IR 05000373/1987003
| ML20212J092 | |
| Person / Time | |
|---|---|
| Site: | LaSalle  |
| Issue date: | 03/04/1987 |
| From: | Merschoff E NRC OFFICE OF INSPECTION & ENFORCEMENT (IE) |
| To: | Harrison J NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III) |
| References | |
| NUDOCS 8703060309 | |
| Download: ML20212J092 (20) | |
Text
.e
'# %, UNITED STATES
,
8 o NUCLEAR REGULATORY COMMISSION 3 s wasHmorow.o.c.coess
- March 4, 1987
l'EMORANDUM FOR: John J. Harrison, Chief Engineering Branch Division of Reactor Safety Region III FROM: Ellis W. Merschoff, Acting Chief Vendor Program Branch Division of Quality Assurance, Vendor and Technical Training Center Programs Office of Inspection and Enforcement SUBJECT: INPUT FOR THE LASALLE EQUIPMENT QUALIFICATION PEPORT (50-373/8703 AND 50-374/8704)
Enclosed are the findings of Mr. R. H. Lasky from the Special Environmental Qualification Team inspection conducted by Mr. A. S. Gautan, Region III, and other NRC representatives on February 2-6, 1987, at LaSalle Nuclear Power Station. The findings and comments are enclosed in Appendix A. Inspection checkoff sheets are enclosed in Appendix Should you have any cuestions concerning this correspondence, we will be pleased to discuss them with yo
Sincerely, W }
Ellis W. Merschoff, Acting Chief Vendor Prooram Branch Division of Quality Assurance, Vendor and Technical Training Center Prograns Office of Inspection and Enforcement Enclosures: Appendix A-Report of Findings and Comments Appendix B-Inspection Checkoff Sheets (24 pages)
cc w/cnclosures:
A. S. Gautan, RIII 0703060309 B70304 PDR ADOCK 05000373 G PDH
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6t John .J. Harrison, Chief . 2- March 4, 1987
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APPENDIX A INSPECTION FINDINGS AND COMMENTS Findings: EQ Master List did not list Rosemount transmitter 2B21-N4020 for Unit Licensee has initiated a chance to add transmitter 2821-N402D to the EQ Faster Lis . EQ Master List gives Environrental Zone H4 for some of the equipmen The Environmental Zone should be H4A. Licensee has initiated a change to correct the EQ Master Lis . File binder EQ-LS027 for Rosemount model 1153 series B transmitters did not properly address plant specific recuired transmitter accuracies. The licensee was able to establish usiag other documents that transmitter accuracies demonstrated during E0 testing were adequate for LaSalle. The licensee has committed to changing file EQ-L5027 to address plant specific accuracy requirement Comments of Equipment Qualification Files: Binder EQ-LS027, Rosemount Model 1153 series B transmitter File was found deficient in that plant specific required transmitter accuracies were not addresse See finding A.3. Supplemental information supplied by licensee showed adeouate cualification of transmitter . Binder EQ-LS027, GE pump notor, Model 5K6339XC109A File indicated that submergence of motors was not applicable but discussions with the licensee indicated that the motors could become submerged. FSAR, Amendment 64, May 1984, Section 3.11.1.4.2c, states that the flooding threat of areas where the pumps are located is not directly connected to the accidents used to establish harsh environmental zones at the plant. Per the FSAR, flooding is not a E0 consideratio . Binder E0-LS021 ITT General, Damper Actuator, model NH41. Adequate qualification was shown by this fil . Binder EQ-LS069, Reliance Pump Motor, Model 184 Adequate qualification was shown by this fil . Binder EQ-LS078, Reliance Pump Motor, Model 365 Adequate qualification was shown by this fil . Binder E0-LS056, Westinghouse Motor, model 182T. Adecuate i qualification was shown by this fil . Binder EQ-LS059, Sierens Motor / Blower, rodel 2CH6 modified by GE. Adequate qualification was shown by this fil . . - .
