United Insulation Documents

SPECIFICATION NO. 5111 C O D E P2E ISSUED 5 - 4 - 6 6 REVISED 8 -2 3 - 0 7 PAGE 1 OF 5

C O D E P2E DESIGN PRESSURE, PSIG 200 DESIGN TEMPERATURE, F 385 DESIGN TEMPERATURE, C 1 9 6 MAX TEST PRESS., PSIG 288(1) MIN TEMPERATURE, F 0 MIN TEMPERATURE, C -17 MAX DIFFERENTIAL PRESS (EXT MINUS INT), PSI

ALLOWANCE FOR CORROSION AND EROSION = .0500 IN. BASIS FOR STRESSES: ASME B 3 1 . 3 THIS CODE WAS P1002E PRIOR TO REVISION NO.12 AUGUST 1971.

(1) SEE SECTION 9, TESTING.

PIPE

NPS SCHED ASTM SPECIFICATIONS 1/2 -1 80 ERW TO ASTM A587 OR ASTM A106 SEAMLESS GRADE B. 1.5 -1.5 40

2 -4 40 ERW TO ASTM A587 OR ASTM A53 SEAMLESS GRADE B; OR API 5L SEAMLESS GRADE B.

6 -10 40 ASTM A53 ERW GRADE B; ASTM A135 ERW GRADE B. 1 2 - 3 6 STD

QUALIFICATIONS ASTM A53 SEAMLESS GRADE B OR API 5L SEAMLESS GRADE B MAY BE SUBSTITUTED. PRIOR TO 1988, PIPE WALLS WERE OF A THINNER SCHEDULE. ALL BRANCH WELDS TO THINNER SCHEDULE MUST BE REINFORCED AS SPECIFIED UNDER FITTINGS. ----------------------------------------------------------------------

DATE 8-24-94 SPECIFICATION NO. 5111 P2E PAGE 2

FITTINGS

NPS WEIGHT SPECIFICATIONS

1/2 - 2 3000LB SOCKET-WELDING, FORGED STEEL, ASTM A105 ANSI B16.11. HAVE APPROXIMATELY 1/16” CLEARANCE BETWEEN END OF PIPE AND BOTTOM OF SOCKET WELD WHEN TACK IS MADE.

1/2 - 1 80 BUTT-WELDING, CARBON STEEL, ANSI B16.9, ASTM A234 1.5 - 36 STD GRADE WPB OR WPBW.

1/2-1.5 80 LOKRING FITTINGS SERIES MAS-3000 CARBON STEEL PER 2- 3 40 LOKRING CORPORATION, PARAMUS, N.J.

QUALIFICATIONS

COLD BENDS ARE ACCEPTABLE, PROVIDED THEY MEET THE REQUIREMENTS OF ASME B31.3 (1.5/3D 18% MAX. THINNING, 5D 10% MAX. THINNING) OR P36E WITH MINIMUM BENDING RADIUS IN ACCORDANCE WITH THE FOLLOWING TABLE.

P2E ( 200. PSIG AT 385. DEG F ) MINIMUM BENDING RADIUS SIZE(IN) SCHED .5 .75 1. 1.5 2. 3. 4. 6. MATERIAL A587 80 3D 1.5D 1.5D A106 GR B 80 3D 3D 3D A587 40 1.5D 1.5D 1.5D 1.5D A106 GR B 40 3D A53S GR B 40 3D 3D 3D A53ERW GR B 40 5D

WELDING ELBOWS SHALL BE LONG-RADIUS UNLESS OTHERWISE SPECIFIED. ----------------------------------------------------------------------

BRANCH CONNECTIONS IN ACCORDANCE WITH SP1.1B OR ASME B31.3 ARE ACCEPTABLE. THE BRANCH CONNECTIONS IN THE FOLLOWING TABLE MUST BE FULLY REINFORCED.

P2E ( 200. PSIG AT 385. DEG F ) RUN 45 DEGREE 60 DEGREE 75 DEGREE 90 DEGREE (NPS) BRANCH BRANCH BRANCH BRANCH 16 16 - - - 18 16-18 - - - 20 18-20 - - - 24 1.5-24 18-24 - - 30 .50-30 .50-30 .50-30 .75,1.5-30 36 .50-36 .50-36 .50-36 .50-36

----------------------------------------------------------------------

J O I N T S

NPS - 24 TYPE SPECIFICATIONS 1/2 - 4 RUNS BUTT-WELD 1/2 MAINTENANCE LAPS MADE ON ERW PIPE TO ASTM A587 WITH AND FIT-UP TO DIMENSIONS PER P34E WITH CLASS 150; FLANGES. DUCTILE IRON BACKUP FLANGES PER SP8C, CLASS I OR FORGED STEEL SLIP-ON BACKUP FLANGES; ANSI B16.5, ASTM A105. GRIND 1/8 IN. - 45 DEG. BEVEL ON CORNER BETWEEN BORE AND FACE OF FLANGE.

