corporate approvals page 1 of 1 / 2014-11-11 crn-registration

Corporate Approvals

of 1 / 2014-11-11

Kommanditgesellschaft: Sitz Klingenberg – Amtsgericht Aschaffenburg HRA 1819 Komplementärin: WIKA Verwaltungs SE & Co. KG – Sitz Klingenberg – Amtsgericht Aschaffenburg HRA 4685

Tel. +49 9372 132-0 Fax +49 9372 132-406 E-Mail [email protected] www.wika.de

WIKA Alexander Wiegand SE & Co. KG Alexander-Wiegand-Straße 30 63911 Klingenberg Germany

Komplementärin: WIKA International SE - Sitz Klingenberg - Amtsgericht Aschaffenburg HRB 10505 Vorstand: Alexander Wiegand Vorsitzender des Aufsichtsrats: Dr. Max Egli

CRN-Registration Province Number Expiry Date

Ontario 0H7851.5ADD4 2022-04-10

Alberta 0H7851.52 2022-04-10

British Columbia 0H7851.51 2022-04-10

Saskatchewan 0H7851.53 2022-04-10

Manitoba 0H7851.54 2022-04-10

Quebec 0H7851.56 2022-04-10

New Brunswick 0H7851.57 2022-04-10

Nova Scotia 0H7851.58 2022-04-10

Prince Edward Island 0H7851.59 2022-04-10

Newfoundland and Labrador 0H7851.50 2022-04-10

Yukon 0H7851.5Y 2022-04-10

Northwest Territories 0H7851.5T 2022-04-10

Nunavut 0H7851.5N 2022-04-10

January 28, 2014

IWIKAII WIKA INSTRUMENTS L TO.

3103 Parsons Road Edmonton, AB Canada.T6E 5K3

Tel: (780) 463-7035 Fax: (780) 462-0017

RE: OH07851.5C Catalog Thermowell, Canada Wide CRN stamping

To whom it may concern,

In accordance with Section 4.3 .2 of the CSA B 51-09, "if a design is registered in all provinces and territories, the CRN stamped on the nameplate and marked on the data report may be shortened to include the designation of first registration plus the letter "C" ... "

Therefore WIKA INSTRUMENTS LTD has selected the option of stamping Canada wide approved thermowells under the designation of"OH07851.5C". Supporting documentation's from all Provinces and Territories are attached in this document.

Authorized Signature:

HEAD OFFICE WIKA INSTRUMENTS L TO. 3103 Parson Road Edmonton, AB Canada Tel: (780) 463-7035 Fax: (780) 462-0017

Ro rt Woo, P.Eng Engineering Manager

WIKA INSTRUMENTS L TO. 2679 Bristol Circle, Un~ #1 Oakville, Ontario L6H 6Z8 Tel: (905) 337-1611 Fax: (905) 337-2716

WIKA INSTRUMENTS L TO. 4932- 52 Street S.E. Calgary, AB Canada T2B 3R2 Tel: (403) 237-5960 Fax: ( 403) 264-0095

Date: January 28. 2014

WIKA INSTRUMENTS L TO. #204, 9804-100 Avenue Grande Prairie, AB TBV OTB Tel: ( 780) 513-7480 Fax: (780) 513-7379

WIKA INSTRUMENTS L TO. 901 First Avenue North Saskatoon, SK S7K 1 Y 4 Tel: (306) 664-1105 Fax: (306) 244-7037

WIKA INSTRUMENTS L TO .. 4627 Frances Street Burnaby, B.C. VSC 2R9 Tel: (604) 299-3855 Fax: (604) 299-4566

September12, 2014

ROBERT WOO WIKA INSTRUMENTS LTD 3103 PARSONS RD NW EDMONTON AB T6N 1 C8 CA

Service Request Type: BPV-Fitting Registration Service Request No.: 1469132 Your Reference No.: ADD MFG LOCATATIONS TO CRN OH7851.5ADD3 Registered to: WIKA INSTRUMENTS LTD

Dear ROBERT WOO,

14th Floor, Centre Tower

3300 Bloor Slreet West

Toronto, Ontario

Canada M8X 2X4

Tel.: 416.734.3300 Fax: 416.231.1626 Toll Free: 1.877.682.8772

www.tssa.org

Technical Standards and Safety Authority (TSSA) is pleased to inform you that your submission has been reviewed and registered as follows:

CRN No.: OH7851.5ADD4 Main Design No. : N/A Expiry Date: 10-Apr-2022

Please be advised that a valid quality control system must be maintained for the fitting registration to remain valid until the expiry date.

Note: To add three manufacturing locations - WiKA Alexander Wiegand SE & Co. KG Alexander-Wiegand-StraBe, D-63911 Klingenberg, Germany. - Wika Instruments India Pvt. Ltd. Plot no.40 Gat no.94+100, Hi cliff industrial estate, Village Kesnand, Wagholi, Pune, 412207, India. - WIKA Process Solutions, L.P. 950 Hall Court, Deer Park, TX 77536 USA.

The stamped copy of the approved registration and the invoice are mailed separately. Should you have any questions or require further assistance, please contact a Customer Service Advisor at 1.877.682.TSSA (8772) or e-mail [email protected]. We will be happy to assist you. When contacting TSSA regarding this file, please refer to the Service Request number provided above.

Yours truly,

~ 0rv~ Nj ,_, Norman Ngai, P. Eng. Mechanical Engineer BPV Tel.: 416-734-3557 Fax: 416-231-6183 Email : [email protected] www. tssa.org

Putting Public Safety First

TECHNICAL STANDARDS & SAFETY AUTHORITY

Show facsimile of manufacturer's logo or trademark, as it will appear on the fitting, in the space below

14th Floor, Centre Tower 3300 Bloor Street West Toronto, Ontario Canada M8X 2X4 ' A' or 'ATS'

STATUTORY DECLARATION Registration of Fittings

1 Robert Woo, Engineering Manager · ----------------------------------------------~-------------------------------------(Name and Position, e.g. President, Plant Manager, Chief Engineer)

of Wika Instruments Ltd .

(Name of Manufacturer)

Located at 3103 Parsons Road, Edmonton, Alberta, Canada

(Plant Address)

780-463-7035 780-462-0017

(Telephone No.) (Fax No.)

[lJ 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 2010 and ASME B31 .3- 2012

(Title of recognized North American Standard)

which specifies the dimensions, materials of construction, pressure/temperature ratings, identification marking the fittings and service;

D or are not covered bv the orovisions 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, pressure/temperature ratings and the basis for such ratings, the marking of the fitting for identification and service.

I further declare that the manufacture of these fittings is controlled by a quality system meeting the requirements of ISO 9001 :2008

________ which has been verified by the following authority, _A_B_S_A_~-------------------' The ~ems covered by this dedaration, for which I seek registration, are category H type fittings. In support of

this application, the followinQ information and/or test data are attached as follows: CRN OH7851.5ADD3

(drawings, calculations, lest reports, etc.)

Declared before me at Edmonton in the Province of Alberta ---------------------------- ---------------------the __ 2_7 _____ day of August AD 20 14

-----'

t' (Signature of Declarer)

FOR OFFICE USE ONLY 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 registration in Category ---'H....:..... ____ _

CRN:

Registered by:

Dated: l£ff. \2 I '2,() 14

NOTE:

oH l~~r . c:; AD"D4-••• I

f'J Of\ \;V\?.-N' 1\) J C...:

S§:>l )'2.,, 2:o' ~-·· ...... PV 09553 (11/12) Nt>'TG. ~ t>L.GA.Sb SEE: ATTACHGD '\>A.~t:; FvR 5copc= OF- Rf;ql$7f24Trot0.

N_ll, ~T.I2,2Dif .

Technical Standards and Safety Authority 14th Floor- Centre Tower 3300 Bloor Street West Toronto, ON M8X 2X4

Service Request No: 1469132

Re: Scope of Registration

WI

Robert Woo Wika Instruments Ltd.

