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June 23, 2016

SCOTT ISLIP
ROUND ENGINEERING INC
10 SEGWUN RD
WATERDOWN ON L0R 2H8
CA

Service Request Type: BPV-Fitting Registration


Service Request No.: 1885042
Your Reference No.: EH-CRN-17
Registered to: ENDRESS + HAUSER CONDUCTA INC

Dear SCOTT ISLIP,

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

CRN No.: 0F18550.5


Main Design No.: MEMOSENS CLS82D HYGIENIC CONDUCTIVITY SENSORS
Expiry Date: 23-Jun-2026

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

A stamped copy of the approved registration and invoice for engineering services will be mailed to you
shortly. Should you have any questions or require further assistance, however, please contact a
Customer Service Advisor at 1.877.682.TSSA (8772) or e-mail customerservices@tssa.org. We will be
happy to assist you. When contacting TSSA regarding this file, please refer to the Service Request
number provided above.

Yours truly,

Zivko Gacevic P. Eng.


Mechanical Engineer, BPV
Tel.: 416-734-3429
Fax: 416-231-6183
Email: zgacevic@tssa.org

Page 1
Show facsimlle of manufacturer's logo or trademark, as it will
TECHNICAL STANDARDS &
appeâr on thê fifiing, in the space bdow
SAFETYAUTHORITY
14lh Floor, Centre Tower
3300 Bloor Street West
Toronto, Ontario
Canada M8X2X4
Endress+ Hause r
People for Process Automation
El
RY ON
Registration of Fittings

t, MIKE YOUROSKI, QUALITY MANAGER


(Neme and Pos¡Ion, e.g. Presldeni Plant Manageí Chiel Engìnaer)

o¡ ENDRESS+HAUSER CONDUCTA lNC.


(Narne oÍ Manufaclurcù

4123 LA PALMAAVE., ANAHE|M, CA, USA,92807


Located at 1-714-577-5600
(Plant Adclress) (Telephona No.) (Fâx No)

dosolemnlydeclarethatthefittingslisledhereunder,whicharesubjecttolheTechnlcalstandardsandSafefyÁcl Boilers
and Pressure Vessels Regulation, comply with all of the requirements of
ASME 83I.3, ASME VII1.1
(nile of recognlzad Noíh Amarican Stândad.)
wtriÍ spe<Ífies the dmensions, rnaterids of ænstrudion, pressurcriernperafure ratings, llenlification maúing ûre frttirUs arìd service;

n ot are not covered bv lhe provisions of a recognized Norlh American standard and are herefore manufactured to comply with
supported by the attached dats which ldentifies the dimensions, materiaf of construction,
pressure/temperature ralings and the basis for such ratings, the marking of lhe ffiling for identification and seMce.

I furlher declare that lhe manufacture of these fttings is controlled by a quality system meeting lhe requiremenls 6¡ ISO 900112008
wtriú has been verffed bytre folloving aufrrcrity, sos
The itens co¿ered byfris dedanatim, ftrwtridr I æok registahn, am categrory F Fittinss t¡pe ftlings. ln support of
h¡s apdicatkn, üe fo[oú¡ing infonnalion and/or test data ale attadted as folþr,r¡s:
DRAWNGS, CALCULATIONS, REPORTS, SCOPE OF CRN
(draw¡ngs, calculat¡ons, lesl ¡êpodq efc.)

Declared before me at >4 in fhe of

the 7 n( ,OJÁ day of øt

"o^t*';ffffi4-F, hy¡¡
name) ägF
ë=F
Ësñ
Yru'
E-i Nl
FOROFFICE USEOA'I
To the best of my knorvledge and belief, lhe applicalion meets ûre requlrements
.$tandards hesstreVessels ËH=
SafeU t
Techntcal Slandards and SafegAcf, Boilers and pressure Vessels Srfoty hogram
CSA Standard 851 and is accepted for registralion in Category

CRN oFt r REGTSTBRBD


Registered by: - vVo 6aú vtc c*¡1.r,,9,f*{-8{,{9ri,*ooo'......
Dated; ol6 sig"*."ß.*.:...2,*,..D......
NOTE: This
PV 09553 (06/0.1)

Äloh t, ? Lo¡c tc ¿ (lre a((acl*&? { /o, ( l. Jcop< o/ re2tr/tatu.


z^ ê- 6/ü/ ?6
ACKNOWLEDGMENT

A notary public or other officer completing this


certificate verifies only the identity of the individual
who signed the document to which this certíficate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange )

On June 7 , roru before me, William E. Zinn, Notary Public


name and title of the office r)

personally appeared //
who proved to me on the basis of satisfactory ence to be the person(pfwhose name(S) is/arc
subscribed to the within instrument and acknowledged to me that he/såc/ttrey executed the same in
his/he#ttl-eir authorized capacity(ie;i), and that by his/heøTñeir signatureþ on the instrument the
person(s], or the entity upon behalf of which the personþ) acted, executed the i nstrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

WITNESS my hand and official seal fD


t-
0 o
fn -l
ORANGE COUNTY t)
Term Ëxp. August 25, Aotg
Signature (Seal)

THIS IS PART OF
cRN OF l?ffo . r
Tæhnical Standards & SafetyAuthority
Boilers & Pressure Vessels
Safety Program

z- c- c/zt/ ¡¡
THIS IS PART OF
ENDRESS+HAUSER CONDUCTA INC. CRN OFßççO,f 27-May-16
4123 LA PALMA AVE. Tæhnical Standards & SafetyAt¡üorlty
ANAHEIM, CA Boilers & Pressure Vessels
92807, USA Prog ram
SCOPE OF CRN REGISTRATION z.é. €
PRODUCT DESCRIPTION

Description Design Standard End Gonnections Drawings EH Tl Document

ASME 83,I.3, ASME 403711-2415,403712,


1" NPT, G1", PG13.5, 1-112" and 2" ASME BPE, 1SO2852, DIN
Memosens CLS82D BPE, ASME VIII-1 403150,403159, Tto1 188C/07/EN/03.16
32676 Clamp Ferrule (Note 1)
UG-101{m) 403168,403170

PRESSURE - TEMPERATURE RATINGS

MDMT MAWP AT 68 F MAWP AT 248 F MAWP AT 284F NOTES

23F 247 psig 131 psig at248F 87 psig a1284 F None

MATERIALS OF CONSTRUCTION
PROCESS ADAPTER MATERIAL
SENSOR SHELL MATERIAL NOTES
(NOTE 2)
POLYPHENYLEN E SULFIDE PLASTIC,
POLYPHENYLENE SULFIDE PLASTIC, ASTM A479-3161, Optional process adapter materials may be
ASTM A479-316L, STAINLESS STEEL
STAINLESS STEEL'1.4435 TYPE 3161, UNS S31603, CERAMIC used. See Note 2.
1.4435 TYPE 316L, UNS S31603