1 / 2 - 2 4 MAINTENANCE CLASS 150 FORGED STEEL WELDING NECK (BORED AND FIT-UP TO TO MATCH PIPE) OR SLIP ON (DOUBLE WELDED) FLANGES. FLANGES; ANSI B16.5; ASTM A105.

3 0 - 3 6 MAINTENANCE CLASS 150 FORGED AND ROLLED STEEL SLIP-ON AND FIT-UP TO (DOUBLE WELDED) OR WELDING NECK (BORED TO FLANGES. MATCH PIPE) FLANGES; AWWA C207, CLASS E, ASTM A105.

1 / 2 - 2 4 FIT-UP TO FLAT FACED CLASS 150 FORGED STEEL WELDING CAST IRON NECK (BORED TO MATCH PIPE) OR SLIP ON (DOUBLE FLANGES. WELDED) FLANGES, ANSI B16.5, ASTM A105.

1 / 2 - 2 FIT-UP TO MINIMUM LENGTH, SCH. 80, NIPPLE SAME THREADED EQUIP- MATERIAL AS PIPE, ONE END THREADED, OTHER MENT. END FLANGED AS SPECIFIED FOR MAINTENANCE. BACK WELD THREADED CONNECTIONS WHERE

ACCEPTABLE. USE TEFLON ® THREAD LUBRICANT P25E, CODE J50 OR J51 ON THREADED JOINT.

GENERAL FLANGE FACING FINISH SHALL BE SERRATED-CONCENTRIC OR SERRATED-SPIRAL, PER ANSI B16.5. PIPE FABRICATED WITH LAP-JOINTS SHALL HAVE A STOP WELDED TO THE PIPE THAT WILL LIMIT MOVEMENT OF THE BACKUP FLANGE TO A MAXIMUM OF 3 INCHES WHEN THE JOINT IS DISASSEMBLED. STOPS ARE NOT REQUIRED WHERE FITTINGS OR BUTT-WELDS WILL LIMIT THE MOVEMENT TO LESS THAN THE ABOVE VALUE. ----------------------------------------------------------------------


BOLTING

DESCRIPTION MATERIAL ASTM

BOLTS CARBON STEEL A307

NUTS CARBON STEEL A563

GRADE QUALIFICATIONS

B HEAVY HEX. ANSI B18.2.1

A HEAVY HEXAGON: ANSI B18.2.2

OR

STUDS ALLOY STEEL A193 B7 THREADED FULL LENGTH

NUTS CARBON STEEL A194 2H HEAVY HEX, ANSI B18.2.2

QUALIFICATIONS

THREAD LUBRICANT: ANY COMMERCIAL ANTI-SEIZE --------------------------

--------------------------------------------

GASKETS REFERENCE STANDARDS MAT’L: S U 2 A , U 2 A

SIZES: U9A OR ASME B16.21 NPS THICK(IN.) CODE QUALIFICATIONS 1/2- 24 .175 G62G4 1/2 - 8 1/16 G84 BETWEEN TWO FLAT FACES, USE FULL-FACE 10 - 36 1/8 GASKETS.

G84 IS AN OPTIONAL GASKET, SEE P&SI FOR GASKET.

----------------------------------------------------------------------

VALVES REFERENCE STANDARDS P1V NPS ENDS GATE GLOBE CHECK TRANSFER BALL 1/2-2 FL G32K T32H C32E(1) 3-24 FL C32A(2) 3-10 FL G32C T32A 1/2-2 SW G37C T37T C37H(1) 1/2-1 (3) G37AB(6) 1/2-2 TH SV280(4) 3-16 FL SV269(7) 1/2-2 (8) SV267 1/2-2 TH SV235(4) 2-12 FL SV296 2-24 FL G32C 1-6 FL X32A 1/2-2 TH SV518 1/2-2 TH DSV518


QUALIFICATIONS (1) LIFT TYPE CHECK VALVES. INSTALL IN HORIZONTAL LINES ONLY. (2) SWING CHECK VALVES. (3) ONE END SOCKET WELD. ONE END FEMALE PIPE THREAD. (4) 3-WAY TRANSFLOW – “TEFLON” SLEEVE PLUG VALVE. 150 PSI AT 400 F MAX. (5) DELETED. (6) USE AT PRESSURE GAUGES, INSTRUMENT CONNECTIONS, DRAINS AND VENTS. (7) WITH WORM GEAR OPERATOR AND CHAIN WHEEL. (8) ONE END SOCKET WELD; ONE END CLASS 150 FLANGE.