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-2- Binder EQ-L5035, Validyne Model P232 transmitter. Adequate
~ qualification was shown by this fil Comments on Plant Walkdown: _ The following items were examined during the plant walkdown: Rosemount-Transmitters:
1) 2B21-N4020 2) 2C11-N016B 3) 2PT-CM028 4) 2ER-N007A 5) 2CM-032,-Rosemount seal only 6) 2E21-N006A, Rcsemnunt seal only 7) 2E51-N003, Rosencunt seal only Reliance Motors:
1 2EB51 C003 2 2C41 C001A GE Motor, 1E12 C002A Validyne transmitter, 2VG009FT ' Westinghouse motor, 2VG02C Siemens Potor/ Blowers 1) 2E32-C001 2) 2E32-C002 All items examined during the plant walkdown appeared to be generally well naintained and in good condition. No deficient conditions were note General Inspection Comments: Files were auditable and appeared well maintained. The major concern with the files examined was the handling of the submergence issu Submergence was mentioned in most files but was not discussed in enough detail te give the inspector confidence that the issue was adequately considered by the licensee. See comment . Master List findings A.1 and A.2 were not considered to be a generic concerns with respect to accuracy and adequacy of the lis O
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APPENDIX B CHECKLIST FOR REVIEW 0F LICENSEE EQ DOCUMENTATION FILES This chekkTist. is provided. for use in performing evaluations of the ade-quacy of a qualification package for a piece of equipment. Such reviews will determine the adequacy of the EQ program for the device and will determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one fil For other files, items not reviewed should be marked "N/A" in Comments Colum 'o- 7 73/97 c 3 Za.s dy Plant / Docket No.: So- 3W/8)oy .
Reviewer:
Component (s): RosewouvY, Mode l /153 Senes "8 "
Equipment Documentation File: b der A/e. Ed - /S O 2 7 Criteria: 10 CFR 50.49 i or 00R Guidelines _
or Other puRES 0T/8 caf .T Covered in EQ Occumentation .
EQ Issue
'
Yes g Comments Positive statement by the Y licensee that the equipment is qualified for its applicatio . Full description of the Z_
' equipment.
. If qualification sample is X not identical to. the instal-led devices, a similarity analysis has been provide . Allowed mounting methods and K orientations.
l Interfaces - conduit, housing N seal, et . A qualified life has been 1
established based on accel-erated aging-thermal, radiation, cyclic, as
,
appropriat . All type tests performed Y on the same specimen (N/A 00R Guidelines).
l l
Appendix B, 2515 B-1 Issue Date: 03/27/86 I- -
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TRANSMITTER PHYSICAL INSPECTION CHECKLIST Component 10 No.: (EE BElote.) Reviewer: /MtV ]
Installed Condition Acrees with Occumented Yes No Comments Documented Information Location .
,_Y_
81d Room Elev A Nanutacturer Pesemov af _,,,, Model N //f ? reriks '8" < , Range / Type Coda ,,_, _ Serial N /A4 + f, /e _
Mounting Description X . ~ h d .wR suaW h raale t Orientation A/ crAca/ P Process Connection Type - X m et Laweal _
A Electrical Connection Type i l Housing Seals in Good Condition, I _
Covers in Place I
Does Installed Device Experience _ _
(If yes, review documentation to a Significant Temperature Rise determine whether from Process? considered)
i (If ambient temp-
' 1 Ambient Normal Expected Temperature __
erature exceeds Range normal expected, l
l verify that quali-l fied life evalu-ation considered)
General Comments on Physical Inspection:
pg]pg[
p,y,(g,g 2821 - Attfo g a . z y QM roS.7o)
t 2 Cll - D 014 8 - PT t15 ? &Bf usnc ps my-pr e a, - ne ac:aer p ,, ,,3 2 ea - um - er
-- n ...as, c 9515 l
. . - ~ _ _ _ _ _ _ _ _ _ _ _ _ . _ . _ __ _ . _ _ _ _ _ _ _ _ . _ . _ _ . _ _ _ _ _ _ _ _ _ _ . . . . _ . _ . . - _ _ . _ _ _ _ _ . . __
_ . _ . . _ _ . _ _
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APPENDIX 8 CHECKLIST FOR REVIEW 0F LICENSEE EQ DOCUMENTATION FILES This chetiffst. is provided. for use in performing evaluations of the ade-quacy of a cualification package for a piece of equipment. Such reviews will determine the adequacy of the EQ program for the device and will determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one file. For other files, items not reviewed should be marked "N/A" in Comments Colum S~o ~ 3 73/ $702 Plant / Docket No.: 50 - 3'7W 6?oV ,
Reviewer: Z A ~Ey
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Component (s): 6E Pu. w p /fo /o r Equipment Documentation File: L der N Go - 25 aog Criteria: 10 CFR 50.49 X or D0R Guidelines ~
or Other NARC 6 orge cd 1~.
