SPECIFICATION NO.

5111
C O D E P2E
ISSUED 5 - 4 - 6 6
REVISED 8 - 2 3 - 0 7
PAGE 1 OF 5

CODE P2E
DESIGN PRESSURE, PSIG 200
DESIGN TEMPERATURE, F 385
DESIGN TEMPERATURE, C 196
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.

12 -36 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
----------------------------------------------------------------------
DATE 1-31-92 SPECIFICATION NO. 5111 P2E PAGE 3

JOINTS

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 - 24 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.

30 - 36 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 - 24 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. -------
---------------------------------------------------------------
DATE 11-26-96 SPECIFICATION NO. 5111 P2E PAGE 4

BOLTING
GRADE QUALIFICATIONS
DESCRIPTION MATERIAL ASTM
B HEAVY HEX. ANSI B18.2.1
BOLTS CARBON STEEL A307

NUTS CARBON STEEL A563 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: SU2A, U2A

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
DATE 11-26-96 SPECIFICATION NO. 5111 P2E PAGE 5

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 - W A Y T R A N S F L O W – “TEFLON” S L E E V E P L U G V A L V E . 1 5 0 P S I A T 4 0 0 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

A C C O R D A N C E W I T H T H E L A T E S T E D I T I O N O F A S M E B31.3 F O R N O R M A L
FLUID SERVICE.

BACKING RINGS ARE NOT PERMITTED.

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

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

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

AND LOOSE WELD SPATTER.

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

REVISIONS

0 8 - 2 4 - 9 4 U P D A T E D B31.3 B E N D R E Q U I R E M E N T S . A D D E D G 8 4 G A S K E T
OPTION. REVISED WELDING.
11-26-96 A D D E D S V 5 1 8 .
8-23-07 ADDED LOKRING FITTINGS. ADDED G62G4 GASKET. ADDED
ALLOY STEEL BOLTING.
12-10-08 ADDED DSV518
 SPECIFICATION NO. 5111
CODE P356
ISSUED 2-18-75
REVISED 01-08-08
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 B 3 1 . 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

ASTM SPECIFICATIONS
NPS SCHED

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 3-2-93 SPECIFICATION NO. 5111 P356 PAGE 3

JOINTS

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.

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

BOLTING
DESCRIPTION MATERIAL ASTM GRADE QUALIFICATIONS

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

NUTS CARBON STEEL A563 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 FL G32K
3-12 FL C32A(2)
1/2-2 SW G37C C37H(1)
1/2-1 (3) G37AB
1/2-6 FL SV310(4)
1/2-2 FL 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 5
− ---------------------------------------------------------------------

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

M A X I M U M C A R B O N C O N T E N T O F 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

− ---------------------------------------------------------------------
United Insulation Co., Inc. Estimate
2010 N. Kerr Ave.
Wilmington, NC 28405 DATE ESTIMATE NO.

8/3/2010 2529

NAME / ADDRESS

The Roberts Co Field Services, Inc

Attn: Accounts Payable
133 Forlines Road
Winterville, NC 28590

ITEM DESCRIPTION QUANITY COST TOTAL

LS - DAK...Vessel
Furnish labor, materials, equipment, supervision, and services to
insulate 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. Estimated 1 4,200.00 4,200.00
size 2 1/2 ft. x 36 ft.

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

Estimate Good For 30 Days

TOTAL $42,320.00
FEB-05-2010 FRI 08:55 Aft FAX NO. P. 02
Tools Page 1 of I

Experience MocfifiClltioJl Rating History

Emplaya' MInna: LINITED INSULAllON co OF WILMINGTON IN!:

A4dn:sr. 2010 N KERRAveNUE, WJLHlNGroN, NC 2B1OS
eov ••.• ge ItIt 06592820
CombD Id: 4252343.
$a£o......., Names: INC, UNITa.1INSULATION. UNJl'ED INSULATla-f COOFWILMINGTON, UNlTED
INSUlATION COMPANY OF 1IIIIU4lNGTDN me
ateaJve &piratJon exp ReviSIOn Rating
Date 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-

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

OSHA's Form 300A
Summary of Work-Related Injuries and Illnesses
~ '~'l":"