FOR USE AT: (A) PRESSURE GAUGE TIE-INS. (B) INSTRUMENT CONNECTIONS. (C) WHERE PIPING UNDER PRESSURE IS CONNECTED

DOWNSTREAM. − --------------------------------------------------------------------- FABRICATION, ERECTION, TESTING, AND EXAMINATION FABRICATION, ERECTION, TESTING, AND EXAMINATION SHALL BE IN ACCORDANCE WITH THE LATEST EDITION OF ASME B31.3 FOR NORMAL FLUID SERVICE. BACKING RINGS ARE NOT PERMITTED.

− ----------------------------------------------------------------

-----STRESS RELIEVE - NOT REQUIRED. ----------------------------

------------------------------------------CLEANING - REMOVE DIRT

AND LOOSE WELD SPATTER.

− ---------------------------------------------------------------------

REVISIONS

08-24-94 UPDATED B31.3 BEND REQUIREMENTS. ADDED G84 GASKET OPTION. REVISED WELDING.

11-26-96 ADDED SV518. 8-23-07 ADDED LOKRING FITTINGS. ADDED G62G4 GASKET. ADDED ALLOY STEEL BOLTING. 12-10-08 ADDED DSV518


SPECIFICATION NO. 5111 CODE P356 ISSU ED 2-18 -75 REVI SED 0 1-08 -08 PAGE 1 OF 5

CODE P356 DESIGN PRESSURE, PSIG 192 DESIGN TEMPERATURE, F 385 DESIGN TEMPERATURE, C 196 MAX TEST PRESS., PSIG 305 MIN TEMPERATURE, F -20 MIN TEMPERATURE, C -28 MAX DIFFERENTIAL PRESS (EXT MINUS INT), PSI

ALLOWANCE FOR CORROSION AND EROSION = 0.000 IN. BASIS FOR STRESSES: ASME B31. 3

(1) ************************************************************

∗ MILL TEST REPORTS ARE REQUIRED FOR ALL GRADE TP304 SST *

∗ COMPONENTS. MATERIAL HAVING A MOLYBDENUM CONTENT *

∗ GREATER THAN 0.500% SHALL NOT BE USED. *

************************************************************

PIPE

NPS SCHED ASTM SPECIFICATIONS

1/2 -4 10S GRADE TP304 OR TP304L WELDED STAINLESS STEEL PIPE TO SW41M OR ASTM A312.

6 -12 5S GRADE TP304 WELDED STAINLESS STEEL PIPE TO ASTM A312.

---------------------------------------------------------------------------

DATE 8-25-94

FITTINGS

NPS WEIGHT SPECIFICATION NO. 5111 P356 PAGE 2

SPECIFICATIONS

1/2 - 4 10S BUTT-WELDING STAINLESS STEEL; ANSI B16.9 ASTM A403 6 - 12 5S GRADE WP304 OR WP304L.

1/2- 3 10S LOKRING FITTINGS SERIES SS-40 316L STAINLESS STEEL PER LOKRING CORPORATION, PARAMUS, N.J.

QUALIFICATIONS

FOR STUB ENDS, SEE “JOINTS.”

COLD BENDS ARE ACCEPTABLE, PROVIDED THEY MEET THE REQUIREMENTS OF ASME B31.3 (1.5/3D 18% MAX. THINNING, 5D 10% MAX. THINNING) OR P38E WITH MINIMUM BENDING RADIUS IN ACCORDANCE WITH THE FOLLOWING TABLE.

P356 ( 192. PSIG AT 385. DEG F ) MINIMUM BENDING RADIUS SIZE(IN) .5 .75 1. 1.5 2. 3. 4. 6. MATERIALSCHED 3D 1.5D 1.5D 1.5D 1.5D 1.5D 1.5D 10S 304L SW41M 304 A312W 10S 3D 3D 3D 3D 3D 3D 3D 304 A312W 5S 5D

WELDING ELBOWS SHALL BE LONG-RADIUS UNLESS OTHERWISE SPECIFIED.

BRANCH CONNECTIONS IN ACCORDANCE WITH SP1.2B OR ASME B31.3 ARE ACCEPTABLE. THE BRANCH CONNECTIONS IN THE FOLLOWING TABLE MUST BE FULLY REINFORCED.

--------------------------------------------------------------------------

P356 ( 192. PSIG AT 385. DEG F ) RUN 45 DEGREE 60 DEGREE 75 DEGREE 90 DEGREE (NPS) BRANCH BRANCH BRANCH BRANCH 6 6 - - - 8 1.5-8 3-8 4-8 4-8 10 .75,1.5-10 2-10 3-10 3-10 12 .50-12 .75,1.5-12 2-12 2-12

DATE 3 - 2 - 9 3 SPECIFICATION NO. 5111 P 3 5 6 PAGE 3

J O I N T S

NPS - 12 TYPE SPECIFICATIONS 1/2 - 4 RUNS BUTT-WELD 1/2 MAINTENANCE LAPS MADE ON SW41M PIPE WITH THE CONRAC AND FIT-UP TO MACHINE SP2.1A, FIGURE 1A, (.5-4), SP2.1A. FLANGES. CLASS 150 BACKUP FLANGES SHALL BE GALV. DUCTILE IRON, SP8C, CLASS I, II, IV; OR GALV. FORGED STEEL ASTM A105 SLIP-ON FLANGES, ANSI B16.5. GRIND 1/8” 45 DEGREE BEVEL ON CORNER BETWEEN BORE AND FACE OF FORGED STEEL SLIP-ON FLANGES.