3103 Parsons Rd Edmonton, Alberta T6N 1 C8

September 11, 2014

The scope of this registration is to add the following manufacturing locations to existing CRN OH7851.5ADD3.

WIKA Alexander Wiegand SE & Co. KG Alexander-Wiegand-StraBe D-63911 Klingenberg Germany

Wika Instruments India Pvt. Ltd Plot no.40 Gat no.94+ 100 Hi cliff industrial estate Village Kesnand, Wagholi Pune, 412207 INDIA

WIKA Process Solutions, L.P. 950 Hall Court Deer Park, TX 77536 USA

Regards,

/~ Robert Woo P.Eng. Engineering Manager E-mail: [email protected] Phone #: 780-463-7035 Fax#: 780-462-0017

Alt:crra MUNICIPAL AFFAIRS

I, Robert Woo, P.Eng.

Engineering Manager

the prenure equipment safety authority

STATUTORY DECLARATION Registration of Fittings

(company title, e.g. vice president, plant manager, chief engineer) (must be in a position of authority)

of Wika Instruments Ltd.

(name of manufacturer)

located at 3103 Parsons Road, Edmonton, Alberta, T6N 1 C8

(plant address)

do solemnly declare that the fittings listed hereunder, which are subject to the Safety Codes Act (check one)

AB-41 2005-02

In this space, show facsimile of manufacturer's logo or trademark as it will appear on the fitting.

'A' or

'ATS'

comply with the requirements of ASME 831.3 & 831.1 - 20 I 0 which specifies the dimensions,

(title of recognized North American Standard)

materials of construction, pressure/temperature ratings and identification marking of the fittings, or

D 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,

materials of construction, pressure/temperature ratings and the basis for such ratings, and the marking of the fittings

for identification.

I further declare that the manufacture of these fittings is controlled by a quality control program which has been verified by the

following authority, ISO 900 I :2008 & ABSA as being suitable for the manufacture of these fittings to the

stated standard. The fittings covered by this declaration, for which I seek registration, arc catalogue style thennowells

ln support of this application, the following infonnation, calculations and/or test data are attached:

ATS-2096 Sheet 1,2,3 Revision 7,4,4; ATS-2106 Sheet 1-3 Revision 5,3,4; ATS-2111 Sheet 1,2,3 Revision 4,3,3; ATS-21 00 Sheet 1,2,3 Revision 6,5,5; ATS-2100 Sheet 4 Revision 4; ATS-2100 Sheet 5-37 Revision 5; ATS-2100 Sheet 38-70 Revision 4 ; ATS-2100 Sheet 71 -76 Revision 3; ATS-2100 Sheet 77-82 Revision 2

DECLARED before me at Edmonton in the Province ----------------- -~~~~----------of Alberta

' 2013 (Year) - -----

(print)~~~dt~~~W~~AfilamL-__

(sign) ------11---4rlllft-1~e+----

For Office Use Only

To the best of my knowledge and belief, the application meets the requirements of the Safety Codes Act and CSA Standard 851, Clause 4.2, and is accepted for registration in Category ' /

--~L-~~~~~r--+,~~---------------------

Registration Number: 0 H 0 J-8 5 / ~ S 2_

Date Registered: __ :J __ ~ ___ 0_~--1---'-/_S _ _ _ (For the Administrator/Chief nspector of Alberta)

Expiry Date: 'j?_ l L..... (0

The mformation you provide is necessary only for the administrat' n of the programs as required by the Alberta Safety Codes Act and Regulations m the Boiler Disc· hne.

the pressure equipment safety authority

January 07, 2013

Tik Man (Ashling)Dick

WIKA INSTRUMENTS L TO

3103 PARSONS ROAD EDMONTON, AB T6N 1 C8

Dear Tik Man (Ashling)Dick,

9410-20 Ave N.W.

Edmonton, Alberta, Canada T6N OA4

Tel: (780) 437-9100 I Fax: (780) 437-7787

The design submission, tracking number 2012-01422, originally received on March 01, 2012 was surveyed and accepted for registration as follows:

CRN : OH07851.52

Reg Type : Addition to Ace. Fitting

Drawing No. : SEE BELOW Rev SEE BELOW As Noted

Fitting Desc: THERMOWELL

Description MAWP SEE BELOW kPa

Accepted on: January 07, 2013

Expiry Date: April 10, 2022

Design Temperature oc

The registration is conditional on your compliance with the following notes:

This registration is valid only for fittings fabricated at the location(s) covered by the QC certificate attached to the accepted AB-41 Statutory Declaration form. This registration is valid only until the indicated expiry date only if the Manufacturer maintains a valid quality management system approved by an acceptable third-party agency until that date. Should the approval of the quality management system lapse before the expiry date indicated above, this registration shall become void.

- The following drawings are part of this registration: ATS-2096 Sheets 1,2,3, Revisions 7,4,4; ATS-2106 Sheets 1-3, Revisions 5,3,4; ATS-2111 Sheet 1,2,3 Revision 4,3,3; ATS-2100 Sheet 1,2,3 Revision 6,5,5; ATS-2100 Sheet 4 Revision 4; ATS-2100 Sheets 5-37 Revision 5; ATS-2100 Sheets 38-70 Revision 4; ATS-2100 Sheet 71-76 Revision 3; ATS-2100 Sheet 77-82 Revision 2.

An invoice covering survey and registration fees will be forwarded from our Revenue Accounts.

Enclosed are stamped prints for your reference.

Sincerely,

STERLING, CAMERON, P. Eng. Design Survey Engineer

Page 1 of 1

s~

WIKA INSTRUMENTS CANADA LTD 3103 PARSONS ROAD EDMONTON AB T6N 1C8

Attn: TIK MAN (ASHLING) DICK, E.I.T.

Re: Application for Design Registration

505 - 6th Street, Suite 200 New Westminster, BC V3L OE1

Toll Free: 1-866-566-SAFE

Fax: (778) 396- 2064 www.safetyauthority.ca

Date: May 18, 2012 Account#: 46490 Journal#: 54616 Our File#: 5081546

The design, as detailed in your, Dwg: ATS-2096 et al. , for a Fitting is accepted for registration as follows:

Registered To: WJKA INSTRUMENTS CANADA L H CRN: OH7851.51

Conditions Of Registration: 1- CRN Renewal; Thermowells, Drawings ATS-2096 Sheet 1-3, ATS-2106 Sheet 1-3, ATS-2111 Sheet 1-3, ATS-2100 Sheet 1-82. 2- Fitting Registration Expiry Date: Apr 10, 2022 with the condition of a valid manufacturer's Quality Management System Certificate of Registration.

Amount

Fee for reviewing your design: $144.00

HST

$17.28

Total

$161.28

Total: $144.00 $17.28 $161.28

Less amount received with submission: $0.00 ·------------------------------~~~

An invoice for $161.28 will follow. $161.28

(PROD) 30400-20 GST #: 87391 2802 RT0001

Contact me if you have any questions.

ALIREZA BONAKDAR (778) 396-2032 Alireza. [email protected] Design Engineer

cc:

(PROD) 30400-20

505 - 6th Street, Suite 200 New Westminster, BC V3L OE1

Toll Free: 1-866-566-SAFE

Fax: (778) 396 - 2064 www.safetyauthority.ca

GST #: 87391 2802 RTOOO 1

••• Technical • Safety Authority • of Saskatchevvan

330- 1855 Victoria Avenue Regina, SK S4P 3T2 Canada REGISTRATION APPROVAL 306-787-1443 [email protected]

www.tsask.ca

Thursday, June 21 , 2012 Wika Instruments Ltd.