MANUFACTURING LOCATIONS
Endress+Hauser Conducta
215021 Suzhou, Endress+Hauser Analytical lnstruments Suzhou Co. Ltd.
P.R. China
Endress+Hauser Conducta
4123 LA Palma Ave., Anaheim, CA
92807, USA

Note 1) The assembly clamp is not part of the CRN and is not manufactured by ENDRESS+HAUSER. Pressure-Temperature ratings may be limited by the
clamp type used in the joint assembly. Consult clamp Manufacturer for clamp Pressure-Temperature ratings.
Note 2) The following additional alloys of superior or equivalent properties to those listed above are also included in the scope of registration as follows:
N06022, 8574tBis64, (C-22,2.4602); N10276, B'574tB,564, (C-276,2.4819); S31803, A4791A182, F51, (3181N, 1.4462); 532750, p¿ OtA182, Fs3, (2507,
1.4410); 532760, A4791A182, F55, (Zeron 100, 1.4501);N06600, Bíô6/8564, (|ncone|600,2.4816);N06625,8446/8564, (tnconel625,2.4356);N08825,
842518564, (lnconel 825,2.4858); 530400/530403, 4479/A182, (304ßA4L, 1.ßA1n.ß0611.ßAT);8381-F3, (Titanium Grade 3, UNS R50550) Note: Titanium
limited to 247"F max
~~ ··~·

505 - 6th Street, Suite 200

s~
New Westminster, BC V3L OE1
Toll Free: 1-866-566-SAFE
Fax: (778) 396 - 2064
www.safetyauthority.ca

Date: July 27, 2016


TECHNICAL STANDARDS & SAFETY AUTHORITY Account#: 35231
345 CARLINGVIEW DRIVE Journal #: 66044
TORONTO ON M9W 6N9
Our File#: 5601212

Attn: TANYA FRANCIS

Re: Application for Design Registration


The design, as detailed in your, TSSA SR# 1900896, for a Fitting is accepted for registration as follows:
Registered To: ENDRESS+ HAUSER CONDUCTA CRN: OF18550.51
INC
MDMT: 23 deg F MAWT: 284 deg F MAWP: 247 psig

Drawing #:Design Report EH-CRN-17 Drawing Revision: 0

Conditions Of Registration:
Registration of Memosens CLS82D Hygienic Conductivity Sensors as per scope of registration sheet.
This design was registered based on a technical review performed by the province of initial registration in
accordance with the Association of Chief Inspectors policy on reciprocal recognition of design review.

Re•lie'l.·ter's Netes:
As required by CSA 851 4.2.1, this registration expires on June 23, 2026. This CRN is valid until the expiry date as
long as the Manufacturer maintains a valid quality control program verified by an acceptable third-party agency until
that date. Should the certification of the quality control program lapse before the expiry date, this registration shall
become void.

Contact me if you have any questions. The invoice for registration will be forwarded under separate cover.

SHARON PETERS

boiler.designregistration@safetyauthority.ca
Design Administration

cc:

'0 ROD) 30400-20 GST #: 87391 2802 RT0001


THIS IS PART OF
CRN ofi8!'S"0.5"
ENDRESS+HAUSER CONDUCTA INC. 27-May-16
4123 LA PALMA AVE. ~~&Safety~
ANAHEIM,CA Boitets & Pl'e$S!Jte ~
92807, USA
, safety Program
SCOPE OF CRN REGISTRATION z. ~. '{J,lf 16

PRODUCT DESCRIPTION

Description Design Standard End Connections Drawings EH Tl Document

ASME B31.3, ASME 403711-2415,403712,


1" NPT, G1", PG13.5, 1-112" and 2" ASME BPE, IS02852, DIN
Memosens CLS82D BPE, ASME Vlll-1 403150,403159, TI01188C/071EN/03.16
32676 Clamp Ferrule (Note 1)
UG-101(m) 403168,403170

-
PRESSURE TEMPERATURE RATINGS

MDMT MAWPAT68F MAWPAT248F MAWPAT284F NOTES

23F 247 psig 131 psig at 248 F 87 psig at 284 F None

MATERIALS' OF CONSTRUCTION
PROCESS ADAPTER MATERIAL
SENSOR SHELL MATERIAL NOTES
(NOTE2)
POLYPHENYLENE SULFIDE PLASTIC, POLYPHENYLENE SULFIDE PLASTIC, ASTM M79-316L, Optional process adapter materials may be
ASTM M79-316L, STAINLESS STEEL
STAINLESS STEEL 1.4435 TYPE 316L, UNS S31603, CERAMIC used. See Note 2.
1.4435 TYPE 316L, UNS S31603

MANUFACTURING LOCATIONS
Endress+Hauser Conducts Endress+Hauser Conducts
70839 Gerlingen incl. rnanufacluring slles 215021 Suzhou, Endress+Hauser Analytical Instruments Suzhou Co. Ltd.
04736 Waldheim and 64823 Gross-Umstadt, Germany P.R. China
Endress+ Hauser Conducts
4123 LA Palma Ave., Anaheim, CA
92807, USA

Note 1) The assembly clamp is not part of the CRN and is not manufactured by ENDRESS+HAUSER. Pressure-Temperature ratings may be limited by the
clamp type used in the joint assembly. Consult clamp Manufacturer for clamp Pressure-Temperature ratings.
Note 2) The following additional alloys of superior or equivalent properties to those listed above are also included in the scope of registration as follows:
1q000~~. 8!ff4iB564, (e-!Z, !.4962), 14192'1'6, B61o4/e564, (6 276, 2.4819), 661896, A479/A182, F51, (318W, 1.4462), 932¥56, Al!o49lA182; F53, !2597,
1,4410); 532760, A4791A182, F55, (Zeron 100, 1.4501 ); N06600, 8166/8564, (lnconel600, 2.4816); N06625, 844619564, (lnconel625, 2.4856); N08825,
842518564, (lnconel825, 2.4858); S304001S30403, A4791A182, (304/304L, 1.430111.430611.4307); B381-F3, (Titanium Grade 3, UNS R50550) Note: Titanium
limited to 247•F max
345 Carlingview Drive
Toronto, Ontario
CANADA M9W 6N9
Tel.: 416.734.3300
Fax.: 416.231.1626
Toll Free: 1.877.682.8772
www.tssa.org

August30,2016

SCOTT ISLIP
ROUND ENGINEERING INC
10SEGWUN RD
WATERDOWN ON LOR 2H8
CA

Service Request Type.: BPV-National ACI Central


Service Request No.: 1900888
Your Reference No.: EH-CRN-17
Registered to.: ENDRESS+ HAUSER CONDUCTA INC

Dear SCOTT ISLIP,

Please find enclosed the original response from PEl, NS, NB, NFLD, YK, NWT, NU registered under the
CRN No.: OF18550.59870YTN.

As all jurisdictional fees are handled by the Technical Standards and Safety Authority (TSSA), you do not
pay any jurisdictions directly.