Covered in EQ Documentation .
'
Yes No Comments EQ Issue
! Positive statement by the X licensee that the equipment is qualified for its application.
,
l Full description of the L equipment.
l l If qualification sample is 1 not identical to.the instal-led devices, a similarity analysis has been provide . Allowed mounting methods and X" _
orientation . Interfaces - conduit, housing JC seal, et . A qualified life has been < _
l established based on accel-
!
erated aging-thermal, radiation, cyclic, as I appropriat . All type tests performed on the same specimen (N/A
[_
00R Guidelines).
Appendix B, 2515 B-1 Issue Date: 03/21<86
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ELECTRIC MOTOR PHYSICAL INSPECTION CHECKLIST Component ID: 2 H/0 - E/2 c oc 2A Reviewer: ]
' '" Installed Condition Aarees with Documented Yes No' Comments Documented Information
. Location %
Bldg Room Elev _
' Nanufacturer GE X Nodel N SG339/Clo?A 'K , Serial N _ Voltage vooo HP 600 L _ Mounting and Orientation d *
tier h eal . Accessories
.
Coolers _
o e '/
Lubricant Reservoirs 8 Heaters IAtM _ s Housing Seals and Covers _ X in Place and Tight Area Surrounding Motor is %
Clean and Dry Ambient Normal Expected ~_
Temperature Range Junction Box Type 2$ Orainage Method d General Comments on Physical Inspection:
C-6 Apcendix C, 2515 Issue Date: 03/27/86
_-- ._- - .- ... _ - . - . _ _ - _ - _ .._.- __ _._ __ _ __ _ _ _ _ _ _ _ - _ __ _. _ - _ - _ _ - _ -
._
,
- - *
APPENDIX B CHECKLIST FOR REVIEW OF LICENSEE EQ DOCUMENTATION FILES This chetkTist. is provided. for use in performing evaluations of the ade-quacy of a qualification package for a piece of equipment. Such reviews will oetermine the adequacy of the EQ program for the device and will
' determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one file. For other files, items not reviewed should be marked "N/A" in Comments Colum C0-???/97o2 Plant / Docket No.: 90 ?7y/e7o y Reviewer: z'A LF v'
'
Component (s): TTT Geeerol Dwper AeGh<
Equipment Documentation File: E der A/o. Ed -4502 /
Criteria: 10 CFR 50.49 '/ or 00R Guidelines _
or Other pvRE& O::8R ca1. I Covered in EQ Documentation Yes No Comments EQ Issue ~
\
- Positive statement by the '<
licensee that the equipment l
-
is qualified for its applicatio . Full description of the X _
equipmen . If qualification sample is _M not identical to the instal-I led devices, a similarity analysis has been provide . Allowed mounting methods and M orientation . Interfaces - conduit, housing 6 _
seal, et . A qualified life has been _Y
,
established based on accel-erated aging-thermal, radiation, cyclic, as
,
appropriat . All type tests performed on the same specimen (N/A 00R Guidelines).
Appendix B, 2515 8-1 Issue Date: 0,1/27/86
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EQUIPMENT DESCRIPTION Component ID: 2F1-VGoo3 Revfewer:
,,- .- Installed Condition
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Aareas with Documented Documented Information Yes No Comments Location Bldg Room _ Elev
' Manufacturer ITT 6emea/ {
~ ~ ~ Model N Mll 9 / ..
-
- Serial N p(ikfX/4 8 J Mounting Description -
be>lled Orientation aleelncal ~
cowarL-ed (sees up sc h kr ce-kr^~e ee oe.neoe por,z 4 1 Process Connection Type Electrical Connection Type m Housing Seals in Good Condition, .