31 03 Parsons Road Edmonton, AB T6N 1C8

ATTENTION : Kevin Sorokan jour File : 8797 [

With reference to your submission respecting the registration of the item below, for legal use in the province, please note we have surveyed, approved and registered this design as noted.

MANUFACTURER: Wika Instruments Ltd.

CATALOG OR DRAWING : ATS-2096, ATS-2106, ATS-2111 and ATS-2100

ITEM : Wika Catalogue Thermowell TW1 0, TW15, TW20 and TW30

CRN: OH7851.53

We wish to point out that every fitting must be constructed strictly in accordance with the registered design. Fitting registrations are required to be resubmitted for validation after ten (10) years from the registration date in accordance with CSA 851, Clause 4.2.1 . The date of expiry for this registration is April 10, 2022

C des and Standards Compliance REMARKS: This registration is limited to only the fittings manufactured by Wika Instruments

Ltd, Edmonton under ABSA QMS AQP-5020. Valid quality management system must be maintained for the fitting registration to remain valid until the expiry date.

0 F

111• • • Technical • • Safety Authority • • of Saskatche\Nan

I, Wyan Shankaruk

Vice President

Statutory Declaration Registration of Fittings

Boiler & Pressure Vessel Safety 330- 1855 Victoria Avenue REGINA, SK S4P 3T2 Ph: 306-787-1443 Fax: 306-787-9273

LIB-1008 In this space, show facsimile of manufacturer's logo or trademark as it will appear on the fitting.

1} T5 '

(company title, e.g. vice president, plant manager, chief engineer)

(must be in a position of authority in the manufacturing plant where the fitting is produced)

of Wika Instruments Ltd. (name of manufacturer)

located at 3103 Parsons Road, Edmonton, Alberta T6N 1C8 (plant address)

do solemnly declare that the fittings listed herein under, which are subject to the Saskatchewan Boiler and Pressure Vessel Safety Act (check one)

® comply with the requirements of ASME 831.3 & 831 .1 - 2010 which specifies the dimensions, (title of recognized North American Standard)

materials of construction, pressure I temperature ratings and identification marking of the fittings, or

0 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, materials of construction, pressure I temperature ratings and the basis

for such ratings, and the marking of the fittings for identification.

I further declare that the manufacturer of these fittings is controlled by a quality control program which has been

verified by the following authority, A8SA as being suitable for the manufacturer

of these fittings to the stated standard. The fittings covered by this declaration, for which I seek registration, are

category H

In support of this application, the following information, calculations and I or test data are attached:

- Drawings (ATS-2096 Sht 1-3, ATS-2106 Sht 1-3, ATS-2111 Sht 1-3, ATS-2100

For Office Use Only To the best of my knowledge and belief, the application

meets the requirements of the Boiler and Pressure

Vessel Safety Act and CSA 851 , Clause 4.2, and is accepted for registration in Category (For the Administrator I Chief lnsp7 tor)

Expiry Date: lrpr { 0 '2 0 2 L / LIB- 1008 Rev. 06/2010

Labour and Immigration

Inspection and Technical Services www.firecomm.gov.mb.ca/codes_steam_pressure.html

May25, 2012

Wika Instruments Ltd. 3103 Parsons Road Edmonton, AB T6N1C8

Attention: Tik Man (Ashling) Dick

REGISTRATION OF VALVES AND FITTINGS

Manufacturer: Wika Instruments Ltd.

500 - 401 York Avenue Winnipeg, MB R3C OP8 PH: (204) 945-3373 Fax: (204) 948-2309

The design(s) for the following Valves/Fittings has been received by us and has been examined and accepted for registration in the Province of Manitoba as follows.

DRAWING I CATALOGUE CRN FILE ATS-2096 SHT 1 - 3 ATS-2106 SHT 1 - 3

OH7851.54 31575 ATS-2111 SHT 1-3 ATS-21 00 SHT 1 - 82

An invoice covering survey and registration fees is enclosed.

NOTE: This registration includes catalogue TWJ 0, TW15, TW20 and TW30. This registration expires April I 0, 2022.

This registration is valid until the indicated expiry date only if the Manufacturer maintains a valid quality management system approved by an acceptable third-party agency until that date. Should the approval of the quality management system lapse before the expiry date indicated above, this registration shall become void.

The registration of this design does not relieve the manufacturer, the owner or his agent of the responsibility for the design or construction of a fitting in accordance with the applicable Acts, Codes and Standards. Inspection and Technical Services assumes no responsibility by registering designs, examining plans and/or inspecting equipment or facility.

Yours truly,

7,~~ Ryan DeLury, C.E.T. Senior Design Surveyor, Inspection and Technical Services

MANITOBA DEPARTMENT OF LABOUR AND IMMIGRATION 500 -401 YorkAnnut Winni~g, Manitoba R3C OP8

(a) Design Qualification

1. ___.K. ..... e.._"'-v LJ.l n..L--:-::-=S~ou.n ..... vuk""'a/'L"""'--',___ _ _ (See Note 2)

fV!j !rzeerlllj MtV1a:Je r

located at .S /03 Parson,>

STATUTORY DECLARATION REGISTRATION OF FITTINGS

Gee f "5 olher ~

Gee do solemnly declare that the fittings listed hereunder, which are subject to the Boilers & Pressure Vessels Act,

comply with all the requirements of the ANSI/ASME codes as to their dimensions. or g 31. 3 c} 13 3/. I - 2 of o

arc not covered by the provisions of the ANSIJASME codes, and are therefore constructed to comply with -....,-----,,....-----,----,-----,------,----code or standard, and are designed to the best current engineering practice, as shown by the supporting test data.

(b) Quality Control of Manufacture

I further dCflarc the manufacture of these fittings is controlled by a quality control program which con:plies with the requirements of ISO root:.2oo3and has been verified by the following authority or authorized agency _ ..... Ar.....r...L.g"--'~:::..~f-lt..._L-_ _____ ____ _

The fittings covered by this declaration, for which I seek registration, are _...,,...,«o..de..t<L~_.. ... c~ry_,__,_/--/__,_ _ ____ ________ _

In support of the application, the following information, calculations and/or test data arc attached:

= ia~~ ?Atf 2?:lf:f:~ZATS -210( 51rt 1-J , AT?-,111/5},{(-IJllJ-oeclared before me at Edmonb211 in the province/.state-of A/ be eta the f1_f:j, day of

,, /2_ ~

1 oo Matia · rtorOa

:.\lberta --------~~~~~~~~~~~'9

~r Official Use Only) The application is accepted for registration in Category in accordance with the Boilers and Pressure Vessels Act and CSA Standard 851.

This registration must be revalidated after ten (I 0) years from the date of acceptance.

E""V?IBES Apa.l' For the Chieflnspector

Date: Mft1 ~\.} 1 $J,a

Notes: (1) This j orm shall be completed and signed by the president or highest official in the manufacturing plant where the filling is produced. (2) Two completed copies of Statutory Declaration form together with ill!Q copies of Catalogs, drawings or Bulletins illustrating above fittings shall be submitted. (3) All fittings are required to he registered in the name of the Manufacturer.

100 Shtt-'IL' -;

(

() ~:

l ist of Manuracturtng Facilities- CRN OH7851.52

WlKA AJexaBcfer Wiegand SE & Co. KG Alexander-Wiegaud..strat!c 0·63911 Klitgcmberg Otii'IIUaly

Wlka lastrumenh J11dla Pvt. Ltd Plot no.40 Oil no.94+ 100 lil clift'indulal estate Village kesnamd, WaghoJi Fwle, 412207 INDIA

WIKA lnsh'Ument Corporadon- 'Electrical Temperature Dmfion ~aaneourt Deer Parl<, TX 77536 USA

Regards,

Kevin Sorokan Engineering Manager

InSpection & Boiler & Tcchnocal Service& PreS$ure Vessel Manitoba Safety Program

Manitoba-~ THIS IS .PART OF CRN

Ot-\'l . \ ~

/ · ( lll!ll(.lll!IIOOIOII'ul O.mMI

r..~lll"....,,.,...