Should you have any questions or require further assistance, I will be happy to assist you.
For general enquiries, please contact a Customer Service Advisor at 1.877.682.TSSA (8772) or e-mail
customerservices@tssa.org. When contacting TSSA regarding this file, please refer to the Service
Request number provided above.

Yours truly,

Joanna Karpinski

Tel.: 416-734-3377
Fax: 416-231-6183
Email : jkarpinski@tssa.org

Putting Public Safety First


07-29-16;09:51AM; ;902-368-5526 # 14/ 20

UNIFOBM STATUIORYJlECLARAIION FORM EO.B TJ:!e REG!STBAT!ON QF Fm!NG O§S!Qt:!S


NEW BRUNSWICK NOVA SCOTIA PRINCE eCWARO ISI.ANO NgWFOlJNCI.ANO ANO l.I\6RAOOR
NUNAVUT YUKON NORTHWI!ST TERRITORIES

MANUFACTURERS NAME: ENDRESS+HAUSER CONOUCTA INC.


MANUFACTURERS ADDRESS~ 4123 LA PALMA AVE •• ANAHEIM, CA, USA, 9~807
PlANT LOCATIONS: GERMANY, P.R. CHINA, USA
CA'(§GQ.BV Q!! FITIIt!!;!S !0 B§ B§~U~UU!.gl2a CIB~I.!;. Qf:lli. !f6I§GO~Y ~«l.'t' fRUCIION~

A Plpo ftltlngs, Including couplings. taos, albows, Vs, plugs, unions, l)lpe caps, or roduc:ota -ASMEB31.3
B Flonooa: oil nonoos ·ASMEVIII-1
c Valvaa; all line valvos
0
D Expansion lalnta, noxlbla conn~tr:llon~, an~ haso oGsombllea: all typos
Strainers. Altora, 1aparatora, ond :~Ia am traps
MeiiSurlng dOVICOI, Including pressure oaugos, lovol gaugiJD, sight QIQQSO~. lavuls, or
pro3Gure transmiUara
0 Cortlflad cJJpaclty-ratetJ presaure relluf devlceo oc;coptabh.J $1J prtmary avor pro.!laurl'l prateellan on
boller3, pranura vaaaals, piping and ruslbla pluoq
H PrtUUt11 retaining campanenla lhat do not faQ lola ono of the abova oalogorlos
N Nuolear compononla: Claaa 1 0 Class 2 0 CloaG 3 CJ, (Meeting CNSC or ASME raqulllolments)
SHOW_MANUi=ACTl RERS NAME.. IK DR ~aGO AS IT WILL APPI"AR~ON_TH•E PROOLIC1' ['{J>JIO~ ' -
Endress+ Hauser
People for Process Automation
m fiORaeoXi wnLal!a
CI\ST 0 OTIIQ"
OUOI\18e Olli~lt
Mel"AL AND PLASTIC
jl WROUQIIT K

LIST OF= SVPPQBTINQ DOCUMENTATION f.NP.lQENTIFICA naN CF THe "'' Ul\l llEMS l'O Be lEI:'

·DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN

'

DECLARATION:
1 MIKE VOUR.OSKI. QUALITY MGR 1nm 11014 ~~ employed by ENDRESS+HAUSER \llld being the pon;Qn havlnq ftJllll1,1\hority OIIQ
rosponalblllty forth" quality of tho end prod1.1ct do solemnly doclare that the Information contalnod !n tl'lli form I~ trv~ ond to the bcm or
my knowlodgo represents tho product for whlch registration I~ souglll. The dimensions, matQrlal$ of conatructlon, presauro
temperature rating$, and ldonuneatlon marldngs oro In occortt~nco wlth the horcoln nl\me<l $tonc1Qtdl;l. I fynher declara lhQt the
manufacture of the so flt!II'IQG hi regulated by a Ouallly Control Program which extends to oach plant where fobrlcallon occur~ In whole
or In part and has been verified by sas tiSO 9001:2006\ as being aullablo ror thot purpose and lll\OKO this sol~ll11l
declaration conscientiously believing It to bo true, ond knowlngtha\ It Ia of the sRme force and effect as If made \mdor oalll,

Slgnaturs of Declarer: ..:r:l/dJ 'd_~ ' WILLIAM E. ZINN


Ooclarod boforo me at _i1tv:t.P.-<rl'l..., t!A= !COMM ...2121281
This ...., day of .;GJ Q.c'.. I AD .?. aI~ NO~A~M~:~~~~~~ORNIA
Commissioner of Oaths MyTerm Exp. August25, 2019
or Notary Public: (sign)-------:::;;;,.......,~-----
Tills sp~co for Raaulalory Aulhorlly use
,_ll,!.u-~··· n must be revalidated after len (1 0) year& from the dale or acceptance.

eRN: _o_F_la_s_s_o_._s__ ACCEPTED


PIOVlNCE OP l'llNCE EDWAlD ISLAND
FlO#: _1_4_8_78_ _ __
COMMUNII'IES, UND &ENVIRONMENT

==0~
Nolas:
1. AlllllllngB shall bo raglatorod In lho namo of tha Monuf~cturor,
2. Each c:otooory llhall bo supportod with two St;~tutory Doclarollon
lorm~ and ano copy of :.upportlnA lolocumontntlon.
3. iho daclarallon st\tlll bo mado by the pomon having lull authority and
ro~pon~lblllly for lho quQIIty of tho ond product. INSPBCTION SEI.VlCES SECIION
4, Quality control programo shall bo rosvbmltlad for validation BOII..Elt1PRESSUl VESSEL BRANCH
at o maximum lnlorvlll of llvo (5) yaar11. soet. 1.0 • Flltlnos Rov. 1 OGt2003
12:06:35 p.m. 07-29-2016 7/13
19024288770 Labour &Advanced Education

..
UNIFORM §TATUTOR'( DECLARATION EORM FOR THE R§GIS!BAT!Otl OP f!UING Q§.SISU!S
NEW BRUNSWICK NOVA SCOTIA PRINCE EDWARD ISI.ANO NeWFOUNOI.ANO AND lABRADOR
NUNAWT YUKON NORTHWI!ST TERRITORIES

MANUFACTURERS NAME: ENORESS+HAUSER CONDUCTA INC.