1/2 - 12 MAINTENANCE STUB ENDS, SAME SPECIFICATION AS OTHER AND FIT-UP TO FITTINGS, EXCEPT LENGTH PER MSS SP43. FLANGES. CLASS 150 LAP JOINT BACKUP FLANGES, GALV. FORGED STEEL ASTM A105, ANSI B16.5; OR GALV. DUCTILE IRON ASTM A395, ANSI B16.42.

1/2 - 2 FIT-UP TO MINIMUM LENGTH, SCH. 80S (NPS 1/2-1), SCH. THREADED EQUIP- 40S (NPS 1.5-2), NIPPLE SAME MATERIAL AS MENT. PIPE, ONE END THREADED, OTHER END FLANGED AS SPECIFIED FOR MAINTENANCE. BACK WELD THREADED CONNECTIONS WHERE ACCEPTABLE. USE

TEFLON ® TAPE P25E, CODE J51 ON THREADED JOINTS IF NOT BACK WELDED.

GENERAL FINISH ON FACES OF ROLLED LAPS SHALL BE “SMOOTH.” FINISH ON STUB-ENDS AND WELDING FLANGES SHALL BE SERRATED-CONCENTRIC OR SERRATED SPIRAL PER ANSI B16.5. BLIND FLANGES IN ACCORDANCE WITH P6E ARE ACCEPTABLE. PIPE FABRICATED WITH LAP-JOINTS SHALL HAVE A STOP WELDED TO THE PIPE THAT WILL LIMIT MOVEMENT OF THE BACKUP FLANGE TO A MAXIMUM OF 3 INCHES WHEN THE JOINT IS DISASSEMBLED. STOPS ARE NOT REQUIRED WHERE FITTINGS OR BUTT-WELDS WILL LIMIT THE MOVEMENT TO LESS THAN THE ABOVE VALUE. BACKUP FLANGES SHALL BE GALVANIZED PER ASTM A153.

--------------------------------------------------------------------------

BOLTING DESCRIPTION MATERIAL ASTM GRADE QUALIFICATIONS

BOLTS CARBON STEEL A307 B HEAVY HEX. ANSI B18.2.1

NUTS CARBON STEEL A 5 6 3 A HEAVY HEXAGON: ANSI B18.2.2

OR STUDS ALLOY STEEL A193 B7 THREADED FULL LENGTH

NUTS CARBON STEEL A194 2H HEAVY HEX, ANSI B18.2.2

QUALIFICATIONS THREAD LUBRICANT: NEVER-SEEZ (REGULAR) FOR GALVANIZED FLANGES, BOLTING SHALL BE GALVANIZED PER ASTM A153. − ---------------------------------------------------------------------

GASKETS REFERENCE STANDARDS MAT’L: SU2A, U2A SIZES: U9A, ASME B16.21

NPS THICK(IN.) CODE QUALIFICATIONS 1/2- 12 .175 G62G4 1/2 - 8 1/16 G84 G84 IS AN OPTIONAL GASKET 10 - 12 1/8 G84 − ---------------------------------------------------------------------

VALVES REFERENCE STANDARDS P1V

NPS ENDS GATE GLOBE CHECK BALL 1 / 2 - 3 F L G 3 2 K 3 - 1 2 F L C32A(2) 1/2-2 SW G37C C37H(1) 1/2-1 (3) G37AB 1/2-6 FL SV310(4) 1 / 2 - 2 F L C32H(1) 4-12 FL G32C 1/2-2 TH DSV518 (5)

QUALIFICATIONS

(1) LIFT TYPE CHECK VALVE, INSTALL IN HORIZONTAL LINES ONLY. (2) SWING TYPE CHECK VALVE. (3) ONE END SOCKET WELD, ONE END FEMALE PIPE THREAD. (4) STAINLESS STEEL FOR THROTTLING SERVICE. (5) STEAM AND CONDENSATE SERVICE ONLY

DATE 8-25-94 SPECIFICATION NO. 5111 P356 PAGE 4

FABRICATION, ERECTION, TESTING, AND EXAMINATION FABRICATION, ERECTION, TESTING, AND EXAMINATION SHALL BE IN ACCORDANCE WITH THE LATEST EDITION OF ASME B31.3 FOR NORMAL FLUID SERVICE. PIPE SIZES LESS THAN NPS 2 SHALL USE THE GAS TUNGSTEN ARC (GTAW) WELDING PROCESS.