~'!lor ON t'ilfra

Or_,.,..,. '2N. eeoj.j . \(lOA-,, ................ ..o YliVIIIl 'lt:''/SO<SI)l~ Fw:710•:11f· t;;';'

..,_ ;t;Q:A;,..C tl(!IUo ~-.,v. $>< 6 JL •,:-;,

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I'll-: !Cf If!' !»~·IV~ Yg; !CO ~6) COif

~ ca~'#t · •e• t r,.., iQ:)·A< ~llfl ~ ll:" ff' 111)5 r.~:!CS-.,.. "'~

IWIKAII Pl't8$Vl't.nd ~ MC8SUmlltnt

WlKA l~ents UP;t. Edmon101l-Ofro.rl 310S Ptnons Road Edmonton, AS TON tea TGJ: 780 • 463 · 7035 fa:;(: 780 . 462 . 0017

www.will~ }l'fc~a.ca

July 25, 2011

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Quebec::: Regie du batiment du Quebec

Le 20 juin 2012.

MRS. TIK MAN DICK WIKA INSTRUMENTS LTD 3103 PARSONS ROAD EDMONTON ALBERT A CANADA T6N 1 C8

REFERENCE: C.R.N. application ATS-2096 SHT. 1 REV. 6 SHT. 2 & 3 REV. 3

FITTING (CRN RENEWAL)

OUR REFERENCE: 961464

MANUFACTURER : WIKA INSTRUMENTS LTD 3103 PARSONS ROAD EDMONTON ALBERT A CANADA T6N 1 C8

Dear Madam,

According to our law respecting pressure vessels, your plan has been accepted and registered under the number OH07851 .56.

lnspecteur

Service de !'inspection de Ia fabrication d'appareils sous pression 545, boulevard Cremazie est, 7 erne etage Montreal (Quebec) Canada H2M 2V2

Telephone: (514) 873-6459 Sans frais : 1 866 262-2084 Telecopieur : (514) 873-9936

Rjgltl dUbitlmMt

Qu~bec :=:

Statutory Declaration Registration of Fittings

(a) Design Qualification

~eVi n .Soroka n , P> ~ .

fsee a!J-.ad~d) "'

Located at 3 / Q S Par>on5 Rd E drno~n. A lS ' (plant address)

TtN !CR 1: 3 oiJ,eo (s&? ai&J,edj do solemnly declare that the fittings listed hereunder, which are subject to the Boilers & Pressure Vessels Act:

comply with all the requirements of the ANSIIASME codes as to their dimensions, material, identification & service for which are

Or required: 831,3 + B31> I - 1..01 O

0 are not covered by the provisions of the ANSIIASME codes, and are therefore constructed to comply with --:---.-----:---,-------code and standard, and are designed to the best current engineering practice, as shown by the supporting test data.

(b) Quality control of Manufacture

I furt_her declare the manufacture of these fittings is controlled by a quality control program which complies. with the requirements of .I .SO '/00 I ;; 2. 003 , and has been verified by the following authority or authorized agency A 55 A The fittings

2 covered by this declaration, for which I seek registration, are ---loc--.~rlea.....!::~;g..!f~o:...Jq'...Jfr----'H--''-------------

In support of the application, the following information, calculations and/or test data are attached: . /./:. . Drawitljs (f17>-?-.01G Slrt !-~ 8T5 -J!Ob 5hiJ-~ llT5 -2111 5/r£-1-3

1 AT5- 21031 /-?2.1

Declared before me at Edrnonfon 4- .5Ct.ntf/e. de>!J·1... c.alc- tZ.bon>

In the of

The

For Official Use Only

The application is accepted for registration in Category _ _.H'-'---- in accordance with the Boilers and Pressure Vessels Act and CSA Standard B51.

This registration must be revalidated after ten (10) years from the date of acceptance.

~

Registered Number CRN ____________ _ For the Chief Inspector

Date 2 B MAl 2012 I

Three completed copied of Statutory Declaration form together with three copies of Catalogs, drawings of Bulletins illustrating above fittings shall be submitted.

2 All fittings are required to be registered in the name of the Manufacturer. 3 This form shall be completed and signed by the president of highest official in the manufacturing plan where the fitting is produced.

P:IUSAOERMECPSK1\CORBIMSTATVTORYOfCLARAT'IOHREQISTAATIONOFFfTTIHO$,()()C

u:\corbln\anglais-complet (2003-03-31]

12

UNIFORM STATUTORY DECLARATION FORM FOR THE REGISTRATION OF FITTING DESIGNS

NEW BRUNSWICK (' · NUNAVUT

NOVA SCOTIA YUKON

PRINCE EDWARD ISLAND NORTHWEST TERRITORIES

NEWFOUNDLAND AND LABRADOR

I I ; Wikalnstruments Ltd. and 3 other manufacturers (see attached) - MANUFACTURERS NAME: " . :

MANUFACTURERS ADDRESS: 3103 Parsons Road, Edmonton. Alberta TpN 1C8.(see attached)

PLANT LOCATIONS: 3103 Parsons Road, Edmonlon, Alberta T6N 1 C8 (s'ee attached)

CATEGORY OF FITTINGS TO BE REGISTERED. CIRCLE ONE CATEGORY ONLY I ITtE OF THE .~TANDARD'OE CON~TR!,!CTION

· A Pipe fittings, including couplings, tees, elbows, Ys, plugs, unions, pipe. caps, or reducers ASME BJ1.3 & 831.1-2010 .

B Flanges: all flanges C Valves: all line valves D Expansion joints, flexible connections, and hose assemblies: all types E Strainers, filters, separators, and steam traps F Measuring devices, including pressure gauges, level gauges, sight glasses, levels, or

pressure transmitters G Certified capacity-rated pressure relief devices acceptable as primary over pressure protection on

boilers, pressure vessels, piping and fusible plugs @Pressure retaining components that do not fall into one of the above categories

N Nuclear components: Class 1 0 Class 2 0 Class 3 0 , (Meeting CNSC or ASME requirements)

SHOW MANUFACTURERS NAME TRADEMARK OR LOGO AS IT WILL APPEAR ON THE PRODUCT · TYPE OF CQNSTRUCTION

FORGED 0 WELDED 0 WROUGHT 0 ('{1 7 (AT5 ) CAST 0 OTHER 0 DESCRIBE OTHER:

01

LIST OF SUPPORTING DOCUMENTATION AND IDENTIFICATION OF THE ACTUAL ITEMS TO BE REGISTERED:

- Certificate of Authorization for our Quality Control Program - ISO 9001:2008 Certificate of Registration - List of Wika Manufacturing Location for this CRN -Copy of Ontario CRN Approval (OH7851.5R2), ACI CRN Approval - Sample design calculations - Current Wika Thermowell Catalogue (TW10. TW15, TW20, TW30) - Previous Wika Thermowell Catalogue

0 -Drawings (ATS-2096 Sht 1-3, ATS-2106 Sht1-3, ATS-2111 Shl1-3, ATS-2100 Shl1-82) .•

DECLARATION; I Kevin Sorokan. P.Eno !•••note 3) employed by Wika Instruments Ltd. and being the person having full authority and responsibility for the quality of the end product do solemnly declare that the information contained in this form is true and to the best of my knowledge represents the product for which registration is sought. The dimensions, materials of construction, pressure temperature ratings, and identification markings are in accordance with the herein named standards. I further declare that the manufacture of these fittings is regulated by a Quality Control Program which ex1ends to each plant where fabrication occurs in whole or in part and has been verified by ABSA as being suitable for that purpose and I make this solemn declaration conscientiously believing it to be true, knowing that it is of the same force and effect as if made under oath.

