PIPELINE AND HAZARDOUS MATERIAL SAFETY ADMINISTRATION CYLINDER REQUALIFICATION FACILITY INSPECTION REPORT GENERAL INFORMATION

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PIPELINE AND HAZARDOUS MATERIAL SAFETY ADMINISTRATION CYLINDER REQUALIFICATION FACILITY INSPECTION REPORT Inspection : RIN Number: Company Name and Address: Company Officials: Title: Interviewed GENERAL INFORMATION What type(s) of cylinders are being requalified? 3A 3AA 3AL 3B 3HT 4B 4BA 4BW 4D 8 UN Receptacles 6351-T6 (Aluminum) Others? 180.209(a) Are Foreign cylinders being requalified? 171.23(a)(4), 173.301(j), 180.209 Are Special Permit cylinders being requalified? What method is used to requalify cylinders? Water Jacket/Volumetric Proof Pressure Visual Only Direct Expansion Ultrasonic Acoustic Emission Eddy Current If Water Jacket/Volumetric, what type of equipment is utilized? Burettes Computerized Weigh Bowl Are Cylinders sent to outside vendors for requalification or other services? If Yes, include hired services and vendor name and address: Services: Name/Address Fire Extinguisher Service Does company provide fire extinguisher service & supply? 173.309, 180.209(i) If Yes, what type(s) of fire extinguishers? Dry Chemical Halon/Halotron CO2 Others? Compressed Gas Filler/Distributor Does company provide compressed gas filling and/or distribution services? If Yes, what type(s) of gasses? Oxygen Argon CO2 Nitrogen Air Others? Are cylinder dates checked prior to filling?

REQUALIFER INFORMATION Requalification Operator(s): Initials: Years Experience: Interviewed Publications/CGA s Requalifier Identification Number (RIN) Letter issued: Is a hard copy of 40 CFR or internet access available? If hard copy, what is the year of publication? Are all applicable CGA s on hand 171.7 If yes verify dates: C-5 (91*) C-6(93) C-6.1(02) C-6.2(96) C-6.3(91) C-8(85) C-13(00) Others: * Redefined 1995 If Special Permit cylinders are requalified, list several examples: If Special Permits are used, are hard copies or internet access available? If hard copies, are Special Permits current? Visual Inspection Is a visual internal/external inspection performed before testing? 180.205 Are all outside labels, corrosion, and excessive paint removed prior to visual inspection? If yes, what method is used to remove paint and/or surface debris? Are all attachments (boots, bands, etc.) removed for visual inspection? 180.205(f)(2) & (g)(1) How is the internal visual inspection of neck and shoulder area being completed? Various CGA references Is an internal inspection light used? If yes, is it functional during the inspection? If yes, is it capable of illuminating the interior of the cylinder? Are aluminum cylinders of 6351-T6 alloy inspected for evidence of sustained load cracking (SLC) in accordance with Appendix C to Part 180? 180.205(f)(4), CGA C-6.1 If yes, how is the cylinder marked? 108.213(f)(9) (Obtain VE stamp sample) Has the facility developed, updated and maintained a written examination procedure applicable to the test equipment it uses to perform eddy current examinations? Appendix C to Part 180, CGA C-6.1

What method is used to determine aluminum/steel cylinders? Is a Hammer Test conducted on steel cylinders during visual inspection? 108.209(b)(1)(iii).CGA C-6 Yes NO N/A Are 3HT cylinders requalified in accordance with CGA C-8? 180.209(k) Yes NO N/A What criteria are used to condemn a cylinder visually 9dents, burns, arc marks, abrasions, pits, fire damage, etc.)? 180.2059d) Are low pressure aluminum cylinders dried following hydrostatic testing? (CGA C6.3) Yes NO N/A If yes, at what temperature? (not to exceed 350 F) Requalification Markings Are cylinders marked Before or After requalification of visual/hydro/ue/ae testing? 108.213(d) How is cylinder requalified by the Visual Only method marked? 108.209(g) & 180.213(f)(5) (obtain E stamp sample) Are markings legible? 108.213 (b) Yes NO N/A Are Special Permit cylinders (previously Exemption cylinders) marked E-6498, E-7042, E- 8107, E-8364, or E-8422 being requalified and marked 3AL? 173.23(c) If yes, obtain 3AL stamp sample: Yes NO N/A If foreign cylinders are requalified, how are they being marked? 171.23(a)(4), 180.209(l) Are applicable requalifications marking methods being followed? 180.213(c), 180.215(f) Yes NO N/A How are low pressure cylinders used as fire extinguishers marked? (Obtain completed pressure sensitive label) Stamp: Proof Pressure designation S : Pressure Sensitive Label: Are DOT 3HT cylinders being marked with low-stress steel stamps? Yes NO N/A Are composite cylinders being marked with a pressure sensitive label? Yes NO N/A If yes, obtain complete pressure sensitive label: Are cylinders successfully passing requalification marked accordingly? 180.213 Yes NO N/A If yes, obtain RIN stamp samples: High Stress: Low Stress: :