MANUFACTURERS ADDRESS: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92B07

A Plpa ftttlngs, lnc:lucflng coupllnga, 1101, alboWa, Va, plugs, unlona, plpa aapa, or reducers ·ASMEB31.3
B Flangos: au Rangos ·ASMEVIII-1
c Valv11: allllna valves
o Expanalan Jalnta, naxlbla c:annacUana, and holt aaaombllaa: all typos
.( Strainers, liltara, aaparalara, and·alaam traps
W Maaaurlng davlc:oa, Including praaauragaugos, lovol gaugoa, alght glnsea, laval:!, or
prassura transmiUors
a Certified capaclly·ralod prasaura rallaf d11vlcot a~:Ceptabla as primary avar pra$auro protacllon on
bollont, praaaure veaaola, piping and fualbla plUgs
H Prassur11 retaining camponanta tltql da not falllnla ana af the abova cataga!lo.
N Nudaar c:umponanta: Claaa 1 C Claas 2 C Claaa3 C, (Maattnv CNSC or ASME ,.qulramontsl
s

Endress+ Hauser ff!J


People for Process Automation

·DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN

DECLARATION:
I MIKE YOUROSKI, QUALITY MGR ''" no11 a1 employad by ENORESS+HAUSER and balnQ lh11 Pillion tr'vlng full authQrity and
responsibility for \he quality of the end pradLJ~ da aalamnJy daclaro that tho Information c:antalned In U1l:s form Is true and \o th11 bast at
my knowladge repreaenllllha praduC\ far which rqglrstn•llon le sought. Tho dimensions. materials of c:onaiNcUQn, pruaure
temperature ratings, and ldenUilcatlon markings are In a~onh1nce with the hai'Qin named standard a. I f\lrther declare tMl the
manufacture of these RttlngsiS regulated by a Quality Control PI"Qgram Which extends to a!lch plant where fabrlcqtlon OC~:Urtln whole
or In part and haa been ver!lled by S(lS nso 9001 :2008\ . a• baing •ult11ble for lha\ purpose and I make thl~ solamn
declaration conaclentlously believing It to be true, and l<nowlnglha\ Ills of the 1111me fo~e and e!f11C\ aa If made under oath,

Signature of Declarer: 1(/J;/, ~ ' WllllAM E. ZINN


Oedaredbeforemeat 19.tu:J,~'~' 4A- u '3 I; r !I !COMM...2121281
This ...., day of .:C~J fl-t",. r AD tl r N~AgtJ~~~=RNIA
Commissioner of Oaths Tann Exp. Augusl25, 2019
or Notary Public: (sign) -----~....:::-r-----

Thla,-,.,.....-•. -
CRN: _o_Fl_a_s_s_o_.s__
FlO#: _1_48_7_8_ __

Notus:
1. Alllllllnga shall be reglslored In lho namo of the Manufocturar,
2. Each category shqll bo supportocJ wllh lwo Sla\lllory Declaration
form!l anrJ ana copy of supporting documantallon.
3. The daclarallon shall be made by the person having full authority and
raaponalbiiRy lor lha quaiiiV of tho and product.
4. QuqJIIy control programa shall be rasubmlttqd lor valldaUQn
at a maximum lnleNal of Ava (5) yaars. Sect. 1.0 ·Filling~ Rav. t OG/200J
UNIFORM STATUTORY DECLARATION
.
FORM FOR THE REGISTRATION OF FITTING. .DESIGNS
. . -· -- - - -

NEW BRUNSWICK NOVA SCOTIA PRINCE EDWARD ISLAND NEWFOUNOL,ANO AND l.Ai'JRAOOR
NUNAVUT YUKON NORTHWEST TERRITORIES

MANUFACTURERS NAME: ENDRESS+HAUSER CONDUCTA INC.


- ---. ---- --- --
MANUFACTURERS ADDRESS: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92807
-
PLANT LOCATIONS: GERMANY, P.R. CHINA, USA
CATEGORY OF FITTINGS TO BE REGISTER!;;D, CIBCb§ ONE CA TEGOR:f: QNl. Y TIHE Qf: THE !!TANpABD QF CCNSTRVCTl~

A Pipe fittings, including couplings. tees, elbows, Ys, plugs, unions. pipe caps, or reducers
-ASME 831.3
I
B Flanges: all flanges
C Valves: all line valves
-ASMEVIII-1 I
@
D Expansion joint~>, flexible connections. and hose assemblies: all types I
Strainers, filters, separators, and steam traps
Measuring devices, including pressure gauges. level gauges. sight glasses, levels. or II
pressure transmitters
G Certified capacity-rated pressure relief devices acceptable as primary over pressure protection on
boilers, pressure vessels, piping and fusible plugs
II
H Pressyre retaining components that do not fall into one of the above cats9orie!> ~
N Nuclear components; Class 1 0 Class 2 0 Class 3 Cl, (Meeting CNSC or ASME requirements)
I SHOW MANUFACTURERS OGO AS IT WILL APPEAR ON THE PBODUCT TYI>t;; F ~ NSTRUCTJQ!l
J
-- --- NAME. . RADEMARK OR
--
FORGEP~ WELDI!O l'J WRQUGtil K I
Endress+ Hauser Ill CAST 0 QTI11;R
I)ES!;RIBIO OTHIOR
METAL AND PLASTIC
M
II
People for Process Automation
LISTOF SUPPORTING QQCUMENTA TION AND IQ5f!!TIFICA TION OF THE: ACTlJAL ITEMS TO f!s REGISTERf;D: ·-- - - -
l
I
-DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN
II

-----
I I
DECLARATION:
I MIKE YOUROSKI. QUALITY MGR (soq notQ 3l employed by E~_I?RESS+HAUS~R . and l;leing the person h~ving full aYII1orily an e)
responsibility for the quality of the end product do solemnly declare that the Information contained in this form h~ true and to the best ot
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 fvrther declare that the
manufacture of these fiWngs is regulated by a Quality Control Program which extends to each plant where fabrication occurs in whole
or in part and has been verified by sas CISO 9001:2008\ as being suitable for that p1,1rpose and I miJke this solemn
declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath,

Signature of Declarer: ·1'(/t.f< ~".-A~ ' WILLIAM E. ZINN


Declared before me at !ftxc/'4:1"-l v A- :COMM ...2121281
NOTAR't PVBLIC·CAUFORNIA
This _ _'/-'---- day of ..:::Jv () -6 ' ORANGE COUNTY
Commissioner of Oaths Exp.August25,2019
or Notary Public: (sign) ~------=-~f------

eRN: _o_F_1_8s_s_o_.s__
FlO#: _1_4_8_7_8_ _ __

Notes·
1. All fittings shall be registered in the name of the Manufacturer. ~:
2. each category shall be supported with two Statutory Declaration tor
forms and one copy of supporting documentation Ct'Rf' IIOLEA V"'a·-r~_...
....
3. The declaration shall be made by the person having full authonty and
responsibility for the quality of the end product.
4. Quality control programs shall be resubmitted for validation
DAn: -:t / Q9 /Jol ~
at a maximum interval of five (5) years. 0 SU~s Qect. 1 Of'Vttings Rev. 1 0512003

Q FITTIN~ 0 COMPONENTS.
UNIFQBM STATUTORY DECLARATION FORM FOR THE R§GISIRATIQN QF FJITIN9 D§SISH:!.§..
NEW BRUNSWICK NOVA SCOTIA PRINCE EDWARD ISLANO N~;WFOUNOLANO AND LABRADOR
NUNAV\Sr YUKON NORTHWEST TERRITORIES

MANUFACTURERS NAME: ENDRESS+ HAUSER CONDUCTA INC.


