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tl!911,"Ibow,. v». plugs. unions. pipe C3p~. or rClduc~TJ;
fittings. Includirtg coupli~s,
FI"ngBs;
AND LA8RADOR
NO~THWEST TERRITORIES
Dl" FITTING
CATI:C;;ORY
NEWj:OUNDLAND
f:l~INCS EDWARD ISLAND
03 25
P003/026 F-0r50
i-543
3025663133
INC
NOVASCOTlA
YUKON
New BRUNSWICK
PAGE
DEL PUBLIC SAFETV
902-424-3239
FROM-ALI CEJllTRAL
11.'1412005 12:12
1111
f1!1"rlO'
all line v<llves
IhIIVA1'l;
911lype~
SIr~lners. fillers. separalors, :md ~teom Irll'S
.
.F Me1llluring devices. inclucllnQpressure l)auges. level g3uges.,~i!ilhl gIM~~3, levels. or
e
E~p<)l'lgtor"ljOll'ltt. lIEl~I\)(e COl'lnBetlons. anll hMI! '~MmbliM;
IlTessura"lrllTlSmll'lors
G Certffied capacity·rated p~llBurB rel/ef devices acceplable ~~ "rim",1'11ever pre~"tJre protactlon on
boil~~, pressure vesqell>, piping and fu~fbl~ plu"ll
H Pf9ssure ret9i"mQ COI'I'IIlO"!ll'ltlllhat dO nOI (alf into one of lh~ ~"ov" Ollh:gorl!!1'l
N Nuclear ",mponeo\!!.: CIM~ 1 0 Clan 20
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e
UFACTURERS
Class30,
(Meeling AECe orAGMS rolllilromcnts)
I'lK OR LOGO
AS 1''' WH.l. A 'P
r"''''r-.ll''
DUCT
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FORG60 ~el.OF.p
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DES~RIa'E
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ME!N AIION
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50
Pt.
if KJ,..{8 uE.
113~
OF THE ACTUAL ITEMS ro BE REGISTER EO;
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AND I
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I'''.MI. ~I~mployod by ~SlrnJ
1Jd().v~d
being lne person having full aulhority ~nd
l1uall1y of tne end product do solemnly declare that lhe inforfMlion contained In tht:l form II! true I"Jnd10 the best of
reSllon\:il:lilily for Ii'll!!
my Knowledge reprl!l&l!lMtS 1M product for wnlch registration 1$sought The dimensions. materials of construction, pressure
lemperalure ratings. and Identlflcation markln~s are in ~QeorClQnc~with the h~r'!in named standards. I further declare Ihatlhe
m~nuf!letur~ of these fitllngs Is regltted
by iil Quality Conlrol Program which extends1tl each ptsnt where fabrlcetiOrl occurs in whO!!>
or in part and hal; 109M vgrlfl~d by ~
~~Jlll,j
as being suitable for that purpose and I make tnis solemn
dectaration canscisntiously believing it to bs lrulil. and knowing thtlt It io of the same forco lind effect as If made under oalh.
? t{.:.cJ-l..-
Signature of Declarer: ~
OI!!ClIDfCd
This
bel'ore me al
..J ?Jf4.-
day
~~bA-t.
n-
"1-:m-~
Commissioner
of Oaths
or Notary Public: (sign)
AD
2J!;r::;b
~!~
.':1~--~-~(AlIlI( OHlcf,1
~!!~I te
the rl~ht)
T!\i; SO:lCll for Regulatory
b,ull'lor:ly ur.C!
This regiSlratlon mll!:l be revalidOltlld aftl;!r len (10) yl;';lra from lhe~"p~";l1f.~~:Jt9I~~
eRN:
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Notes.
1. All roUlng5shell be registered In lhe nllme of [1\8 M3llulaeturer.
2. F."r:h e:lfagf.lTV ~1'I:l1IbO ~UPflCItM with lINe SIAtutOryDClOIIHlltIO"
torrns and one copy of su~po"inll
documenllliioll.
Do. teJ~'i.·_·IA/·D..Io.-..•
C.R.N.. O~J~~~·,~~··········'········
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3. TM doclQr<)llon sMIl be mide by ll1e person having lull authority 'In':
1lI~"onr.itlility lOf llle qUl\Iil¥ of thO allIS produel.
4. QUBllly control prog~ms shall bEl resuomiltP.<l fOr validalion
01 II I'II'Il!u:lmum Int"IVIII of fllte (5) years.
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Sign2~_.~
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