Signature of Declarer:

Declared before me at

This 121

h day of -==*"'n'7."1-A'IT"' Commissioner of Oaths ~--

or Notary Public: (sign) ---lf-W'~i----------

This space for Regulatory Authority UffOILER & PR~SSURE VESSEL ACT This registration must be revalidated after ten (10) years from the date of acceptance.

CR~ OH7851.5 REV2

FID#: _2_8_4 _ ___ _

Notes: 1. All fillings shall be registered in the name of the Manufacturer. 2. Each category shall be supported with two Statutory Declaration forms and one copy of supporting documentation. 3. The declaration shall be made by the person having full authority and responsibility for the quality of the end product. 4. Quality control programs shall be resubmitted for validation at a maximum interval of five (5) years.

REGISTRATION ONLY

CRN _. , }0 8'SI.S1Rev)2

! EXAMINER- ,.:::·"'~~"-1~~e-1~......,._,.

for Clii£F BOILER INSPECtOR

DATe:O 5/o~ / c?o\)_

D BLRs 0 PVs Sect. 1.0- Fittings Rev. 1 06/2003

FflT'NG~ n r.O!I~'PO~FI\!T.!;

85/BB/2012 13:23 982-424-3239 DEL PUBLIC SAFETY PAGE 13/21

UNIFORM STATUTORY OECL.ARAT!O~ FORM FOR THE REGISTRAnON OF' FJTl'JNG OESJGNS

NSW BRUNSWICK r--\ NUNAVUT . .NOVA SCOTIA .YVKON

PRINCE EDWARD ISlAND NORTHWEST ~AArTOFU!;S

.. NEWFOUN£:?1:ANP AND LABRADOR •'. ··c·i ,.

,. MANUFAt=TURERS NAME: · • WXa ln!!lflp'nal)ts_ l.!Q, and s olher manufac!Urers (see attached) ! . ' . ~ . . . . .. . :·· ..

' . MANUFACTURERS AODRESS: 3103 Paraone Road. Edmonton. Alberta TGN 1C8 {see abaehed) . .•..... . .· .~ ~. . . . . \~

' . PLANT LOCATIONS:' 3103 Pars om Road,, Edmantori, Alberta TBN 1 CB (S:ee-attaensd) . . .. . ' . ; .. . . ; .. < . •;- •·•·

CA!5GQ.Bt OE F.!II!NGS IO E!5: BEGl~I5BE12! Q!BC!..:S.P~~ Q6I§GQRY O~b Y

A Pipe tl111n;t, InCluding <»f.IPI!nga, ttee, efbowo, Ya, ptups, unions. pipe ~. or reducors ASME 631.3 &·631 •. ? -~'1Q . . B Flanges: all flangu .... c VeiV!Ic: a.U line valve& D Expansion Jofnte, fleXIble ~;onneetlona, am! hilae assemblies: 111 types .. . • E strainers, rllters, aeparatom, and staam trll'p& " F MeasurJng davteas, lnc:ll.ldlng preseUill p&tJgea, leVel gaug"s, eight glasses, levels, or . .

prcmtll'tl tmnamllleTB ... G Certified CtJpaclty-ratocl preaaure rollaf devices accaptsble as primary over pressure proteellon on

@ boller.>, pmsure vea&als, piping and fualblt ptilgs . Pressure retalillilg components that do nol taU Into one pi' the obove categorfes ..

N Nuolear compot~t~nts: CJ11ss 1 0 C!BSll 2 0 Clas~ 3 0, (Meeting CNSC or ASME requirements)

SI:IOW MANUFAC URERS NAME. .nR rlr'lf AS 'WI 4P~..-.IIR ON Tl-fE Pj:lQDUCT ~

I'OIIOtO b \WI.DEI> c WROUGHT 0

c/-1 I 'AT5 J ~ITT .c OTHfR c Dl!SCRll!l£ OTWI!Il:

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b!S! OF SUE!f!QBilf!G OOCUME:HT6,TION ANQ !O§t:!J.:!FICA TION OP THE ACTUAL ITEMS IQ S§ Bmt~IEREO:

- CGrtl1lcat11 of Authorlu!Uon tor our Ouauty control Propram -ISO 9001:2008 Cer1lflcete of Regl!ftrallon ·

I

- UGI of 'Mka Manufaelurtng l..ocatlon for !Ills CRN ·Copy of Ontario CRN Approval (OH7851.5R2), ACI CRN Approval - Sampla cloolgn ealcUltlllona -Current 'Mka Thennowell Catalogue (TWIO, TW16, T\11120, TW30)

0 - Prevloue Wiks Thermowell Catalogue -_Drawings (ATS-2.098 Sht 1-3, ATS-2106 Sht Hl, ATS-2111 Sh! 1-3, ATs-2100 Sht 1·S2)

,.

OECLARAiiON: 1 Kevin Sorokan. P.Eno 1-mne3). employed by·\'IAka lnstrumanlll!Jd. and bel"g the person having full authority-and responsiblllty for .the quality of the end prodtJct do. solemnly declare !net the information contained In thle form ls true end to. 1he.best or · my knowledge represems the product 1or which- re!fistratlon Is sought. The dimensions, materials of construction, pressure temperature ratings, and Identification marlcJngs ere In accordance wllh th~ herefn named stanoarda.- f further declare thet the mariufacture of these fl1tlngs ls regUlate~ by a Quanty Control Program which .extends to each plant where fabrlcalloo occurs ln.whole or in part and has been vstified by ABSA ·as being suitable for that purpose and I m&ke this solemn declaretJon consclenUously believing It io be true, -knowing tnst Ills of lhe same force and effect as If made untler oeth. '


Declared .before me at Thle 12th day of ~~~~W4ffiil1 Commissioner of Oaths .---or N~tary Public: (sign)--+-*~~-------

U S E T 'H I S S P .A C E F !) !·:

0 F F ·I (: I A l ~ I~ ,\ I

ihfs epsca·for Regulatory Authority Ulle

This registration must be revalidated attar ten (1.0) years from..Jtlt!II-Uitre

CR~ OH7851.5 REV2

FID#: 284

Nole::: 1. AU fiUfn11a ahllll be regle~tered In tha msme of the Monutactvrer. 2. l:ac;;h caiSiJQf')' :~haA be !11/Pporte(l Wllh two Stall.ll.ory Declaretlon

....... forms and one copy of supportlnp documentflflon. 3. Tho decl•rallon shslll>o mpde by the person hsvln9 Ml aulhortfy and rospoj'lalblllly for the quality of llle and prorJuo\, 4. QuaH!y conll'l:)f proprtHM shall be refloubmltted fot valld!tllon ala maximum Interval of five ,{S) yoars.

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NEW BRUNSWICK ()NUNAVUT .

' . .

NOVA SCOTIA ~ Yl)KON


NEWFOUNDl-AND AND LABRADOR .

. . 1 , .... _, MANUFACTURERS NAME: Wika lnslrumenlJi.L(d. and 3 other manufacturers (see attached) . .. ·' ·' '• ' .. ·, ; .~ .

~ANUFACTURERS AC)DREsS:. ,3103 ~ars.of1s Road, Edmonlon,.Aiberta T6N 1C8.(see altached) ., ·. ' ' .. · . .. ·.·· ·r· . . . \ ' ; .. 3103 Parsons Road, Edmonton, Alberta T6N 1C8 (see atlached)

.. . . PLANT LOCATIONS:

. . ~ ~ .. : ...... . ;.· . . . · ... . . . CATEGORY OF FITTINGS TO BE REGISTERED. CIRCLE ONE CATEGORY ONLY T! L!; F THE STAN£ ARD ' f'. ONSJRUCTKN

A Pipe fittings, including couplings, tees, elbows, Ys, plugs, unions, pipe caps, or reducers ASME.B31.3 & 831,.1 ~ .2010

,.