MANUFACTURERS ADDRESS: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92807
PlANT LOCATIONS: GERMANY, P.R. CHINA, USA
W&gQBX 21: EIIIIUQl! IQ lUI BEQI~§~Q. SiiB!(!.Ji Qfii ~l!aiiiQQBX Qt!!.X Ill! l'lHI!

A Plpo tltUngs, lllcludlng coupl'ng,, taos, elbows, Vs, plugs, unions, pipe cap!l, ot reducers -ASMEB31.3
B Flongos: aK ftangaa
• ASME Vlll·1
C Valves: aH line valves
D Exponalon Jolnta, RaKiblo coMectlons, and hoso aasombllea all types
0 Strainers, fdtera. saparatota, and steam traps
Measuring dovlcaa, lndulllng prasaure gaugos, levolgaugoa, aightglauas, levala, or
praasure lfanamlttors
0 Certified c:opaclty-rated presaure rollof devlcell acceptable JS prlmaty ovar pressure protacUon on
boilel3, praasura VOIIIIII, plpli\Q lind rllsll)le piUIJS
H Prossure ratalnlng components Uuat do not fall Into o~u of tho abov11 categor (Qs
N Nuektar components; Clau t 0 Class 2 0 ClaaG3 0, (Meellno CNSC or ASME requirements)
SHOW_liiANt• •NAME. . OR LOOO A.S IT WILL APIII!AR CJN rHI! IYPI! OF CQNS1
·~QI!I))(i WI!LQI!Q i WRQUQitl K
Endress+Hauser rnJ
C:AIT 0 OTIIIlf\
IIUQRIIII QTHaR.
METAL AND PLASTIC

Peop\e for Process Automation


I.ISTOF'Sl P l"fATIONAND Of' fHI! AC1 UA\.ITI:MS roBE .
·DRAWINGS, CALCULATiONS. REPORTS, SCOPE OF CRN

DECLARATION:
I MIKE YOUROSKI. QUALITY MGR ,,oo
~ ll employed by ENDRESS+HAUSER and being 1he pQrson h""ing filii authority and
rasponslblllly for the quality of the end prod1.1c1 do aolemoly doclare that the lnformallon contained In lhlll form IG truo anclto the belli ol
rnv knowledge represents lhe product for which roglatratlon IIJ souQIIt. The dimensions, m~lerlals of cona\rucUtm, PfiiSIUfO
temperature ratings, an(i ldentlncaUon markings are In occord~nce wllh Ute h~rl!ln nNned ~Jtandards. I ftJrther d~claro \hllllho
manufacture of these flttlngs ta regulqted by a Quality Control Program which .,xlends to each plaot where febrlcatlon occur~ In whole
ar In part and has been verified by sos nso 9001 :20061 as being suitable far lhot wrpoeo and 1rnlilko lhls solemn
~cleraUon conadentlously beUevlng It to be true, and knowing that Ilia of \he aarne force and effec:t ulf madelll\dor oatl'l.
\

Signature of Declarer: , X'fltb 'd._~


Declared before me at Jlbva,k'(t"-' 4,4 u '3 L r ''
This .., day or ;Et o~... r AD a
:t I (., '-' r
Commissioner of Oaths
or Notary Public: (sign)-------::,......~'-----~
Tills space for Regulatory Authority uaa
This n must be revalidated aner tan (10) yeara rromthe da\uf acceptance. 4... .·

