‘4h Foo, Cente Tower £3300 Blo Stoo West Tevet, Orao Canada MEX 2X4 Tel: «18 734.3300 Fas 418.231.1628 Tob Foe. 1877882877 woew 883.079 May 12, 2015 BADRELDIN AHMED PENTAIR VALVES & CONTROLS US LP - ANDERSON GREENWOOD CROSBY 3950 GREENBRIAR STAFFORD TX 77477 us Service Request Type.: BPV-National AB Service Request No: 1537022 Your Reference No.: 0615484.5 - ADD TO SCOPE: BROCHURE CROMC-0207, ADD MFG SITE: (SHANGHAI, CHINA) - NATL SERV Registered to.: PENTAIR VALVES & CONTROLS US LP - ANDERSON GREENWOOD CROSBY Dear BADRELDIN AHMED, Please find enclosed the original response from AB, registered under the CRN No.: 0618494.52 ‘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, | will be happy to assist you. For general enquiries, please contact a Customer Service Advisor at 1.877.882. 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, Tanya Francis Administrative Assistant_BPV Engineering Tel. : 416-734-3423 Fax: 416-231-6183 Email :trancis@tssa org Putting Public Safety FirstCelebrating 20 years 9410 - 20 Ave N.W. 1995 ~ 2016 Edmonton, Alberta, Canada T6N 0A4 Ber ramre canny exhort Tel: (780) 437-9100 / Fax: (780) 437-7787 March 04, 2015 Attention: Tanya Francis TECHNICAL STANDARDS & SAFETY AUTHORITY 3300 BLOOR STREET WEST 14 FLOOR CENTRE TOWER TORONTO, ON MBX 2x4 The design submission, tracking number 2014-10357, originally received on December 10, 2014 was surveyed and accepted for registration as follows: CRN: 0615494.52 Accepted on:March 04, 2015 Reg Type: Addition to Acc. Fitting Expiry Date: September 11, 2022 Drawing No. : CROMC-0297 Rev US-1404 As Noted Fitting type: PRESSURE RELIEF VALVES. Design registered in the name of : PENTAIR VALVES & CONTROLS LP. The registration is conditional on your compliance with the following notes: This revision constitutes the addition of the manufacturing facility located in Shanghai, China, and update to catalog CROMC-0297 (Rev US-1404). No othor changes have been considered. 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. An invoice covering survey and registration fees will be forwarded from our Revenue Accounts. Enclosed are stamped prints for your reference. Sincerely, Bafoeke BRANDON, GREG Page 1 of 1‘A841 2008-02 Aberia MUNICIPAL AFFAIRS Ti this space, show facsimile oF manufacturer's logo or ‘trademark as it will appear on the fitting, ARSA ‘he pees aupent ate aonty STATUTORY DECLARATION Registration of Fittings ‘Anderson Greenwood Crosb L Frank Medrano ff ree Quality Engineering (Company ttle, 3. vice president, plant manager, chief engines) (must be ina posion of auton) ‘of _Pentair Valves & Controls LP - Anderson Greenwood Crosby (name of manufacturer) located at See attached list: Manufacturer List (pant olds) do solemnly declare that the fittings liste hereunder, which are subject othe Safety Codes Act (check one) comply withthe requirements of _ ASME Section & VIII, Div 1__which specifies the dimension, of esoptized Noa American Standard) ‘materials of construction, pressure/temperature ratings and identification marking of the fittings, or 1 arenot 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. | further declare thatthe manufacture of these fittings is controlled by a quality control program which has been verified by the following authority, as being suitable for the manufacture of these fittings to the ity ing stated standard. The fittings covered by this declaration, for which I eck registration, are _G Category In support of this application, the following information, calculations and/or test data are attached: Cat CROMC 0291, 0292, 0293, 0294, 0295, 0297, 0330 and HSL. drawing packages. DECLARED before me at Stal al inthe Corte of _F£. Pod Tx ft hse tap teem a 2 WY, coorEt trim) Resin Compan {oo Mra et ee VLA 1 eewrission Exbie8 1 (Signature of Applica) pute Coes Comnmisioner fr Oats) For Office Use Only (ier tance Letter for the comments To the best of my knowledge and belief, the application meets the requirements ofthe Sa fe Cae A Standard BSI, Clause 4.2, and is accepted for registration in Category np RegisraionNomber OG 15494 59 Le Le ae For the Aniston Chie Inspector of Alberta) Date Registered: MAP O 4 2015 Expiry Date: GED 9022 ‘Te information you roid smecesr only fr the admiration of he programs srr bythe Albers Salty Codes Act and Regan in he Bole DicePentair Valves & Controls US LP ~ Anderson Greenwood Crosby 3950 Greenbriar Stafford, Tx 77477 Tele: 281-274-4400 Fax: 281-274-6907 > PENTAIR VALVES & CONTROLS Date: 11/6/2014 Statutory Declaration Attachment Catalog Number — Product Type CRN 0G15494 Facility Address 1. Variennes, Canada - Pentair Valves and Controls Canada Inc. - Varennes 579 Boulevard Lionel Boulet, Varennes Quebec J3X 1P7, Canada 2. Burlington, Canada - Pentair Valves and Controls Canada Inc. - Burlington 1080 Clay Avenue, Unit #4, Burlington Canada L7L OAL 3. Edmonton, Canada - Pentair Valves and Controls Canada Inc. ~ Edmonton 5538-48 Street N.W.; Edmonton, Alberta, T6B 221 Canada 4, Stafford, Texas - Pentair Valves and Controls US LP - Anderson Greenwood Crosby, 3950 Greenbriar, Stafford, Texas 77477 5. Pasadena, Texas ~ 4607 New West Drive, Pasadena, Tx 77507 6. Everett, Washington - 830 80" Street SW, Suite 400 Everett, Wa 98203 7. Qingpu, China ~ No. 777, 787, Jiu Ye Road, Ging Pu Industry Zone, Shanghai, 201712, P.R. China 0G15494.52 Frank Medrano/ Quality Engineering MAR 0 & 2015Pentair Valves & Controls US LP ~ Anderson Greenwood Crosby 3950 Greenbriar Stafford, 1x 77477 Tele: 281-274-4400 Fax: 281-274-6907 Date: 11/6/2014 TSSA Statutory Declaration Attachment 0G15494 - Catalog Number — Product Type Catalog: Product Type CROMC-0297 JOS-E, JBS-E, JLT-JOS-E, JLT-JBS-E, JOS-H-E CROMC-0293, Series BP Omni-Trim CROMC-0294 Crosby Series 800 & 900 Omni Trim CROMC-0295 HE and HCI ISOFlex, Series (HCI, HSI, H) Series Restricted Lift CROMC-0330 PVR-3, PVR-4 CROMC-0291 Crosby Style JQ cROMC-0292 Crosby Style HL Safety Valve HSL Drawing package (N= Frank Medrano/ Quality Engineering