THE ROOT PASS FOR ALL PIPE SIZES SHALL BE

GTAW. INERT GAS BACKUP IS REQUIRED. BACKING RINGS ARE NOT PERMITTED. WELDING QUALIFICATIONS FILLER MATERIAL SHALL BE TYPE 316L STAINLESS STEEL HAVING A MAXIMUM CARBON CONTENT OF 0.025%. UNDER NO CONDITION IS GALVANIZED STEEL TO BE WELDED TO OR NEAR STAINLESS STEEL. WHEN GALVANIZED STEEL IS WELDED OR CUT IN THE FIELD, ALL STAINLESS STEEL IN THE IMMEDIATE VICINITY AND BELOW SHALL BE PROTECTED FROM SPLATTER, SPARKS, SLAG, AND MOLTEN ZINC WHICH RESULTS FROM THE WELDING OR CUTTING OPERATION. − --------------------------------------------------------------------- STRESS RELIEVE - NOT REQUIRED. − --------------------------------------------------------------------- CLEANING - REMOVE DIRT AND LOOSE WELD SPATTER. − --------------------------------------------------------------------- GENERAL QUALIFICATIONS FOR STAINLESS STEEL PIPE AND FITTINGS, MARKING PAINT OR INK USED FOR IDENTIFICATION SHALL NOT CONTAIN ANY HARMFUL METAL OR METAL SALTS, SUCH AS ZINC, LEAD, COPPER OR SULFUR, WHICH CAUSE CORROSIVE ATTACK ON HEATING. SEE SP3D. − --------------------------------------------------------------------- REVISIONS 8-25-94 UPDATED B31.3 BEND REQUIREMENTS. ADDED G84 GASKET

OPTION. REVISED WELDING. 8-23-07 ADDED LOKRING FITTINGS. ADDED G62G4 GASKET. ADDED ADDED ALLOY STEEL BOLTING. 01/08/08 CHANGED LOKRING FITTING FROM C/S TO S/S. 12-11-08 ADDED DSV518 − ---------------------------------------------------------------------

− ---------------------------------------------------------------------

DATE 8-25-94 SPECIFICATION NO. 5111 P356 PAGE 5

Estimate

DATE

8/3/2010

ESTIMATE NO.

2529

NAME / ADDRESS

The Roberts Co Field Services, IncAttn: Accounts Payable133 Forlines RoadWinterville, NC 28590

United Insulation Co., Inc.2010 N. Kerr Ave.Wilmington, NC 28405

Estimate Good For 30 Days TOTAL

ITEM DESCRIPTION QUANITY COST TOTAL

LS - DAK...VesselFurnish labor, materials, equipment, supervision, and services toinsulate one (1) Vessel. Per specifications received by AK.

001 Insulate Vessel 1 29,120.00 29,120.00

002 Insulate estimated 400 ft. of 1 1/2" piping, and 90 degree elbows. 1 6,000.00 6,000.00

003 Fabricate and install removable pads after Vessel tie-in. Estimatedsize 2 1/2 ft. x 36 ft.

1 4,200.00 4,200.00

004 Re-install removable cover's on nozzles. 1 3,000.00 3,000.00

$42,320.00

FEB-05-2010 FRI 08:55 AftTools

FAX NO.

Experience MocfifiClltioJl Rating History

Emplaya' MInna: LINITED INSULAllON co OF WILMINGTON IN!:A4dn:sr. 2010 N KERRAveNUE, WJLHlNGroN, NC 2B1OS

eov ••.• ge ItIt 06592820CombD Id: 4252343.

$a£o......., Names: INC, UNITa.1INSULATION. UNJl'ED INSULATla-f COOFWILMINGTON, UNlTEDINSUlATION COMPANY OF 1IIIIU4lNGTDN me

ateaJve &piratJon exp ReviSIOn RatingDate Date ~ MAP Number StabJs

02/16/2010 02/16/2011 0.&\ 1.00 0 Final

02116/2009 02/16/2DI0 0.96 1.00 0 Ana.02f16/2008 01./16/21)09 1.00 LO'I 0 Finll'

-c-

P. 02Page 1 of I

https:/Iwww_ncrb.orgIManageARJSta1\dAJoneIT ools.aspx?type""'l'aUng&comboid-4252343 .,' 2/5120·10

OSHA's Form 300A (Rev. 01/2004)

Summary of Work-Related Injuries and Illnesses~ '~'l":" - ._-.trJ-.c:-J •••.;;:~-'o:t....,.?o ~!1 •..~I"'~ • '\ •••• C:~ '.'

All establishments covered by Part 1904 must complete this Summary page, even if no injuries orillnesses occurred during the year. Remember to review the Log to verify that the entries are complete

Using the Log, count the individual entries you made for each category. Then write the totals below,making sure you've added the entries from every page of the log. If you had no cases write "0."

