Application for Registration as a Requalifier of Cylinders for Acetylene Service Pursuant to CSA B339-02

Application for Registration
as a Requalifier of Cylinders for Acetylene Service Pursuant to CSA B339-02

First application:      Yes ( )       No ( )

Company Information

Name*: __________________________________________

Address: __________________________________________

City: ____________________ Province/Territory: ____ Postal Code: _________

Telephone: ________________Fax: ________________

Contact Name: ____________________________

Contact Title: ____________________________

* Please attach a copy of a certificate of incorporation or a business name registration, as applicable.

Address where operations will be conducted (if different from above):

Address: __________________________________________

City: ____________________ Province/Territory: ____ Postal Code: _________

 

Access to Regulatory Requirements and References

 

This facility has a copy of the following documents available for use by its staff:

Cylinders to be Inspected

Specifications of cylinders are _________________________________________

Procedures

For handling, inspecting, and marking cylinders, and for recording results, this facility will use the following procedures:

 

 

 

Other or additional procedures (specify) _________________________________________

 

 

 

___________________________________________________________________________

Equipment

This facility will have available the following equipment for cylinder inspection:

___________________________________________________________________________

___________________________________________________________________________

Inspection Personnel

Name: _____________________________________________________________________

 

 

Name: _____________________________________________________________________

 

 

 

 

Name: _____________________________________________________________________

 

 

 

 

*In accordance with clause 25.3.2 of CSA B339-02, please submit the applicable quality control procedures and include a description of the training, qualifications, and experience that would enable this facility to perform the inspections required by this Standard.

 

 

I hereby authorise inspectors of Transport Canada to examine and to inspect any facilities associated with the requalification of acetylene cylinders in accordance with the Transportation of Dangerous Goods Regulations.

Signature: __________________________________________

Name: __________________________________________

Title: __________________________________________

Date: __________________________________________

Certificate of Registration requested in (check one):

 

 

Please return the completed application form to:

 

 

Transport Dangerous Goods Directorate
Transport Canada (ASDD)
Place de Ville, Tower C
330 Sparks Street, 9th Floor
Ottawa, ON
K1A 0N5

The completed application and pertinent documents may be sent by facsimile to (613) 993-5925. However, due to the nature of facsimile services, we cannot be responsible for misdirected, incomplete, or illegible documents.