B Flanges: all flanges ' . •

C Valves: all line va lves D Expansion joints, flexible connections, and hose assemblies: all types E Strainers , filters, separators, and steam traps · · .,

F Measuring devices, Including pressure g~uges; level gauges, sight glasses, levels, or .. .. pressure transmlllers ..

G Certified capaclly-rated pressure relief devices acceptable as primary over pressure protection on .. boilers, pressure vessels, piping and fusible plugs

@Pressure retaining components that do not fall into ono of the above categories

N Nuclear components: Class 1 0 Class 2 0 Class 3 0, (Mealing CNSC or ASME requirements)

SHOW MANUFACTURERS NAME TRADEMARK. OR l..OGO AS IT Wfl..L APPEAR ON THE PRODUCT TYPE OF CONSTRUCTION .. .. . . FORGED 0 WELOEO 0 WROUGHT 0

ttl 7 (A T5 ) CAST 0 OTHER 0 DESCRIBE OTHER:

(){

UST OF SUPPORTING DOCUMENTATION AND IDENTIFICATION OF THE ACTUAL ITEMS TO BE REGISTERED:

• Certificate of Authorization for our Quality Control Program · ISO 9001:2008 Certificate of Regis tration - List of Wika Manufacturing Location for this CRN • Copy of Ontario CRN Approval (OH7851.5R2), ACI CRN Approval • Sample design calculations ·Current Wika Thermowell Catalogue (TW10, TW15, TW20, TW30)

a • Previous Wika Thermowefl Catalogue ·Drawings (ATS-2096 Sht 1-3, ATS·2106 Sht 1·3, ATS-2111 Shl 1·3, ATS-2100 Shl 1-82) ..

0

DECLARATION; I Kevin Sorokan. P.Eno rseanota3J employed by Wlka Instruments Ltd. and b eing the person having full authority ·and responsibility for the quality of the end product do solemnly declare that the information contained in this form is true and to the best of my knowledge represents the product for which registration is sought. The dimensions, materials of construction, pressure temperature ratings, and identification markings are in accordance with the herein named standards. I further declare that the manufacture of these fillings is regulated by a Quality Control Program which eX1ends to each plant where fabrication occurs in whole or in part and has been verified by ABSA as being suitable for that purpose and I make this solemn declaration conscientiously believing illo be true, knowing that it is of the same force .and effect as if made under oath.


Declared .before me at

This 12th day of-==~~~Clft'P'-Commissioner of Oaths ---

o r Nojary Public: (sign) ---!f.~\4-'r-#----------

U S E T ·H I S S P /' C f. F ~)

0 F F I C I .A L ~~ 1: :\ I

This space for Regulatory Authority use

This registration must be revalidated after ten (10) years from the date of acceptXfCEPTEO

CRN: OH7851 . 5 REV2 PROVINCEOFPRINCEEDWARDJSfA D ENVIRONMENT, LABOUR & J US'fK

FlO#: _2_8_4 ___ _ _

Noles: 1. All fittings shall be registered in lhe name of the Manufacturer. 2. Each category shall be supported with two Statutory Declaration forms and one copy of supporting documentation. 3. The declaration shall be made by the person having full authority and responsiblllty for the qua!lty of the end product. 4. Quality control programs shall be resubmitted for validation at a maximum interval of five (5) years.

C.R.N.~~r:-~~~~W:Je

DA~--~~~~~~--+--

INSPECTION SERVICES SECI'ION BOILER/PRESSURE VESSEL BRANC

Sect. 1.0. Fittings Rev. 1 06/2003

" " · . .. ·.· .. " ' j

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NEW BRUNSWICK

(')NUNAVUT

I '

NOVA SCOTIA YUKON


Vlilka lnstrumenls ltd. l!nd 3 other manufacturers (see aHa chad) '~ MANUFACTURERS NAME:

MANUFACTURERS ADDRESS: 3103 Parsons Road, Edmonton, Alberta T6N 1 C8.(seo auached)

PLANT LOCATIONS: 3103 Parsons Road, Edmonton, Alberta T6N 1 C8 (see attached)

CATEGORY OF FITTINGS TO 81; REGISTERED. CIRCLE ONE CATEGORY ONLY

A Pipe fillings, Including couplings, tees, elbows, Ys, plugs, unions, pipe caps, or reducers B Flanges: all nanges C Valves: all line va lves D Expansion Jolnta, flexible .connections, and hose assemblies: all types E Strainers, fillers, separators, and steam traps F Measuring devices, Including pressure gauges, level gauges, s·lght glasses, levels, or

pressure transmllters G Certified capacity-rated pressure relit! I devices acceptable as primary over pressure protection on

boilers, pressure vessels, piping and fusible plugs @Pressure retaining componenls thai do not fall into one of the above categories

N Nuclear components: Class 1 0 Class 2 0 Class 3 D. (Meeting CNSC or ASME requirements)

lSHOW_MANUFACTURERS NAME. TRADEMARK OR LOGO AS IT WILL APPEAR ON THE PRODUCT

c~ I (AT5 )

()'/ .


..

.. : ......

~E ::JF rH~ STANDAA~ "OF -CC NS-TRUC. TION

ASME 831.3 & 831..1 · 2010

: D:Pf QF !;Q~S!E!;!QTJQN FORGED D W!!t.OED 0 WROUGHT 0 CAST 0 OTHER 0 D!8CRiaE OTHeR:

LIST OF SUPPQRTING DOCUMENTATION AND ID~NTIFICATION OF THE ACTUAL ITEMS TO BE REGISTERED:

- Certificate of Aulhorlzallon tor our Quallly Conlrol Program - ISO 9001:2008 Certlticate of Reglstralion -List of VVIke Manufacturing Location for this CRN -Copy of Ontario CRN Approval (OH7851.5R2), ACJ CRN Approval - Sample de"slgn calculations -Current Wlka Thermowell Catalogue (1W10, TW15, TW20, TW30}

a - Previous Wiks Thermowell Catalogue -Drawings (ATS-2096 Shl 1-3, ATS-2106 Sht 1-3, ATS-2111 Sh11-3, ATS-2100 Sht 1-82)

..

DECLARATION: I Kevin Sorokan. P.Eno fstonoto:JJ employed by Wlka Instruments Ltd. and being the person having full aut~ority and responsibility for the quality of the end product do solemnly declare that the Information contained in this form is true and. to the best of my knowledge represents the producl lor which registration Is sought. The dimensions, materials of construction, pressure temperature ratings, and identification markings l!re in accordance with the herein named standards. l further declare that the manufacture of these fittings Is regulated by a Quality Conlrol Program which extends to each p lant where fabrication occurs in whole or in part and has been verified by ABSA as being suitable for that purpose and I make this solemn· declaration conscientiously believing II to be true, knowing thalli is of the same force and effecl as If made under oath.


1J S E T "H I S S P .f:.. ..:: E r: !~'

Commissioner of Oaths

or Notary Public: (sign) ---+~:4-\--N----------

This space Jot Regulalory Authority us

This reg istration must be revalidated after ten (1 0) years fro

CRN: OH7 85 1 .5 REV2

FJD#: 284

Notes: t. All fittings shall be registered In the name of the Manufacturer. 2. Each category shall be supported with two Slalulory Declaration forms and one copy of supporting documentation. 3. The declaration shall be made by the persDn having full aulhorily and respons ibility for the quality of the end product.

0 F F I C: I .A 1.. :.~ 1: ·'- I

~ GOVEnNMENT OF W~t{~taHW/F:OlJNOLf,ND lit!JrU<Jor· At-;() LABf~DOf~

Registered ~:t-L.W.Af-<1..!.-fs.J.----=.::!~..: Date ---=:-..:~__,,_4~+--

4. Quality control programs shall be resubmitted for validation at a maximum Interval of five (5) years.

UND£::.R THE ,t,UHJOW -y OF 1 HE PUBLIC Sl•.rETY A T Mm

THE BOILEJ~. f~iE!Sf>O lole$-.'ffit'?l ~(~ 03 _ COMPHJ;SSED GAS F~F:CtJU\'i iC• !"