eRN: _o_F_l_a_ss_o_.s__ '· ~~~


FlO/I: _1_4_8_78~--- SwviceNL
~~~~~~~~
Noles;
1. An lllllnga allaH be ragla!lu~td In tho 1\Bma of lite Maoufllclui'Qr.
Od•--~~~~~~~~-
'2. Each categoty shnll bQ supportqd with two Statutory Oeclamtlon
form!i and ona copy of aupporthlQ documBntaUon.
~'~~~~~~~·
3. The daclaraUon shaU be mada by tlla piJtSon having lu:l authority amJ
respon11bHIIy for lh1t q~.tallty ol tho e"d produot. UMOER niE AU'l !<!
i'U9l.IC SAf .·
I 4. Quality conlrol programs shall be reaubmllted for vaiiUallon
at a maximum lnlerval of live (5) yeara. ~Ell~ ~. .. 1\~l.tliUiillo~
C·Jf~SSEO GAS RF.GUl.AfiONS
UNIFORM STATUTORY DECLARATION FORM FOBTHE REGISTRATIQNOF FITIJNGDESIGNS
NEW BRUNSWICK NOVA SCOTIA PRINCE; ~OWARO ISLAND Ni;WFOUNDI.ANQ ANO LABI~AOOR
NUNAVUT YUKON NORTHWeST T!;RRITORIES

MANUFACTURERS NAME: ENDRESS+HAUSER CONDUCTA INC.


- -. .
MANUFACTURERS ADDRESS: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92807
·-
PLANT LOCATIONS: GERMANY, P.R. CHINA, USA
CATEGORY QF FITTINGS TO Be RE~I~TER~Q, C\B!(b!i Q.t:IE 96 T&QQBX QfiLY !l!.!JD.'lr. ·lr, OF ON~TRUC IQJi

A Pipe fittings, Including couplings, tees, elbows, Ys, plugs, unions, pipe caps, or reducers -ASME 831.3
B Flanges: all flangtls
- ASME Vlll-1
C Valves: all line valves
D Expansion Joints, flexible connections, and hose assombiles: all types
@ Strainers, filters, separators, and steam traps
Measuring devices, Including pressure gl!ugt:s, lflvel gauges, sight glasses, levels, or
pressure transmitters
G Certified capacity-rated pressure relief devices acceptablc;t as primary ovt'lr pressure protection on
boilers, pres$ura v~;~ssals, piping and fusible plugs
H Pr"ssurG r&lalnlng componenta lhqt do not fall into one of \hEI el)ov~ (;ateE;JoriE)ll
N Nuclaar componants: Class 1 0 Class 2 CJ Class 3 Cl, (Mealing CNSC or ASMF. raqiJiremenls)
SHOWMANUFACTUR_ERS ~AME. !RAOE:NtARI$. QB ~QQQ.MJUilL..t -APfiEAB Of'J TH§ PRQOUf;T - ~W!ml.l&lJmi
~J
POf\Q!:J}~ Wll.~OI!O r.J WROUGHT ){

Endress+ Hauser ffiJ


CA::IT Cl QTii~l~ W:
D6.S<if\lllll. OlH.Ilf\.
METAL AND PLASTIC

People for Process Automation


..... - ·-- - ...
LIST OF SYPPQ.B.T..IW:!..Q.Q~~IQ.SNTIF'ICA'i'IQN Or IHEACTYAL IJ.§M.tJ~B~ Bf.!;$1§.!~

-DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN

...,,.•. .._,.,.,.....,..
~,
~ ...

DECLARATION:
I MIKE YOUROSKI. QUALITY MGR (no noto 3) employed byE~DR':,SS+HAlJ.SER . and being the p~rson \1avin9 fyll authority aM)
responsibility for lha quality of the eno prodLJct do solemnly decl~re that tha Information contained In 111i!! form I~ tru~ and to tha be&t of
my knowledge represents the product for which reglstratlof1 Is sought. The dimension~. materials of constructiQn, pressun:
temperature ratings, and ldenttncatlon markings are In accord&nc(!) with lha hl)rein named st"ndard~. I furth<'>r declare tl!&t the
manufacture of these fittings Is regulated by a Quality Control Program which extends to each plant where fabrlcQtlon occur& In whole
or In part and has bean VEl rifled by sas nso 9001 :2008) . . ~ as being sullii!ble for tha\ purpotte end I ma!~e thi:) solemn
declaration conscientiously believing It to be true, and lmowlng that It Is of lhe same for<:a and effect as If made under oath,
'
Signature of Declarer:
Declared before me at u '3 l
This "1 day of.....:;~~~~- AD-:::;_;,:,;~~~
Commissioner of Oaths
or Notary Public: (sign) ~~------:;r...:::;.-7------
This space for Regulatory Authority u~a
n must be revalidated after ten (10) years from the date of acceptance.

CRN: _O_F_l_85_5_0_.5~­
FID#: ~1_4_8_7_8~~--

Notes:
1. All fittings shall be r!lgl$tared In tho nam!l of the Manufacturer.
2. Each catago1y shall be supportad with two Statutory OEJclaration
form!! and one copy of supporting ctocum!lnlation.
3. The declaration sh!.lll be made by the person having full authority and
responsibility for tha qua lily or tho and producl.
4. Quality control programs shall be resubmitiad for valldatiofl
at a maximum intllrval of five (5) yeurs. Sect 1.0 - Fittiflgs R~v. 1 OG/2003
..
UNIFORM..SIATUTORY DECLARATION FORM fORTH§ BEGIS!RATJQN QP FIJI1N9J)ES1Gf::!S
N~ BRUNSWICI< NOVA SCOTIA PRINCE I!OWARO ISLANO NliWFOUNOLANO ANO L.AeAAOOR
NUNAVUT YUI<ON NORTHWeST 'l'ERRITORIES

MANUFACTURERS NAME: ENORESS+HAUSER CONDUCTA INC.


MANUFACTUReRS AOORess: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92607
GERMANY, P.R. CliiNA, USA
PlANT LOCATIONS;
CA EGOI;j.V :u; ' eg RliGISTERI!Il CIRCLE ONE DNI.'{ ' ..
A Plpo flttlnga, 1nc111dlng coijpllngs, tees, olbowG, Va, plugs, unions. pipe oaps, or roduc~rs
·ASME 631.3
B Fl~ngrn: OU RllllgU
·ASMEVIII·1
C Volvoa: allllno valves

0
D Expansion )olnts, tlolCiblo c:onneotlons, end 1\oso asaomblleo: oil typaa
Strainers. filtorB, IIOilarlltoro, ond· ~tellm !taps
Mee~surlng dovh:oa, lnc:ludlng presaure gaugoa, lovol gauge~. slgllt gl~esea,lovolo. or
pro:~:~ure tran$mlttorr•
Q Cortlllod copaclly-rated preuuro rollol dovlcoa :scceplablo ea Primary ovor pro9suro protection on
bollcm1, prosouro vonole, piping and fualblo plugo
H Prouvro rotolnlng componentCJ that do not lolllnlo o11e oltho ebovo oHI~goriOG
N Nucloar companonta: Cl11os 1 0 CIQ:15 2 CJ CIDGG 3 0, (Maouno CNSC or ASMe roqulromoota)
!HOW LJRERS NAME. rRA IARI< OR DOC AS ITWtl APPB.AFfB'ili"'i'H'f'PROOUC • - i,U(Uj -
POR<OeD~ W&Laao
CAIIT C OTHUA
§ wnovoHT X
Endress+ Hauser ffiY llll~C:AIOQ OTHilll.
METAl. ANO PLASTIC

People for Process Automation


-i.IST OF Sl PPIJRTING ANC I OP THt:! ACTUAL ITEMS TO BE REC•Il> rt:Rt:t: •

• DRAWINGS. CAlCULATIONS, REPORTS, SCOPE OF CRN

DECLARATION:
I MIKE YOUROSKI. QUALITY MGR !too nota~! employed by ENDRESS+HAUSER ond being lhe porson having fyll aul~orily ilntt
resJ)onalblllty for tha quallly or the end procl1.1cl do solemnly doclare that lht:~lnformatlon contained In ll'lll form lEI truo and to tM bo:st ot
my knowledge representu lho product for which registration re oought. Tho dimonslons. malerlala of construction, prCI!I~\lro
lomperoturc rnllngs, and ldontlflc:allon marl<lnes or11ln acc:ord:.\ncQ with the heroin OPined a\endardo. I ~rthal' doclaro !hal the
manuracluro of lhese flltlnge l:i regulated by a Ouallly Control Progrom which oxtonds to e~;~ch plant whore febriOQtlon occur~ In wholo
or In port and ha& been verlfled by sas IISO aoo1 :2006) as being suitable for lh"\ pvrpoee end I meklllhl:> sol~mn