Covers in Place Does Installed Device Experience (If yes, document-a Significant Temperature Rise ation must be from Process? reviewed to deter-mine if the temper-
' ature rise was considered)
10. Ambient Normal Expected (If ambient temp-( erature exceeds l
Temperature Range normal expected i
conditions, verify that licensee has considered the elevated tempera-
,
'
-
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ture in the qualified life evaluation)
General Comments on Physical Inspection:
l Issue Date: 03/27/86 C-8 Appendix C, 2515 I
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,_ . ,____ . ._.__ - _
_,_ _,____.. - ,- -.- _ - . -. . - . . . . _ _ - - . , - _
_ _ _ _ _ _ _ _ _ _ _ _
i
'
- -
APPENDIX 8 CHECKLIST FOR REVIEW 0F LICENSEE EQ DOCUMENTATION FILES This chekk7fst. is provided. for use in performing evaluations of the ade-quacy of a qualification package for a piece of equipment. Such reviews will determine the adequacy of the EQ program for the device and will determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one fil For other files, items not reviewed should be marked "N/A" in Comments Colum So - r7W 9702 2 4 ff y'
Plant /Occket No.: re 3 N / sp o a/ ,
Reviewer:
Component (s): Re/du L a Mobr Equipment Documentation File: Bsdar Ed-250(9 Criteria: 10 CFR 50.49 )( or 00R Guidelines or Other DtrRE6 Of88 Cod I Covered in EQ Documentation .
'
Yes M Comments EQ Issue Positive statement by the g licensee that the equipment is qualified for its applicatio . Full description of the equipmen $ If qualification sample is _
A not identical to the instal-led devices, a similarity analysis has been provide . Allowed mounting methods and X orientation . Interfaces - conduit, housing seal, et d A qualified life has been Y _
established based on accel-erated aging-thermal,
,
radiation, cyclic, as
,
approprict . All type tests performed _
on the same specimen (N/A 00R Guidelines).
Appendix 8, 2515 8-1 Issue Date: 03/27/86
._ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .
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' ELECTRIC MOTOR PHYSICAL INSPECTION CHECKLIST Component 10: 2 E8 sl C003 - #10 Reviewer: MNV ]
Installed Condition Agrees with Documented Yes No Comments Documented Information
. Location K 81dg Room _ Elev i I Manufacturer d e /li n e- A 3.a. Model No. / 8 4 T, SP, Ph 'N _
,
_ Scrial N _
. Voltage %'d HP 7,$~ I Mounting and Orientation d *
Nor/ 20 h$k l Accessories _ ,
- -
Coolers _ _ ,
Lubricant Reservoirs _
J i
-
^
Heaters _ Housing Seals and Covers K _
l in Place and Tight
,
I Area Surrounding Motor is Y i 7.
Clean and Dry Ambient Normal Expected _
,
Temperature Range Junction Box Type _ _ Orainage Method _
General Comments on Physical Inspection:
l l
l C-6 Apoendix C, 2515 Issue Date: 03/27/66
.
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A
'
. <
~
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-
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- APPENDIX B
'
CHECKLIST FOR REVIEW OF LICENSEE EQ DOCUMENTATION FILES This chetkTTrt. is provided. fer use in performing evaluations of the ade-quacy of.s qualification package for a piece of equipment. Such reviews will detectine the adequacy of tne EQ program for the device and will
' determine tae adequacy of the licensee's review and approval process for the equipse.nt. Perform a complete review for one file. For other filss, items not ruviewed should be marked "N/A" in Comments Colum CD - 773/9?o!
Plant /Dockr.t No.: ro-nv/270v Reviewer: los/y
Component (s): $bb y b ,bu ,J do J ro l Pa a.o No6
'
Equipment Cocumentation File: Ede. A'c. Ed -2507#
,
Criteria: 10 CFR 50.49 1 or 00R Guidelines _
or Other i
! nueE(, ossa ggf. T l Covered in EQ Occumentation ,
, -
D) Issue
'
Yes g Comments Positive statement by the V licensee that the equipment is qualified for its
' applicatio '
l Full description of the I '.
-
equipmen ,;
l
/ If qualification sample is I l not identic*.1 to.the instal-led devides, a similarity analysis has been provid . Allowed mounting methods and K orientation . Interfaces - conduit, housing d seal, et , A qualifigo life has been N _
>
establishtd based on accel-erated aging-thermal, ,;
radiation, cyclic, as appropriate _
l All type tests performed X i on the same specimen (N/A 00R Guidelines).
l
. s l Appendix 8, 2515 B-1 Issue Oata p3/th86
,
, . - - - - ,- - .. n,- ,- - - - . - . - . - - ,,n., , - - - , , , . -,- ,., ._,..-._ .-
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ELECTRIC MOTOR PHYSICAL INSPECTION CHECKLIST Component 10: 2 cV/ coo /A Reviewer: /CIy )
Installed Condition Agrees with Documented Documented o Information Yes g Comments
. Location <
B1dg Room _ Elev _,,_ ' Manufacturer Pelaw t, f Model No. ?u~ 744n he-F 'I ,
Terc-xt Serial N Voltage y_f0,, HP NO /
.