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NEW BRUNSWICK , .,NUNAVUT

NOVA SCOTIA YUKON



\ ...... MANUFACTURI:RS NAME: Wlka Instruments Ltd. and 3 other manufacturers (see atlached)

MANUFACTURERS ADDRESS: 3103 Parsons Road, Edmonton, Alberta T6N 1C6 (see attached)

PLANT LOCATIONS: 3103 Parsons Road, Edmonton, Alberta T6N 1C8 (see attached)

CATEGOBY OE EITTINGS TO B~ BEGISTERED. CIRCLE ONE CA TEGQRY ONLY T LE OF HE STANOAR F NS.TilUCTION

A Pipe fittings, including couplings, tees, elbows, Ys, plugs, unions, pipe caps, or reducers ASME BJ1.3 & 831.1 • 2010

B Flanges: all flanges C Valves: all line valves D Expansion )oii).LS~?CJ1l.!~ .. E9.Q!.l..!!.gtlqf.!~_@!J9. . ..11QaJI ... IIJ1.$.0IDl1lilto; . ..all t~es . ... ...... . . ____ ... . -~·-·· .......... ... ~-···-· -.. --~·-·· -·- ·····-··· ····-· .. ·-··~·~ ---.·~· ~· · ··- -~ ·. ··- .. .... 'E' · Sfiafiieril-;-1ii(ers, separators, and steam traps F Measuring devices, Including pressure gauges, level gauges, sight glasses, levels, or

pressure transmitters G Certified capacity-rated pressure relief devices acceptable as primary over pressure protection on

boilers, pressure vessels, piping and fusible plugs @Pressure retaining components that do not fall In to one of the above categories

N Nuclear components: Class 1 0 Class 2 0 Class 3 0, (Meeting CNSC or ASME requirements)

SHOW MANUFAC RERS NAME. TRADEMARK OR LOGO AS IT WILL APPEAR N THE PRODUCT TYP~ QF !;QNSTR!,!~TIQN

FORGED 0 WfLOfD 0 WROUGHT 0

('fi 7 (AT5 ) CAST 0 OTHER 0 OI!SCRieE OTHER:

(}/

b,!~I OF s u ePQBTING DQCt.!M5NTATION AND IDENTIFICATION OF THE ACTUAL ITEMS TO BE BE~I§TERED:

- Certificate of AuthorizaUon for our Quality Control Program -ISO 9001:2006 Certificate of Registration . List of VV!ka Manufacturing Location fOf this CRN - Copy of Ontario CRN Approval (OH7651.5R2), ACI CRN Approval - Sample design calculations -Current VVika Thermowell Ca talogue (1W10, TW15, TW20, TW30) - Previous VVika Thermowell Catalogue

0 -Drawings (ATS-2096 Sht 1-3, ATS-2106 Sht 1·3, ATS-2111 Sht 1-3, ATS-2100 Sht 1-82) '

DECLARATION; 1 Kevin Sorokon. P.Eno (soonoto3) employed by 'Nikalnstruments Ltd. and being the person having full authority and

responsibility for the quality of the end product do solemnly declare that the information contained In this form is true and to the best of my knowledge represents the product for which registration is sought. The dimensions, materials of cons truction, pressure temperature ratings, and identification markings are in accordance with the herein named standards. I furthe r declare th at the manufacture of these liHings is regulated by a Quality Control Program which ex1ends to each plant where fabrication occurs in whole

or in part and has been verified by ABSA as being suitable for that purpose and 1 make this sole mn decla ration conscientiously believing it to be true, knowing tha t it is of the same force and effect as if made under oath.


Declared before me a t

This 12th day of-=="-!+=~"4--f'~"" Commissioner of O aths

or Notary Public: (sign) ---lr--lK<+-N----------

CRN: OH7851. 5 REV2

FlO#: 284

Notes: 1. All fittings shall be registered In the name of the Manufacturer. 2. Each category shall be supported with two Statutory Declaration forms and one copy of supporting documentation. 3. The declaration shall be made by the person having full authority and responsibility lor the quafity of the end product. 4. Quality control programs shaA be resubmitted for validation at a maximum interval of five (5) years.

U S E T H I S S P .f, .:; E f' 0 :·:

OFFIC. I fll.. :; 1: .\1

Sect. 1.0 - Fittings Rev. 1 06/2003

.'.

MAY-04-2012 FRI 08 :29 AM ELEC/MECH PWS FAX NO. 8678730117

UNIFORM STATUTORY QECLARATION FORM FOR !HE REGISTRATION OF F!Tl'ING D§SJGNS

NEW BRUNSWICK ·(·)NUNAVUT .

NOVA SCOTIA YUI<ON

PRINCE EOWARO ISLAND NORTHWEST TeRRITORIES

. NEWFOUNDIJ\ND AND LAEIMPOR

:

>·- · MANUFACTURERS NAME': Wllla-lnslruments ~td. enc! 3 olher manu(acturers (~ee atlnched) ··· . . ·. '<· ' .. . ; .... ·•.· . . ·• ·

MANUFACTURERS ADDRESS: 3103 P.arsoll! Road, Edmcmlon, Alberta TBN 1 C8.(aee aHeched) . .. .. .. ~·- . . .. ·:·: .. ~. . .. . .. . . .. . ' PLANT LOCATfONS: 3103 Pereona Road, Edmonlon, Alber1e T6N 1C8 (aellallachlld) .. . ' ·. ' .. . ....

CA TEGORV o r: ~JTTINGS T 1 BE REG S'I"EREO. CIRCJ. • ONE-CATEGORY ONLY . TITI.Ii ffFT~ 8 ~. r.

A Plplllllllngs, l"c:tucllng couplings, tees, elbows, Ye, plug a, unions, plp11 capo, or reclucelli ASME BS1.3 & 831.1 ~_201Q '•

B Flanges; all flangl18 . . c Vatvas: ell llno valvcss .. . ,. .; D Expansion )olnla, flexible conneotlona, and hose assemblltlc! all typuu ,. E Strainers, nlters, nparatora, rmd aleam trapa ,.

F Measuring devloe&, lnoludiOil proeaure gaugoi, level gauge&, &)Bhlglalllltta, levels, or .. . . .. pre55ure tranamltlare

G Certified capaclly·mlad pressure relief devices acc:eptable a& primary over Pl'fl&Guro ptotectlon on 6iJ boller£, pre&aure Vl!&6111&, plplns and fusible plugs

Preseure retalnln£1 components that do not fllfllnlo one ollh& ubove celogorles .. N Nuclear componen1s: Class 1 0 Class 2 D CIB55 3 0, (Me11ting CNSC cr ASM[: requlremsnte) ..

SHOW..MANUFACTURERS NAME. IK OR OG 1 A!l W LL APPEAR ON THE PRODL CT FDRoeo C WI!I..D80 0 WROIJGHl Cl ('A } CAT5 ) CA!IT C OTHeR c

. DeaOIIIBII DTHrR:

tJI

b(£I OE SUPFIORift:l!i: QOCUMe~IATJON ANQ IDENTIEICA! fON DE I l:le ACIUAI.IIi MI! ! 0 BS fi~~IQ:n;BfiiQi

• Certrncato of AUthorlmdon for our OuaUiy Conlrol Program - ISO 9001:2008 Certlncate or ReglslraUon - Usl ot \IVII(a Manufacturing Location for this CRN - Copy of OnlariP CRN Approvoi(OH1B51.SR2), ACJ'ORN Approval - Sample design e<~lculeliooa · -Current Wll«< Thermowell Catalogue (TW10, TW1S, 1W20, 1W3D)

0 - Prellloua Wlka Thermowell Calalogue ·Drawings (AT5-2096 Shl1·3, ATS·2106 Sh! 1·3, ATS:2111 6hl1-3, ATS·21DO Sht 1·82) ..