Do the RIN stamp(s) meet the minimum size requirement of 1/8 inch? 180.213(e) Do the DATE stamp(s) meet the minimum size requirement of ¼ inch? 180.213(e) For 10 year requalification tests meeting 180.209(b) requirements, are cylinders marked with a five point star? 180.209(b)(vi), 108.213(f)(2) If yes, obtain five-point star ( ) stamp sample: Does the five-point star meet the minimum size requirement of ¼ inch?180.213(e) For 10 percent overfill markings, are average wall stress calculations computed and marked accordingly? 173.302a(b), 108.213(f), (3), CGA C-5 If yes, obtain plus sign (+) stamp sample: Does the plus sign meet the minimum size requirement of ¼ inch?180.213(e) Where are the reference calculations located? 173.302a(b), CGA C-5 How is a cylinder that fails requalification documented? 180.205(f) & (i) Is the cylinder owner notified in writing? (Get sample notification) Is the cylinder stamped with a series of XXXX s? Is the cylinder stamped condemned? Is the cylinder rendered incapable of holding pressure? Is the cylinder returned to the owner? How is a condemned cylinder shown on test records? 180.205(b)(2) How are condemned cylinders identified/marked? 108.205(i), sample(s) Series of XXX s: CONDEMNED: Other: Are DOT 8 acetylene cylinders successfully passing requalification marked accordingly? 180.209(i), 180.213, CGA C-13 If yes, obtain stamp samples: Shell only S : Shell & Porous Filler FS : Do the stamp(s) meet the minimum size requirement of ¼ inch? 180.213(e) Are cylinders successfully passing Ultrasonic Examination or Acoustic Emission requalification marked accordingly? 180.213(f) If yes, obtain UE and/or AE stamp sample(s): Do the UE and/or AE meet the minimum size requirement of ¼ inch? 180.213(e) Requalification System Is the pressure-indicating device certified to be accurate within ±0.5% or better of its full range? 180.205(g)(3)(i) Does the pressure-indicating device permit readings of pressure from 90%-110% of the minimum prescribed test pressure of the cylinder being tested?

Can the accuracy of the pressure-indicating device be demonstrated within 500 psi for cylinders tested at or above 3000 psi, or 10% of the actual test pressure for cylinders tested below 3000 psi? Pressure-Indicating Device Information: (obtain copy of calibration) Main - psi Increments psi Serial Number Certificate Alt - psi Increments psi Serial Number Certificate How often is pressure-indicating device calibrated? Is the expansion-indicating device certified to be accurate within ±0.5% or better of its full range? 180.205(g)(3)(ii) (obtain copy of calibration) Does the expansion-indicating device used for calibration/testing provide resolution accuracy of ±1% of the total expansion of any cylinder tested or 0.1cc, whichever is larger? If Burette system is utilized, are burettes adjustable? Are readings first taken at zero level? Burette Readings Used: What method is used to confirm equipment accuracy within ±1.0 accuracy? Calibrated Cylinder Other (e.g. Associated Administrator Letter) Calibrated Cylinder Information:: (obtain copy of calibration) #1 Manufacturer Serial Number Calibration #2 Manufacturer Serial Number Calibration How long are cylinders held at test pressure? 180.205(g)(5), any applicable DOT-SP Is there a timing device or clock, which indicates seconds available? How does facility distinguish between a test equipment failure and a cylinder failure? If during a test, the pressure cannot be maintained due to equipment failure, is the cylinder retested? How many retests may be conducted? At what pressure is the cylinder retested? (an increase of 10% or 100psi, whichever is less) Are retests noted on test records with a reason for the repeated test? 180.215(b)(2) If performing a system check, is it done at or below 90% of the cylinders test pressure? (180.205)(g)(5)

Calibration Certificate Readings & Expansion Reading Achieved Calibration Certificate Figures Actual Test Figures Are the actual expansion figures within ±1.0 accuracy of the prescribed test pressures for cylinders tested today? Based on the results of calibration, would you continue to test cylinders today? Facility Requalification Records Do daily calibration and requalification records include the required information?(108.215) Calibration record: of calibration Calibrated cylinder serial number Calibration test pressure Total, elastic, and permanent expansions Legible identification of the test operator Pressure Test and Visual Inspection record: of cylinder requalification Serial number of tested cylinder DOT/ICC Specification, exemption, or Special Permit number Cylinder marked service pressure Actual dimension (size) Manufacturer s Name or symbol (if present) Owner s Name or symbol (if present) Visual inspection results (Pass/Fail) Actual test pressure Total, elastic, and permanent expansions Percent permanent expansion Disposition, with reason for any repeated test, rejection or condemnation Legible identification of test operator An indication of how maximum wall stress is calculated (if applicable) When a second test is conducted after a cylinder failed to hold test pressure, the date of the earlier test is indicated (if applicable) Visual only record: of cylinder inspection (month and year) DOT Specification number Cylinder identification (registered symbol, and serial number, date of manufacture, and owner) Type of cylinder protective coating (including statement as to need of refinishing or recoating)

Conditions checked (leakage, corrosion, gouges, dents, or digs in shell or heads, broken or damaged foot ring or protective ring, or fire damage) Disposition of cylinder (returned to service, returned to cylinder manufacturer for repairs or condemned) Eddy Current record: Equipment manufacturer, model number and serial number Probe description and unique identification (serial number, part number etc.) Specification of each standard reference ring used to perform the examination DOT specification or exemption number of the cylinder, manufacturer s name or symbol, owner s name or symbol (if present), serial number and date of manufacture Name of test operator performing eddy current examination of eddy current examination Acceptance/condemnation results (pass/fail) Requalifier/Retester identification number If ditto marks or a solid vertical line is used to indicate repetition, are they only used for date, actual dimensions, manufacturer s name or symbol, owner s name or symbol, and test operator entries? Investigator obtained records of: Cylinder requalification records RIN letter of approval Calibrated cylinder certificate(s) Pressure gauge calibration certificates Training records ADDITIONAL NOTES: I hereby certify that the documented responses on the previous pages are true and accurate to the best of my knowledge. Person(s) interviewed: Investigator(s):