Employees former employees, and their representatives have the right to review the OSHA Form 300 inits entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.

Number of Cases

Total number ofdeaths

Total number ofcases with daysaway from work

o

Total number of caseswith job transfer orrestriction

Total number ofother recordablecases

o oo(J)(H) (I)(G)

Number of Days

Total number ofdays away from\Alnrk"

Total number of days ofjob transfer or restriction

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Total number of ...(M)

(1) Injury(2) Skin Disorder(3) RespiratoryCondition

o(4) Poisoning(5) Hearing Loss

ooo

o(6) All Other Illnesseso

Post this Summary page from February 1 to April 30 of the year following the year covered by the form

Public reporting burdenfor thiscotlectionof informationis estimatedto average58 minutesper response,includingtime to reviewthe instruction,searchand'gatherthe data needed,and compteteand relliew the collectionof information.Personsare not requiredto respondto the collectionof informationunlessitdisplays a currenUyvalidOMScontrolnumber. If you haveanycommentsabout theseestimatesor any aspectsof thisdata collection,oontact USDepartmentofLa,bor.OSHA OffICeof Statistics.RoomN·3644, 200 ConstitutionAve.NW.Washinaton.DC 20210. 00 not send the comoletedformsto thisoffice.

Year

U.S. Department of Laboroccupational Safety and Health Administration

2007 •Form approved OMS no. 1218-0176

Establishment information

Your establishment name United Insulation Company, Inc

Street 2010 N Kerr Ave

City Wilmington State NC Zip 28405

Industry description (e.g., Manufacture of motor truck trailers)Industrial Insulation Contractor

Standard Industrial Classification (SIC), if known (e.g., SIC 3715)

3 0 6 4-- -- -- ---OR North American Industrial Classification (NAICS), if known (e.g., 336212)

Employment information

Annual average number of employees 35

Total hours worked by all employees lastyear 76,401.00

Sign here

Knowingly falsifying this document may result in a fine.

ined this document and that to the best of my knowledge the entries are true, accurate. and

PresidentTitle

910.395.6851 "1612008

Phone Date

OSHAls Form 300 (Rev. 01/2004)

Log of Work-Related Injuries and Illnesses

Attention: This form contains information relatingto employee health and must be used in a mannerthat protects the confidentiality of employees to theextent possible while the information is being usedfor occupational safety and health purposes,

Year 2007u.s. Department of Labor

Occupational Safety and Health Administration•

t:;:~~Z':;:=~.~":;;]~-=-·~~~~'"'·r..~'·;;;Z" .'.:,~\.-:-::.'~~~~~~<',{'·':2~~~r:r;~Z"iZ:~-,L"f•••,;:"r.,:,,:":~::!:~:';'~·i;;:':a:.:·'·~z:'.L,,~; ~. . ,,". ...' . ~ ;.You must record information about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treabnentbeyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-relatedinjuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904,12, Feel free to use two lines for a single case if you need to. You must complete aninjury and illness incident report (OSI-IA Form 301) Dr equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local OSHAoffice for help.

'~:::~;~'.::~::'::~','~;:,

Form approved OMS no, 1218-0176

Establishment name United Insulation Company, Inc

r- ;'"\ide-iltltYth-e''' person Describe the case

City

Classify the case

Wilmington State NC

.- "

Enter the number of(A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the "injury" column or choose one type of

Case Employee's Name Job Title (e.q, Date of Where the event occurred (e.q, Describe injury or illness, parts of body affected, the most serious outcome for that case: worker was: illness:No. Welder) injury or Loading dock north end) and objecUsubstance that directly injured or made

<f)onset of person ill (e.g. Second degree burns on right (M) <1)

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illness forearm from acetylene torch) On job <f)

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'2 'e 0 <f)...J <f)- 0 •.• "0 0 Q)

Public reportng burden for this collection of information is estimated to average 14 minutes per response, including time<f) ,- C '" OJ sis 0.0 '15 c

to review the instruction, search and gather the data needed, and complete and review the collection of information,:(lo a. 'cc co lii:l2 0:: Q)

Persons are not required to respond to the collection of information unless it displays a currently valid OMS control Cf) I s:0

number, If you have any comments about these estimates or any aspects of this data collection, contact: US <i:Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210, Do'not send the completed forms to this office, Page 1 of 1 (1) (2) (3) (4) (5) (6)

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.0./1 establishments covered by Part 1904 must complete this Summary page, even if no injuries orillnesses occurred during the year. Remember to review the Log to verify that the entries are complete

Using the Log, count the individual entries you made for each category. Then write the totals below,making sure you've added the entries from every page of the log. If you had no cases write "0."

Employees fornier employees, and their representatives have the right to review the OSHA Form 300 inits entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR1904.35, in OSHA's Recordkeeping rufe, for further details on the access provisions for these forms.