O'ECLARA TION: 1 l<evlo Sorokcln, P.EnQ 101pnato3) employed by Wlko lnelrumentsl.ld. and being the ·person ~avtng fuJI a~thor1ty:and respom;lbllfty for the quality of the end product do solemnly declare that the Information contained ·In this form· Is true end to the. besl.of my knowledge represents the product tor which r~glslretfon Is sounht. The dimenelonti, malerlaJs of construction, pressure tempemturo ratings, and Identification markJnga ero In accordance wi!h the herein named stendarda. I furlhllr deeJare that the manufacture ot tnaoe finln!J6 16 regulated by a Quellly Control Program which extends to each plant where fabrication occurs in whole· or In part end has been verified by ABSA es being suitable for tllat purpose and I make this solemn declaration eonsolen~oualy believing If to be true, knowing that It Is of the sam71orce and effect e& If made under oath.


Commissioner of Oaths or Notary Pui>Jic: {slen) __:__.1~44~--------

U S E T ·H I S S P ./, C E F 0 t·; . ·. ,. ' .: · 0 F F I C: J ~ I. C r. ·' I

1'hls lipace for Regulatory Alllhot!ty UBII

This reglstlllllon m~61 be revalidated after ren {10) years from the dat

CRN: OH.7851. 5 REV2

FlO#: 284

Noles: 1. AA Jllllnp: shan be registered In the nama or the Monufacturor. 2. 1;1!1'11 calego,y 11hDI/ be aupportacl wlfh two Stotulory Doclsratlon

0 forma and one oopy of 5Upportlng documenltoillon. 3, Tha declo,..Uon ~hall be made by the parson hovlng fllli aulhorlly and responelblllty tor t/le quality of 1/le end procluc;t. · .q , Quality control programs ahan be reeubmnted lor V3UdeUon ala maximum Interval of five (5) years.

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MRY-03-2012 16:50 From: To:902 5663133

UNIFORM STATUTORY DECLABAIION FORM FOR THE REGISTRATION OF FITTING DESIGNS

NOVA SCOTIA YUKON

PRINCE EDWARD ISLAND NORTt:IWZ:ST TeRRITORII:S

Nf!WFOUNDl.AND AND LABRADOR

.__. MANUFACTURERS NAME: 'M~ Instruments ~td. ani! 3 otnar trn~nufaeturera. faee aU.chlld)

MANUFACTURERS ADDRESS: 310:1 Pereone .Road, Edmonton, Alberla TBN 1CB.(aoo ollllchocJ)

PLANT LOCATIONS: 3103 PorGons Road. Edmonton, AIMrta TGN 1CO (11ee attacllad) . . .. .. . . !;;ATiiili!ORY Q!; Ef!IINI!~ I~ In: B~~I§It'i!:Ui/:!, ~B~I.Ei Qt:li C6I~~Qf!Y QN!. V rn'irml'

A Ptpo ftnlngG,Inctudlng oouptll)g5, toes, elbow,, Ya, plup&, untons, pipe capa, or reauce11 ASME E!ll1.S & 83( 1 -2010

e Flanpaa: all tlangaa . . c varves: arr nne varves D ~p•n•ton Joints. nolflbtc oot~neorlom. enll hOfle aaaembrtes· atltypea E Stralnara, nrtera, aoparato~, end 'lllam trap:; F Moesutlng devlcea. Including preeaure gauge,, tel/Ill gaugsa, ar;nt 1JII1111111 1ove1a, or

pressur11 lrllnJmltlllra G CertJnea cepaetiY•rate!l pres£ure r•u•r devices acc;eptable n primery over pro11sun: protection on

bo!fOrG. procauro ve:~Gel::, pJplnll and fttGible PIUg6 @ Prtuuro retaining component' th11l do not rarr Into onv <1f "'" UbCive oatcgorle6 N Nuelur component!: Clue 1 0 C/us 2 0 Class 3 CJ. (Meeting CNSC or ASME rcqu/rc:monts)

I SHOW rURERS NAME. TRAOl;MARK OR CC G:C A!: IT WI APtirfAR ON THi!"PR.ODUCT IYt'b Qt ;Q@fi!ucnp~t~ ,01101!0 C weLDI!O 0 WIIOUO/fT 0

~A ' CAT5 ) C'AJT C CI'YMIII Q 11C8CMII! OTHI:I't

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J.llli Qr:: ~!,!PPQR.TJN!i DQCUMf:rmJ:IQt:l !flll21!;li:t:!IIEI~IIQt:l QE It:!E ACTUAl. fTJiM9 TQ Bs R!f.gt~TF,jRfi!2i

• Certtncate of Authorl.l:ctllon ior our Ouallly Control Program • ISO 9001:2008 Certfflcetc. of Rcgl3111lllon • USt or \Mko Monufoclunng l.ocallon 101 ll~s CRN ·Copy or Onlllrlo CRN Approval (OH7851.SR2}. ACI CRN Approval • Sample deJign cok:ullllions -Current W!ke 'ThermoVo~BII Callllugue (TW10, lW1S, TW20, 'TW30}

a • PrevfoUJ VVIkB Thermowell CDIIIIogue • Orov.ingc (ATS·209e Sf\11-3, ATS·210!5 Sht 1·~. ATS-2111 Sht 1-3. ATS-2100 Sht 1·82)

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DECLARATION; 1 Kevin Sorvkan. P.Eno t•nnvl• ~employed by Wika lnotruments Ltd. and being tho person haVIng full author;Hy ana responsibility for the quality of the end producl do solemnly declare that the lnfcrmallcn contained In lhhl form l:o~ true end to the best of my knowledge represents the product for which registration Is a ought. The dimenaicna, msteri&lll of construction, prC:Iiliurc temper"lurlo! rpling,, end identification markings are In accordance wllh the herein named standards. J further declara that lhe manufecrure of these fillings Is regulated by a Quality Control Program which t~xtends to each plant where fsbrlcalion occurs in whole or In part and haG boon verified by ABSA tl.$ being suitable for that purpose and I make this &olemn dacleration comu:ientlously bell~vlng lito be true, knowing that it ia of fha samo forco Qnd offocl as if mode under oath.

Slgnah.ne of Declerer:

Occtarcd boforc me at T H I S S P ·A 0: E r. :) ,.; .

This 12th day of~~~~~~ Commissioner ct Oaths .---

0 F F I ('. I 11 • ·-· · •

NUNAVUT or Notary Public: (sign) ---t~--.~~.,"V---------

r---~~------~-~~--~Tnh~i,~a;pa;~;~c,o~rRR,c~g~ur~at~o~.A!~~ Pressu~VesseJ Ad This registnltlon mug( be revalidated after ten ( 0) ·years from the dste of acceptance. S

CRN; OH7851. 5 REV2

FID#: --.;2;...;8;....4 _ _ _ _ _

NctoJ: f. All fttlln;a a hill be replalerod In the lkJme of lhll Manufacturer. 2. E:~cl! catetgory shall ba supporllld with two Sliltutory Declorotior'! lorrm and one copy of supporting doeumtn~llon. 3, Tha dec:lar.atlon shall be mado by the porcon hovlnQ full aulhor1ty and reaponJiblllty for tilt quality of the end pu>duct. 4. ausllly control propromD 511811 bt rerubmllled for valid<~ lion at 11 moxlmum Interval of frve (5) yeJra.

REGISTERED

CRN ~7~8:...:~=::- '::-'::::S~N~,...~€~ Date --'-l\14ltl<1M~-B~,~· ~~.UJ bb__ Signed {-....--=:;-:::~-~~----

rial Registration Fee L---...L- - • Flltlnps Rev. 1 0

'6'01 I~ I

I

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