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<0148P Sterlcycle' <br /> • Envivonmental5olu6ons <br /> Process Code: <br /> A roval#: <br /> Cost: <br /> Cylinder Inspection Report Quantity of cylinders: <br /> Internal Use Only <br /> Piece Size: <br /> Tracking Number QC by: <br /> Section 1: Generator Information <br /> Generator: Date: <br /> City/State Chemist(s): <br /> Phone#: Manifest#: <br /> Section 2: Cylinder Contents <br /> Contents and concentration(mole%): I u <br /> Physical State Liquified gas I I Compressed gas Non-pressurized gas <br /> Section 3: Cylinder Information <br /> Have pictures been submitted with form? I Yes I I I No <br /> Dimensions(inches) Length(excluding valve)I I Diameter <br /> Cylinder size- Lecture- LE Up to 3"dia.and 13"length or 4"dia.and 10"length <br /> (Check box) Small-S Up to 4"dia.and 24"length <br /> Medium-M Up to 12"dia.and 36"length <br /> Large-L Up to 16"dia.and 56"length <br /> Extra Large-XL Over 16"dia.and 56"length <br /> Yes I No Yes No <br /> Is the cylinder DOT shippable? Exceeds bulge limitations? <br /> Manufactures label attached? External condition in good shape? <br /> Exceeds dent limitations? Vapor tight cap present if Zone A? <br /> Leak test performed?(must be yes to ship) Pass leak test? <br /> Protective valve cover/cap? Valve cap removeable? <br /> DOT/ICC Spec. Color/Markings: <br /> Section 4: Valve Information <br /> Yes No Yes No <br /> Valve appears workable? Regulator or attachments? <br /> Outlet Threads Impaired? Outlet plug in place? <br /> Pressure relief? External condition in good shape? <br /> Relief type(if present) <br /> Section 5: DOT Shipping Information <br /> PSN Yes No <br /> Hazard Class UN/NA ID#I Zonel I Poison Inhalation Hazard <br /> Section 5: EPA/RCRA Information <br /> EPA Waste Codes: Regulatory Information: <br /> Section 6: Additional Information <br /> Section 7: Inspection Completed By: <br /> Print Name: Date: <br /> Signature: Company: <br />