Number of Cases





a ooo(J)(G) (H) (I)

Number of Days

Total number ofdays away from\Ml"\rk


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(4) POisoning(5) Hearing Loss

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(6) All Other Illnesses oo


pUblicreporting burdenfor thiscollectionof informationisestimatedto average58 minutesperresponse,includingtime to reviewthe instruction,searchand-gatherthe data needed,andcompleteand reviewthe collectionof information. Personsare not requiredto respondto the collectionof informationunlessitdisplaysa currenUyvalid OMScontrolrumber, If you haveany commentsabouttheseestimatesor any aspectsof thisdata collection,contact: USDepartmentofL~bor.OSHA Office of Statistics.RoomN-3644. 200 ConstitutionAve.NW.Washinqton.DC 20210. Do notsendthe comoletedformsto thisoffice.

Year 2008 4>'. --:-:-':=::-.;':.,,..;..-:.,;..": •.,....:;:;:-

U.S_Department of LaborOccupational Safety and Health Administration

Form approved OMB no. 1218-0176


Your establishment name United Insulation Company, Inc



Industry description (e.g., Manufacture of motor truck trailers)tndustrial tnsulation Contractor

Standard Industrial Classification (SIC), if known (e.g., SIC 3715)

3 0 8 4-- -- -- ---OR North American Industrial Classification (NAICS). if known (e.g., 336212)



Total hours worked by all emptoyees lastyear 47,963.00

Sign here

Knowingly falSifying this document may result in a flna.

ed this document and that to the best of my knowledge the entries are true, accurate, and

PresidentTitle

910.395.6851 111212009Phone Date

OSHA's Form 300 (Rev. 01/2004)


Attention: This form contains information relatingto employee health and must be used in a mannerthat protects the confidentiality of employees to theextent possible while the information is being usedfor occupational safety and health purposes.



:-~'i'Ll.~~·~3..~~~~~; ••.•~'~CJ,-r•..~:r:i~,~~"~·!!~:":"'..:...o.:..~;",:·':,t':~·~~'>:~~~",;:';:';~"""~,;'.~"z ..:-r.•~;· ,_ '''.... ~ •..• ~ ~ _. _,

You must record information about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatmentbeyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-relatedinjuries and illnesses that meet anv of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete aninjury and illness incident report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local OSHAoffice for help.



. :IdEi6tifY t~e-persori - , Describe the case

City

Classify the case

Wilmington State NC

.- •. - - - -,- - ~- .-- .. _._ . .. ~. .-

Enter the number of(A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the "injury" column or choose one type of

Case Employee's Name Job Title (e.g., Date of Where the event occurred (e.g. Describe injury or illness, parts of body affected, the most serious outcome for that case: worker was: illness:No. Welder) injury or Loading dock north end) and objecUsubstance that directly injured or made .

(M) '"onset of person ill (e.g. Second degree burns on right Q)in

forearm from acetylene torch) On job '"illness Days away Away (j; '" Q)

Death Remained at work transfer or 'E e '" ;§(mo.lday) from work aFrom restriction 0 o c: Ol -I (j;'" - 0 c ClWork is ~:.:: 'c s:

Job transfer Other record- (days) c '0e- '0. '0 a .;::(days) :J c (/) c: C/l ro

or restriction able cases :s :i2 Q) 0 '0 Q) <C(/) a::u a.. J:(G) (H) (I) (J) (K) (L) (1) (2) (3) (4) (5) (6)

Page totals 0 0 0 0 0 0 0 0 0 0 0 0

Be sure to transfer these totals to the Summary page (Form 300A) before you post it. z- (j; ~c Cl '" '":J 'E o ,9 c: '" Q)

.C' ~~ 'c 0 '"....J '"- 0 0 (1)

Public reporting burden for this collection of information is estimated to average 14 minutes per response, including time '" .-c '" Cl §is 0.0 '0 C

toreview the instruction, search and gather the data needed, and complete and review the collection of information. ~u a.. ·cc: co di:i2 a:: Q)

Persons are not required to respond to the coltection of information unless it displays a currently valid OMS control (/) J: x:'0

n~mber. If you have any comments about these estimates or any aspects of this data collection, contact: US ~Department of Labor, OSHA Office of Statistics, Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Donotsend the completed forms to this office. Page 1 of 1 (1) (2) (3) (4) (5) (6)


Summary of Work-Related Injuries and Illnesses·-;~"".:;J,;~,t'<~P'::_~~~,'?~-:tl'b.~'e;:""~~~-..j,;"',~:<;':"

All establishments covered by Part 1904 must complete this Summary page, even if no injuries orillnesses occurred during /he year. Remember to review the Log to verify that the entries are complete

USing the Log, count tile individual entries you made for each category. Then write the totals below,making sure you've added tile entries from every page of the log. If you had no cases write "0."

