Registration of Welding Procedure Form 825

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PRINTED IN B.C.
4500111427
Please refer to our web site or contact a Regional Office to locate the BC Safety Authority office nearest you.
604-927-2041 Coquitlam Street, Suite 400 88 - 6th 250-861-7313 Kelowna New 250-716-5200 NanaimoWestminster, BC V3L 250-952-4444 Victoria
Head Office:
fax 604-927-2047 Kamloops 3rd Floor, 4243 Glanford Avenue fax 250-861-7349 Langley 5B3 250-716-5212 BC V8Z 4B9Prince George Victoria, fax fax 250-952-4458
Vancouver Island Regional Office:
250-314-6000 fax 250-377-4406 1913 Kent Road 604-539-3570 604-539-3573 fax Kelowna, BC fax 250 614 250-614-9972 V1Y 7S6 9949
Southern Interior Regional Office:
Lower Mainland Regional Office: Northern Interior Regional Office: TOLL FREE NUMBER: 20635 Fraser Highway Street, Suite 200, 3740Westminster, BC, V3L 0E1 Opie Crescent 1.866.566.SAFE (7233) New Westminster: 505 - 6th New Website: www.safetyauthority.ca Langley, 778-396-2000 Prince George, BC V2N 4P7 www.safetyauthority.ca Local Phone: BC V3A 4G4 fax 778-396-2174 Toll Free: 1-866-566-SAFE (7233) fax 1-888-660-3508
REGISTRATION OF A WELDING PROCEDURE
NOTE: THE INFORMATION ON THIS FORM ISIS COLLECTED TO ADMINISTER THE PROVISIONS THE THE SAFETY STANDARDS IF YOU HAVE HAVE THE INFORMATION ON THIS FORM COLLECTED TO ADMINISTER THE PROVISIONS OF OF SAFETY STANDARDS ACT. ACT. IF YOU ANY QUESTIONS ABOUT THE COLLECTION, USE, OR DISCLOSURE OF THIS INFORMATION, CONTACT THE RECORDS/FOIPP COORDINATOR FOR QUESTIONS ABOUT THE COLLECTION, USE, OR DISCLOSURE OF THIS INFORMATION, CONTACT THE RECORDS, INFORMATION & PRIVACY THE BC SAFETY AUTHORITY ATAUTHORITY AT TELEPHONE 1-866-566-SAFE (7233). ANALYST FOR THE BC SAFETY TELEPHONE 604-660-6286. ALL FEES PAYABLE TO BC SAFETY AUTHORITY. PLEASE SUBMIT TWO (2) COPIES OF EACH PROCEDURE, ONE OF WHICH MUST HAVE AN ORIGINAL SIGNATURE AND DATE ON THE PROCEDURE QUALIFICATION RECORD (PQR) QW-484 FORM, IN THE SECTION CERTIFIED BY THE RESPONSIBLE PARTY PREPARING THE RECORD. WHEN SUBMITTING A WELDING PROCEDURE FOR REGISTRATION IN BC, ADDRESS ALL ESSENTIAL AND NON-ESSENTIAL VARIABLES. IF SUPPLEMENTAL VARIABLES APPLY, ADDRESS ALL POINTS AS LISTED IN ASME SECTION 9 WITH A READING, A FIGURE, A YES OR A NO. DO NOT USE THE TERM NOT APPLICABLE.
FOR APPLICANTS USE
APPLICANT’S NAME SUITE NO. CITY CONTACT PERSON STREET NO. STREET NAME STREET TYPE PROVINCE PHONE NO. PHONE NO.
(
)
POSTAL CODE
(
PROCEDURE REG. NO. NAME OF TESTING AGENCY
)
REGISTRATION NO. TA THIS APPLICATION MUST BE ACCOMPANIED BY THE REQUIRED A.S.M.E. FORMS QW-482, QW-483, THE LABORATORY REPORT, IF ANY AVAILABLE, AND ANY OTHER FORMS OR REPORTS AS REQUESTED BY THE SAFETY OFFICER. THE REGISTRATION FEE PER PROCEDURE MUST BE PAID AT THE TIME OF SUBMITTING THIS APPLICATION. THIS FEE IS NON-REFUNDABLE. WE HEREBY AGREE TO PAY ALL AND ANY ADDITIONAL CHARGES OVER AND ABOVE REGISTRATION FEE, INCURRED FOR THE TECHNICAL CONSULTING SERVICES OF THE ATTACHED PROCEDURE(S).
APPLICANT’S SIGNATURE
DATE
FOR SAFETY OFFICER’S USE
THIS APPLICATION WAS REVIEWED AND ACCEPTED BY (NAME OF SAFETY OFFICER AND REMARKS)
PROCEDURE REF. No.
SAFETY OFFICER NAME: SAFETY OFFICER SIGNATURE: DATE Y Y M M D D
FOR OFFICE USE ONLY
YYYY OFFICE ENTRY DATE MM DD
TECHNOLOGY:
TOTAL FEE $
BP
PAYMENT METHOD
FILE NO. YYYY MM DD
FEE $
GST $
TRAN DATE
WHITE - Head Office
FRM-0825-01 (2009-05-21) FRM-0825-00 (2004/10/13)
YELLOW - Audit
PINK - Applicant
ORCS 30880-20