigations by the board in the last seven years.

In those cases, a July 17, 2001, explosion at Motiva Enterprise LLC's refinery in Delaware City, Del., killed one worker and injured eight when a spark from carbon-arc welding equipment ignited flammable vapors in a sulfuric acid storage tank.

The other involved a Feb. 23, 1999, fire at Tosco's Avon refinery in Martinez, Calif., that killed four and injured one when workers tried to remove and replace a leaky petroleum pipe attached to an operating oil distillation tower, Horowitz said.

All 15 Victims Identified, Names Released

All 15 workers killed in the BP refinery explosion in Texas City Wednesday were identified Friday as federal investigators began searching for the cause of the fiery blast that also injured more than 100 people.

A married couple who recently moved to Texas City were among those killed in the Wednesday blast that shot flames, black plumes of smoke and metal fragments into the sky. Ten other men and three other women were among the dead.

Those confirmed dead are Morris King, 52; Larry Linsenbardt, 58; Ryan Rodriguez, 28; Larry Thomas, 63; Susan Taylor, 33; Eugene White, 53; Kimberly Smith, 43; Daniel Hogan, 58; Rafael Herrera, 27; Glen Bolton, 50; Jimmy Hunnings, 58; Linda Rowe, 47; James Rowe, 48; Lorena Cruz, 32, and Art Ramos, 59.

"At this point, we are moving from a recovery phase to a stabilizing phase at the plant. What that means is that we will continue working with the families, providing counseling and pastoral care and other support as needed," BP spokeswoman Marti Gazzier said.

Lorena Cruz's family was one of the last to be notified. They were told Friday morning that their daughter and sister died in the explosion.

"She was a go-getter. She decided that she wanted to go out and go to work. She wore a hard hat to work and never let boundaries stop her," Cruz's brother Onorio Villareal said.

Villareal told Local 2 that he blames BP for his sister's death. Before the explosion, he said his sister was moved into an administration trailer and that she thought her life would not be in as much danger.

"She came home and bragged, 'I'm safer now, mom,'" Villareal said.

Becky Hogan lost her beloved husband, Dan, who died on what was supposed to be his last day of work at the refinery.

She said the hardest part has been explaining it to her 4-year-old granddaughter, Casey.

"She's wailing and I said, 'Casey, you know the song Jesus Loves Me that you and grandma sing?' And she said, 'Yeah, yeah, Grandma, I know.' And I said, 'Jesus loves you and Jesus loved Pa and Pa went to live with Jesus in heaven,'" Hogan said.

Her friends and family said Hogan is helping them cope with the tragedy due to her strong faith.