STATUTORY DECLARATION Registration of Fittings

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Asher Denis Payne
5 years ago
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1 TECHNICAL STANDARDS & SAFETY AUTHORITY 14th Floor, Centre Tower 3300 Bloor Street West Toronto, Ontario Canada M8X 2X4 Show facsimile of manufacturer's logo or trademark, as it will appear on the fitting, in the space below OR CEO ERNST FLOW INDUSTRIES JACOBY TARBOr A PRODUCT or CLARK-RE.Aucc 114. CLARIC ANCir COMPANY i Steven R. McGuigan, Research and Development Manager of The Clark-Reliance Corporation (Name. Located - at STATUTORY DECLARATION Registration of Fittings (Name and Position, e,g. President, Plant Manager, Chief Ertgineer) of Manufacturer) Foltz Parkway, Strongsville, OH US/A +1 (440) (Pl,3nt Address) (Telephone No,) (Fax Na) do solemnly declare that the fittings listed hereunder, which are subject to the Technical Standards and Safety Act, Boilers and Pressure Vessels Regulation, comply with all of the requirements of ASME B31.1, B31.3 (Title of recognized North American Standard) which specifies the dimensions, materials of construction, pressure/temperature ratings, identification marking the fittings and service; or are not covered by the provisions of a recognized North American standard and are therefore manufactured to comply with as supported by the attached data which identifies the dimensions, material of construction, 1 pressure/temperature ratings and the basis for such ratings, the marking of the fitting for identification and service. I I further declare that the manufacture of these fittings is controlled by a quality system meeting the requirements of IS09001:2008 which has been verified by the following authority, HSB Registration Services i The items covered by this declaration, for which I seek registration, are category F type:rigs. In support of 1 this application, the follovianizi information and/or test data are attached as follows: ISO Certificate, CSA Certificate, See index of attachments page To the best of my knowledge and belief, the application meets the requirements of the Technical Standards and Safety Act, Boilers and Pressure Vessels Regulation, and CSA Standard B51 and is accepted for registabon in Category F CRN: SA -o (09 T55( (drawings, calculations, test reporis, etc) I Declared before me at i to6 3 3 ro L.--, z P in the N3-1-- of blft the 3_4/1 day of 1A.-- AD 20, i Commissioner for Oaths: I (Pripted nam,_.% (Signature of -r ) 1 1 ) '. e. MY T -T.1 FYPIPP v o i Registered by: Dated: eqc-.12ji sre-s -i60 &A.) SA-- NOTE: This re.istratlon ex es on *NOTE: 1) See the attachment for the scope of mg! 2) This CRN is replacing expired CRN 0F282

2 Jacoby-Tarbox Scope for CRN See attached order sheets for Model code Correlations and Calcualtions Bullseye Style Products 100-ST, 200-ST, 300ST 100-SA, 200-SA, 300-SA S-100HPA-CL3, S-200HPA-CL3, S-300HPA-CL3 S-100HPA-CL6, S-200HPA-CL6, S-300HPA-CL6 S-100HPA-CL9, S-200HPA-CL9, S-300HPA-CL9 S-100HPA-CL15, S-200HPA-CL15, S-300HPA-CL FA, 608-FA, 935-FA F-910HPA-300, F-608HPA-300, F-960HPA-300 F-910HPA-600, F-608HPA-600, F-960HPA-600 F-910HPA-900, F-608HPA-900, F-960HPA-900 F-910HPA-1500, F-608HPA-1500, F-960HPA LR, 90-LR3 Note: 100, 200, 300 model codes use the same pressure bearing components. The difference is an internal indicator only which is nonpressure bearing. 100 = Flapper, 200 = Drip Tube, 300 = Rotor Note: 910, 608, 935, 960 model codes use the same pressure bearing components. The difference is an internal indicator only which is nonpressure bearing. 910 = Flapper, 608 = Drip Tube, 935 AND 960 = Rotor To further explain models above: 100, 200, 300 bodies have threaded end connections. 910, 608, 936, 960 have flange end connections. Wall thicknesses for comparable models are the same regardless of the end connection style or internal indicator style. Example: S-100HPA-CL3 AND F-910HPA-300 have the same wall thicknesses. The only difference is a threaded ends versus flanged ends. Glass Tube Products 805-S 830-F 4000-S Sight Windows Weld On Windows W COMM 5200-PVQ, 5200-PVQ PVQ Bolt On Windows 5005-DWA, 5005, 5005-DVVA-300, 5005-DWA Thread On Windows S-5100 Hygenic Hy-Sight UniSan coresa ATTACHMENT TO -OH Signed: 178RexdaleBoulevard,Toronto,011 Canada IVI9W1R3 Materials of Construction: All Metals used are ASME B31-1 and/or B31-3 Glass will be Borosilicate (annealed or tempered as applicable), Quartz, UniGlas

3 HSB REGISTRATION SERVICES 595 E. SWEDESFORD ROAD WAYNE, PENNSYLVANIA Certificate of Registration This is to certify that: Clark-Reliance Corporation Main Office Foltz Parkway, Strongsville, OH Foltz Parkway, Strongsville, OH Innovation Machining Center 5656 Innovation Drive, Valley City, Ohio Has established and applied a Quality Management System for: Design, Development, Production and Installation of Fabricated Metal Products and After Market Filter Products Associated with the Power and Process Industry Proof has been furnished that the requirements according to ISO 9001:2008 are fulfilled. EA Code: 17 Certificate Number: HQ Q 218 Initial Audit Date: November 18, 1998 Effective Date: February 18, 2014 Expiration Date: February 17, 2017 Revision Date: 7-2 '4457R.41-riot.611 ed on behalf of HSB Registration Services Certificate Number: HQ Q 218 Page 1 of 1

4 HSB Global Standards Code Services Certificate of Achievement Awarded To: Clark Reliance Corporation Foltz Parkway Strongsville, Ohio For the successful quality program audit to the requirements of GSA -B51-09 Annex F Scope: Construction of Pressure Vessel and Assembly of associated Pressure Piping Certificate Issued: March 2011 Certificate Expires: March 2016 Catherine A. Coseno Vice President Code Services Audit performed by: James Gurganus The Hartford Steam Boiler Inspection and Insurance Company of Connecticut.

To: Janet Townsend. Janet Townsend. Your File: DG Request for Design Registration

To: Janet Townsend. Janet Townsend. Your File: DG Request for Design Registration To: Company: Jeremy Payne Ashcroft Inc Pages: 5 Our File: ANR-3389 From: Janet Townsend Phone: 416-747-4291 Location: Toronto Date: January 8, 2015 Your File: DG-5503 Subject: Request for Design Registration