declaration consclentlo~o~sly beHaving It lo bfl truG, and knowing that It ~ of the aamo forco and offect a:~ If mode under oath.

Signature of Declarer: :.rY/th ~'


Declared before moat 11tvJ,fl);,r"-I 1 ?& U S 1.:
This "1 day of _;;;fji f'l.e-,
Commissioner of Oaths
or Notary Public: (sign)..;.._...----~=--~'------
This 3pace for Regulatory
IISJPC.fQIJlltatTtrn must be ravlllldlltod oft6r ten (10)

eRN: _oF_l_a_s_s_o_.s__
1_4_8_78--~-
FIDII: ___

Notes:
t. All fltUngs shall b11 roglaltm~d In tho namo of lho Mllnulncturar.
2. Each ct~logory uhall bo suppor1od wllll two Stntulory Ooclafllllon
form~ ond on~ copy ol :~upportlng documonllltion.
3. Tht~ cJoclaratlon llhllll bo mode by t11e person hnvlno lull authority 011cJ
raaponalblllty lor lh" quality of tho ond product.
tl. Quality control progromn shall bo resubmitted for valldallon
;j\ a ITIDlCimum lniON:II of folie (5) yeQ!G,
UNIFORM STATUTORY DECLARATION FORM FOR THE REGISTRATipN OF FITTING DESIGNS
NEW BRUNSWICK NOVA SCOTIA PRINCg EDWARD ISLAND NEWFOUNDLAND ANO l.A6RAOQR
NUNAVUT YUKON NORTHWEST TI;RRITORieS

MANUFACTURERS NAME: ENDRESS+ HAUSER CONDUCTA INC.


. - -· -- .
MANUFACTURERS ADDRESS: 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92807
PLANT LOCATIONS: GERMANY, P.R. CHINA, USA
CATEGOBY QF EITTINgS TQ BE REGI!;!T§R~O, C!BQ\,§ Otjfa Ct,.!sQQBY.QNLY l!Jj,\' Qi- I·<!' S e\NQA8.~l!Jl.!li\l~

A Pipe fillings, includino couplings. tees, elbows, Ys, plugs, unions. pipe caps, or redt1cers -ASME 831.3
B Flanges: all flanges
• ASME V\11-1
C Valve&: all line valves
0 Expansion Joints, flexible connections, and hose assemblies: all types
@Strainers, filters, separators, and steam traps
Measuring devices, lncluoing pressure g<~uges. level gauges. sight glassa9, level9. or
prassura transmlttors
G Certified capacity-rated pressure relief devices acceptabla ~s primary ov~r pressure protection on
boilers, pressure vessels, piping and ruslblij plugs
H Press~re rcttnlnlng components th<~t do not f<JIIInto one of th11 aoova catagor\QS
N Nuclear components: Class 1 0 Class 2 0 Class 3 0, (Mealing CNSC or ASME requirements)
rvei! i)fCQt~.ll.ll..VJ!.fui.'t
J
m
Si::jOW MANIJFACTURE:RSt\JAI'!lfii, IRAQgM~BtQ28 bO!;ZO AS II WJ).L APPfiAB QNIHEPBODUCT
fORGE!))(! WE~O~O r;J WROUQHT ){
CI\ST 0 OTHqR M
Endress+ Hauser QESQR!De OTH.ijR.
METAL AND PLASTIC

People for Process Automation


... ·-·
LIST OF S!J.EfQ.~.II~Q OQG\JM!iNIA.TIQN ANQ IQEI';jT\~IQeT!ON QF'JHt: ACTUAL IT~.B@.i
~

·DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN

·--
DECLARATION:
1 MIKE YOUROSKI. QUALITY MGR ito~no:n3l employod by ENDRESS+HAUSER . and being lhe p~r~Qn lliWin~ fllll a\Jtl10rity an()
responsibility for the quality of the end product do solemnly dec;lare that the lnfqrmation contained In t11is form I~ true and to the: best of
my knowledge rapresent!lthe product for which r~gistr\\tionl$ sau9ht. Tl1e dimensions, materials of con:>trucllon, pressure
temperature ratings, and Identification marldngs are In acc:orda11ce with the herein m1med $\!ilnd<~r~;ts. I fYrt11er declare lh<lt the
manufaci\Jre of these fittings Is regulated by a Quality Control Program which extends to each plant where fal:lrlcallon occur!> in whole
or In part and has been verified by sas IISO 9001:20081 .. . as being sul\aiJie for thf;!\ purpose end I meke \his solamn
declaration conscientiously believing It to be true, and'knowlng that it Is of t11e same force and ~ffect as If made under oath.

Signature of Decl~:~rer: -w& if<;X,.,.A~ '


Declared before me at !JN:,,ft,;,l\...l ?A- U 3 l
This '( day of ..::[~! n.-t?_. AD --"~<:..W""--
Commissioner of Oaths
or Notary Public: (sign) --------:;;>,.....,:=-;.----~

eRN: _o_F_l_s_s_s_o_._s__
FID#: _1_4_8_7_8_~--

Noles:
1. All fittings shall bo rogisi<HQd In tho nama of the M~nufacturer.
2. Each category shali be swpportql;l with two StattJtarv Declara!ion
forms and one copy of supporting documQntation.
3. The declaration slwll be made by the person having full atllharily a~d
responsibility for tho quality of tho end prodtlct.
4. Quality control programs shall bo resubmitted for validation
at a maximum Interval of five (5) years. Territorial Re
345 Cartingview Drive
Toronto, Ontario
CANADA M9W 6N9
Tel.: 416.734.3300
Fax.: 416.231.1626
Toll Free: 1.877.682.8772
www.tssa.org

September 20, 2016

SCOTT ISLIP
ROUND ENGINEERING INC
10SEGWUN RD
WATERDOWN ON LOR2H8
CA

Service Request Type.: BPV-National AB


Service Request No.: 1900880
Your Reference No.: EH-CRN-17
Registered to.: ENDRESS+ HAUSER CONDUCTA INC

Dear SCOTT ISLIP,

Please find enclosed the original response from AB, registered under the CRN No.: OF18550.52.

As all jurisdictional fees are handled by the Technical Standards and Safety Authority (TSSA), you do not
pay any jurisdictions directly.

Should you have any questions or require further assistance, I will be happy to assist you.
For general enquiries, please contact a Customer Service Advisor at 1.877.682.TSSA (8772) or e-mail
customerservices@tssa.org. When contacting TSSA regarding this file, please refer to the Service
Request number provided above.

Yours truly,

Joanna Karpinski

Tel.: 416-734-3377
Fax: 416-231-6183
Email : jkarpinski@tssa.org

Putting Public Safety First


9410- 20 Ave N.W.
Edmonton, Alberta, Canada T6N OA4
the pressure equipment safety authority
Tel: (780) 437-9100 I Fax: (780) 437-7787

September 02, 2016

Attention: Tanya Francis


TECHNICAL STANDARDS & SAFETY AUTHORITY
345 CARLINGVIEW DRIVE
TORONTO, ON M9W 6N9

The design submission, tracking number 2016-03936, originally received on July 15, 2016 was surveyed
and accepted for registration as follows:

CRN: OF18550.52 Accepted on: September 02, 2016


Reg Type: New Design Expiry Date: June 23, 2026
Drawing No.: SCOPE OF CRN REGISTRATION
Fitting type: MEMOSENS CLS82D HYGIENIC CONDUCTIVITY SENSORS
Design registered in the name of: ENDRESS+ HAUSER CONDUCTA INC
The registration is conditional on your compliance with the following notes:
It is the manufacturer's responsibility to advise the end user that the fittings with Clamps and Varivent connection
can be used only with clamps that have Alberta CRN.

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 and 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.

An invoice covering survey and registration fees will be forwarded from our Revenue Accounts.
Enclosed are stamped .prints for your reference.