Employees former employees, and their representatives have the right to review the OSHA Form 300 inits entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms.

,"



o



o oo(I)(H) (J)(G)

;)..:' :~-;;,:,"

Number 'of D~ys";~i;·~:::~;~{:gL~~ili~.~:.;'~:::1~~;f~~i~,~?

Total number ofdays away from\A/(')rk


o o(L)(K)

·;,t:<:,.•~·;,{·";;r:r~·7/i'$f:~J~~~'t:~~.~i%·_·Injury'and IIIness'Types, ,;;..-:..:;;.;i~~~C.~~;:;';:·

Total number of.._(M)


(4) Poisoning(5) Hearing Loss

oooo

o(6) All Other Illnesseso


public reportingburdenior this collectionof iniormationis estimatedto average58 minutesper response, includingtime to reviewtheinstruction,searchand,gatherthe data needed,and completeand review the collectionof information. Personsare not required to respondto the collectionof informationunlessitdisplays a curren~yvalid OMBconlro1number. Ifyou haveany commentsabouttheseestimatesor any aspectsof thisdsta collection,contact: US DepartmentofL~bor.OSHA Officeof Statistics.RoomN-3644.20D ConstitutionAve. NW.Washinaton.DC 20210. Do not send thecompletedformsto this office.

Year

U,S. Department of Laboroccupational Safety and Health Administration

2009 •Form approved OMS no, 1218-0176


Your establishment name United Insulation Company, Ine



Industry description (e.g., Manufacture of motor truck trailers)Industrial Insulation Contractor

Standard Industrial Classification (SIC), if known (e.q, SIC 3715)

3 0 8 4-- --- --- ---OR North American Industrial Classification (NAICS), if known (e.g., 336212)



Total hours worked by all employees lastyear 27,356.00

Sign here

Knowingly falsifying this document may result in a fine.

d that to the best of my knowledge the entries are true, accurate, and

PresidentTitle

910.395.6851 111112010

Phone Date

OSHA's Form 300 (Rev. 01/2004)


Attention: This form contains information relatingto employee health and must be used in a mannerthat protects the confidentiality of employees to theextent possible while the information is being usedfor occupational safety and health purposes.



'?.sr_~~!;~~~:?:;.~:a--;, ;::;.w,,:,4•.,.':;:a.. "'''::-~i.''',}.l':"'''':':';'-s:'-:~,b,':';'7'.;.~~T1J'~'':''·::'::~::;..:..~:;i.'':'''.-;:~;;St:;:;;'2~~:·7~7.7·:",-.,:,...~.:,~~- • ;':-.:,•.:.:. •.•

You must record information about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatmentbeyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-relatedinjuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904,8 through 1904,12, Feel free to use two lines for a single case if you need to, You must complete aninjury and illness incident report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form, If you're not sure whether a case is recordable, call your local OSHAoffice for help,



-~"'::!~"jBenlify the person Describe the case

City

Classify the case

Wilmington State NC

,-

Enter the number of(A) (B) (e) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the "injury" column or choose one type of

Case Employee's Name Job Title (e.q. Date of Where the event occurred (e.g. Describe injury or illness, parts of body affected, the most serious outcome for that case: worker was: illness:No, Welder) injury or Loading dock north end) and objecUsubstance that directly injured or made

(M) '"onset of person ill (e.q. Second degree burns on right Cll

'"forearm from acetylene torch) On job '"illness Days away Away '- '" CllDeath Remained at work transfer or Cll '" c

(mo.lday) from work -e e a .-From restriction a a c OJ ..J Qj

'" ~g c OJ- Work (5 '2 c s:Job transfer Othe r record- (days) z- '0. '5 a .~ (5

C en C enor restriction able cases (days) :oJ :l2 Cll 0 '0 Q) «E CI) et:o o, I

(G) (H) (I) (J) (K) (L) (1) (2) (3) (4) (5) (6)

Page totals 0 0 0 0 0 0 0 0 0 0 0 0

Be sure to transfer these totals to the Summary page (Form 300A) before you post it. ~ Qj ~c OJ en '"C en Cll:oJ -e ~~ '2 0 '"E ..J '"0 ,-'0 0 CllPublic reporting burden for this collection of information is estimated to average 14 minutes per response, including time '" .- C en OJ @(5 0.0 '0 C

~() c, .;::'-to review the instruction, search and gather the data needed, and complete and review the collection of information, C ctl

:l2 et: Q) Cll

Persons are not required to respond to the collection of information unless it displays a currently valid OMS control CI) I s:(5

number. If you have any comments about these estimates or any aspects of this data collection, contact: US =<Department of Labor, OSHA Office of Statistics. Room N-3644, 200 Constitution Ave, NW, Washington, DC 20210. Do/Iotsend the completed forms to this office, Page 1 of 1 (1 ) (2) (3) (4) (5) (6)

United Insulation Documents

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