- Mounting and Orientation X __
Grozok Go4 ff w h d Accessories _ _ _ _
Coolers __,
~_,,_
Lubricant Reservoirs ,_,_,
d
-~
-
Heaters - Housing Seals and Covers 1 _,_ in Place and Tight Area Serrounding Motor is I clean and Dry Ambient Mormal Expected Temperature Range 9 Junction Box Type _ _,, Orainage Method _,
General Comments on Physical Inspection:
.
C-6 Apoendix C, 2515 Issue Date: 03/27/86
. _ . . _ , _ . - _ . . . . _ _ _ _ . _ _
.
.
- -
APPENDIX B CHECKLIST FOR REVIEW 0F LICENSEE EQ DOCUMENTATION FILES This chetkTfst. is provided. for use in performing evaluations of the ade-quacy of a cualification package for a piece of equipment. Such reviews
,
will detemine the adequacy of the EQ program for the device and will
' determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one file. For other files, items not reviewed should be marked "N/A" in Comments Colum To- ?? r/9103 Plant / Docket No.: ro- ? W/ &;o Y Reviewer: /N#f
Component (s): blesf ae, lie u se Cee/, y 5u w der Equipment Documentation File: &J/e.- t/o . F4 - 45056 Criteria: 10 CFR 50.49 1 or 00R Guidelines or Other Wu 2 ECr ofeo Ca.f. Z Covered in EQ Documentation .
EQ Issue
'
Yes g Comments Positive statement by the ~X licensee that the equipment is qualified for its applicatio . Full description of the X _
equipmen . If qualification sample is K _
not identical to.the instal-1ed devices, a similarity
,
l I analysis has been provide . Allowed mounting methods and X j
orientation . Interfaces - conduit, housing &
seal, et . A qualified life has been N established based on accel-
'
erated aging-thermal, radiation, cyclic, as
,
appropriat . All type tests performed #
on the same specimen (N/A 00R Guidelines).
Appendix B, 2515 B-1 Issue Date- 03/27/86
,
- - - - - - - ~ - , - , - - - . . __
.
.
.- -
ELECTRIC MOTOR PHYSICAL INSPECTION CHECKLIST Component ID: 2 ,">: V', cir Reviewer: 2MIY/ ]
2tik.) ~ V6 c2c Installed Condition Agrees with Documented Yes No' Ccaments Documented Information
. Location 81dg _ Room _ Elev 3 ' Manufacturer kles/9 ous d A i;;,7; .- ':. Nodel N Tl TBK,;~H K
. Serial N _
-+to-- -ce-
. Voltage 440 HP l. 4~ d Mounting and Or,iegtation A -
Henzia%/ Accessories _ _
-
__
-
Coolers
^
Lubricant Reservoirs ~
._
J Heaters _ s Housing Seals and Covers _ A in Place and Tight Area Surrounding Motor is A Clean and Dry Ambient Normal Expected d Temperature Range Junction Box Type X'
9.a.
. Orainage Method A l
l General Comments on Physical Inspection:
t
!
l l
l C-6 Apoendix C, 2515 Issue Date: 03/27/86 l
l
_- ._ - . - _ _ . _ _ _ _ - ._ .-- - . ..-
. . _ _ _
.
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.
APPENDIX B CHECKLIST FOR REVIEW 0F LICENSEE EQ DOCUMENTATION FILES This chaut7firt. is provided. for use in performing evaluationsSuch of the ade-reviews
quacy of a qualification package for a piece of equipment.EQ program for the will detemine the adequacy of the
' detemine the adequacy of the licensee's review and approval process For other for files, the equipmen Perform a complete review for one fil items not reviewed should be marked "N/A" in Comments Colum Eb- 27.W 9763 .
56- 3 7 Y /9 7 W , Reviewer: ddSA'y Plant / Docket No.:
Component (s): SEENSU 5 Ho76rfffgu)gg Equipment Documentation File: FC L /e < /Uo . Ed-4Soff X' or 00R Guidelines or Other Criteria: 10 CFR 50.49 _
uu2Efr 0S88 Cd. i Covered in EQ Documentation .