Sincerely,

TANG, TAO, P. Eng.

2016-03936 Page 1 of 1
Municipal Affairs
1Mpfnour~
~.D~~
fCII,Ii-1 Ufi!IY oull>o<llr
AB-41 2016-01
STATUTORY DECLARATION
Registration of Fittings
In this space, show facsimile of
manufacturer's logo or
trademark as it will appear on
I, MIKE YOUROSKI , QUALITY MANAGER the fitting.
(name of applicant} (position title} (must be in a position of authority}
of ENDRESS+HAUSER CONDUCTA INC. Endress+ Hauser~
(name of manufacturer) People for Process Automation

located at 4123 LA PALMA AVE., ANAHEIM, CA, USA, 92807


(plant address}
do solemnly declare that the fittings listed hereunder, which are subject to the Safety Codes Act
(check one)
comply with the requirements of ASME 831.3, ASME Vlll-1 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
(title of code of construction or other applicable document}

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, SQS (ISO 9001 :2008) as being suitable for the manufacture of these

fittings to the stated standard. The fittings covered by this declaration, for which I seek registration, are
CATEGORY F
(brief description of fittings}
In support of this application, the following information, calculations and/or test data are attached:
DRAWINGS, CALCULATIONS, REPORTS, SCOPE OF CRN

DECLARED before me at A - / ~ · - in the


~ (province or §'tate)

this 7 - /.
day of ~Ht'
~th)'?. (Year)

(print>
(a
Wr/~ 14'1 b hV'd
Comm1ss1oner~s or Notary Pub-he-)~~

NOTES:
To the best of my knowledge and belief, the application meets the req oir.,.,m.,.nt.,
Standard 851, Clause 4.2, and is accepted for registration in Category
---r--------------------------~~
Registration Number: 0 F 18 5 5 Q · 52
Date Registered: JUL 2 5 2016 Expiry Date: j '"' 44 e, 2... ~ ;• 2.0 2-/;
The information you provide is necessary only for the administration of the programs as required by the Alberta Safety Codes Act and Regulations in the
Pressure Equipment Discipline.
ACKNOWLEDGMENT

A notary public or other officer completing this


certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.

State of California

County of _ _ _ -=-f)-~--L....----->
On Ju~t' f'JO/ b A~. ~ before me,
/
t-v&.,.. t~ k-~ /(~
(insert name an~ title of the offi<?er)
personally appeared /r/Jy,q~/ J{pu,r()'~ ,
who proved to me on the basis of satisfactory evidencE? to be the person(s;.ywhose name(8) isk!r"e
subscribed to the within instrument and acknowledged to me that he/Mnmhey executed the same in
his/floe1'1tlleir authorized capacity(W.S), and that by his/h'e1'7their signatur~ on the instrument the
perso~. or the entity upon behalf of which the perso~) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

WITNESS my hand and official seal.

(Seal)

33725038
1750-dotack-20140409rs
ENDRESS+HAUSER CONOUCTA INC. 27-May-16
4123 LA PALMA AVE.
ANAHEIM, CA
92807, USA
<;5$oee."OE,GRN>REG1ShiRA.lt:bN
PRODUCT DESCRIPTION

Description Design Standard End Connections c:u TtJin,.."r!lent


uffl\rn
1" NPT, G1", PG13.5, 1-112'' and 2" ASME BPE, IS ~~62·;f91~·(' 40371 ~~.ll~!712,
ASME B31.3, ASME
Memosens CLS82D BPE, ASME Vlll-1 ! ·v.,J ':::~~[j~ 11P.~~INC'
UG-101(m)
32676 Clamp Ferrule (Note 1)
"··"' -,j L

.......
403168,403170 _, -"&1A~tfE~fA= /03.16

~- .;; ·~) i ~--~F\11\.)l\l UF Fl T!NGS


PRESSURE- TEMPERATURE RATINGS f'lr-

MDMT MAWPAT68 F MAWPAT248 F MAWP AT 284 F m:GISTHi\TION NO. '!:_l_,o:r.kJj_ . ~ :;· 0 " s· I
...,. ....
~ '~- '". oi v!~ •. <'~U.~. fd::{:.....Y~t.i.{:f&.U· 'rrxtli71
23F 247 psig 131 psig at 248 F 87 psig at 284 F
"1"'\fnc· · 11.
· ' ' L vi' I'll 1 ,I J-::10 J.!..lfUJ:10.S"&IU~-ftSfJJ-j) ~·12. . <;fY/5
MATERIALS OF CONSTRUCTION .•.
'" ~1t)HTlALSi~~~
PROCESS ADAPTER MATERIAL ilY..l l fi
SENSOR SHELL MATERIAL Date
(NOTE 2)

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POLYPHENYLENE SULFIDE PLASTIC, · b
POLYPHENYLENE SULFIDE PLASTIC, ASTM A479-.;loL, r-aGe ~ --~ ay e
ASTM A479-316L, STAINLESS STEEL
used. See Note 2.
1.4435 TYPE 316L, UNS S31603
STAINLESS STEEL 1.4435 TYPE 316L, UNS S31603, CERAMIC
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MANUFACTURING LOCATIONS
Endress+Hauser Conducta Endress+Hauser Conducta
215021 Suzhou, Endress+Hauser Analytical Instruments Suzhou Co. Ltd.
- -~

70839 Gerlingen incl. manufacturing sites


04736 Waldheim and 64823 Gross-Umstadt, Germany P.R. China
Endress+ Hauser Conducta
4123 LA Palma Ave., Anaheim, CA
~807,USA - ---

Note 1) The assembly clamp is not part of the CRN and is not manufactured by ENDRESS+HAUSER. Pressure-Temperature ratings may be limited by the
clamp type used in the joint assembly. Consult clamp Manufacturer for clamp Pressure-Temperature ratings.
Note 2) The following additional alloys of superior or equivalent properties to those listed above are also included in the scope of registration as follows:
N06022, B574/B564, (C-22, 2.4602); N10276, B574/B564, (C-276, 2.4819); S31803, A479/A182, F51, (318LN, 1.4462); S32750, A240/A182, F53, (2507,
1.4410); S32760, A479/A182, F55, (Zeron 100, 1.4501); N06600, B166/B564, (lnconel600, 2.4816); N06625, B446/B564, (lnconel625, 2.4856); N08825,
B425/B564, (lnconel825, 2.4858); S30400/S30403, A479/A182, (304/304L, 1.4301/1.4306/1.4307); B381-F3, (Titanium Grade 3, UNS R50550) Note: Titanium
limited to 247°F max
To: TSSA From: Janet Townsend
Company: Endress+Hauser Conducta Phone: 416-747-4291
Inc.
Pages: 6 Location: Toronto
Our File: ANR-4184 Date: September 1, 2016

Your File: 1900904

Subject: Request for Design Registration

Dear Ms. Francis,

CSA has reviewed the documentation submitted by TSSA on behalf of Endress+Hauser Conducta
Inc. These fittings have been registered by CSA for the Province of Québec. In accordance with an
agreement between CSA, the Provinces of Québec and Saskatchewan; this registration is recognized by
Quebec and Saskatchewan. These fittings are acceptable for use in these Provinces.
The letters CSA will be applied as a prefix to the CRN indicate which fittings have been registered in this
manner. A copy of the stamped Statutory Declaration is attached.
The CRN is CSA-0F18550.56.
The cost for this service is $ 760.00 plus HST.
A copy of the Statutory Declaration with an original stamp affixed will be forwarded to you along
with our invoice by regular mail.

Yours truly

Janet Townsend
Account Manager
CSA Group
janet.townsend@csagroup.org
www.csagroup.org