'
Yes ]!o, Comments EQ Issue Positive statement by the g_
licensee that the equipment is qualified for its applicatio . Full description of the X equipoent.
! If qualification sample is X _
not identical to.the instal-
,
' led devices, a similarity analysis has been provided.
! Allowed mounting methods and g orientation . Interfaces - conduit, housing >(
seal, et . A qualified life has been d
' established based on accel-
'
erated aging-thersal, radiation, cyclic, as
,
appropriat . All type tests performed d on the same specimen (N/A 00R Guidelines).
Appendix 8, 2515 S-1 Issue Date: 03/27/86 f
, - _ ,
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EQdIPMENTDESCRIPTION Component ID: 2EJF - (oo / Reviewer: /ASA'M j
.-
~O Installed Condition
,,,
Agrees with Documented Yes No Comments !
Documented Information Location 81dg Room Elev X
' Nanufacturer GIGt1FMS m),iid by GE X Nodel N CGC ,2.7oo Y y .7Ap , Serial N _ Mounting Description ~
d 20Hed Fee'l Orientation Aorlzo da / X Process Connection Type _,
WA Electrical Connection Type ><.
gey -
g Housing Seals in Good Condition, & -
Covers in Place Does Installed Device Experience (If yes, document-a Significant Temperature Rise ation must be from Process? reviewed to deter-mine if the temper-ature rise was considered)
10. Ambient Normal Expected (If ambient temp-
! Temperature Range erature exceeds
,
normal expected conditions, verify l that licensee has (
' considered the elevated tempera-
, '
ture in the qualified
,
life evaluation)
General Comments on Physical Inspection:
l Issue Date: 03/27/86 C-8 Appendix C, 2515
_ - - . . _ -
.
'
- * *
APPENDIX B CHECKLIST FOR REVIEW 0F LICENSEE EQ 00CUMENTATION FILES This chetkTYst. is provided. for use in performing evaluations of the ade-quacy of a qualification package for a piece of equipment. Such reviews will determine the adequacy of the EQ program for the device and will
~ determine the adequacy of the licensee's review and approval process for the equipment. Perform a complete review for one file. For other files, items not reviewed should.be marked "N/A" in Comments Colum D-777/ B7o?
Plant / Docket No.: So -17 v/ 8 ?o v ,
Reviewer: 4 A f N '/
Component (s): %),Jy u F/w fews defer /fede/ Pifa Equipment Documentation File: 3r a /er- N R- Z SCR Criteria: 10 CFR 50.49 y or 00R Guidelines or other h REG 0396 cof .Z'
Covered in EQ Documentation EQ Issue
'
Yes g Comments Positive statement by the X licensee that the equipment is qualified for its applicatio . Full description of the / _
equipment.
l If qualification sample is 'YA not identical to.the instal-led devices, a similarity analysis has been provide . Allowed mounting methods and I orientations.
! Interfaces - conduit, housing X seal, et . A qualified life has been A'
established based on accel-erated aging-thermal,
radiation, cyclic, as
,
appropriat . All type tests performed on the same specimen (N/A 1_
00R Guidelines).
Appendix 8, 2515 B-1 Issue Date: 03/27/86 i
._ . _ _ __ - . ._. _ _ _ _ . . - -
e
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TRANSMITTER PHYSICAL INSPECTION CHECKLIST Component 10 No.: 2 FT- VGoog Reviewer: 2AM/
Flow Trans ter Installed Condition Aarees with Occumented Yes No Comments Documented Information Location 81d Room Elev t/ah J vn g_
/ h Manufacturer _ Model N Range / Type Code 923 _
_
Ng r
-
, Serial N Bot
~ Mounting Description _
e rwel iVO l Orientation uaf crde ka /
gXAMIR0
~ Process Connection Type ~
rne e len ,e o e a. /
Electrical Connection Type d _
a d . Housing Seals in Good Condition, _
Covers in Place Does Installed Device Experience -
(If yes, review documentation to a Significant Temperature Rise determine whether from Process? considered)
Ambient Normal Expected Temperature _ _
(If ambient temp-l 1 erature exceeds Range normal expected, verify that quali-fied life evalu-ation considered)
General Comments on Physical Inspection:
1 .
l l
l
-- .-- a. e esis
_ _ - - . - -_ . - - _ .