All establishments
- ._-.trJ-.c:-J •••.;;:~-'o:t....,.?o ~!1 •..~I"'~ • '\ •••• C:~ '.'
(Rev. 01/2004)

covered by Part 1904 must complete this Summary page, even if no injuries or
Year 2007
U.S. Department
occupational Safety

Form approved
•
of Labor
and Health Administration

OMS no. 1218-0176

illnesses 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, Establishment information
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 in Your establishment name United Insulation Company, Inc
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms. Street 2010 N Kerr Ave

City Wilmington State NC Zip 28405

Number of Cases
Industry description (e.g., Manufacture of motor truck trailers)
Total number of Total number of Total number of cases Total number of Industrial Insulation Contractor
deaths cases with days with job transfer or other recordable
away from work restriction cases Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
o o o o
(G) (H) (I) (J)
-- -- -- ---
3 0 6 4
OR North American Industrial Classification (NAICS), if known (e.g., 336212)

Number of Days Employment information

Total number of Total number of days of

days away from job transfer or restriction Annual average number of employees 35
\Alnrk"
Total hours worked by all employees last
o o year 76,401.00
(K) (l)

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

Injury and Illness Types Sign here

.~";.It,..••.•.
....:.~~-~ ••,;,..;.;~.:"'~.:.. •••••••."",.~ •• .:w .:

Total number of ... Knowingly falsifying this document may result in a fine.
(M)
(1) Injury o (4) Poisoning o
(2) Skin Disorder o (5) Hearing Loss o ined this document and that to the best of my knowledge the entries are true, accurate. and
(3) Respiratory
Condition o (6) All Other Illnesses o
President
Title

910.395.6851 "1612008
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date

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 informationunlessit
displays a currenUyvalid OMS controlnumber. If you haveanycommentsabouttheseestimatesor any aspectsof thisdata collection,oontact US Departmentof
La,bor.OSHA OffICeof Statistics.RoomN·3644, 200 ConstitutionAve.NW.Washinaton.DC 20210. 00 not send the comoletedformsto thisoffice.
 •
Attention: This form contains information relating
to employee health and must be used in a manner
OSHAls Form 300 (Rev. 01/2004) that protects the confidentiality of employees to the Year 2007
extent possible while the information is being used
u.s. Department of Labor
Log of Work-Related Injuries and Illnesses for occupational safety and health purposes,
Occupational Safety and Health Administration
t:;:~~Z':;:=~.~":;;]~-=-·~~~~'"'·r..~'·;;;Z" .'.:,~\.-:-::.'~~~~~~<',{' ,;:"r.,:,,:":~::!:~:';'~·i;;:':a:.:·'·~z:'.L
·':2~~~r:r;~Z"iZ:~-,L"f
••• ,,~; ~. . ,,". ...' .~ ;. '~:::~;~'.::~::'::~','~;:
,

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 treabnent Form approved OMS no, 1218-0176
beyond 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-related
injuries 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 an
Establishment name United Insulation Company, Inc
injury 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 OSHA
office for help.
City Wilmington State NC
r- ;'"\ide-iltltYth-e''' person Describe the case Classify the case .- "

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)
<f)
<f)
illness forearm from acetylene torch) On job '- <1)
Days away Away
(mo.lday) Death
from work
Remained at work transfer or
Q)

"E z-o '"'"

0
...J
c
.-
From restriction 0 C OJ
c: lii
"§g
is'"
OJ
Work 'c0 s:
Job transfer Other record- (days) e- c
'0.. '6 C
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0
or restriction able cases (days) ::J :l2 '"C
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'15
a.
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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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OSHA's Form 300A
Summary of Work-Related Injuries and Illnesses
(Rev. 01/2004) Year 2008
U.S_Department of Labor
4>
Occupational Safety and Health Administration
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Form approved OMB no. 1218-0176
.0./1 establishments covered by Part 1904 must complete this Summary page, even if no injuries or
illnesses 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, Establishment information
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 in Your establishment name United Insulation Company, Inc
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rufe, for further details on the access provisions for these forms. Street 2010 N Kerr Ave

City Wilmington State NC Zip 28405

Number of Cases
Industry description (e.g., Manufacture of motor truck trailers)
Total number of Total number of Total number of cases Total number of tndustrial tnsulation Contractor
deaths cases with days with job transfer or other recordable
away from work restriction cases Standard Industrial Classification (SIC), if known (e.g., SIC 3715)
o a o o
-- 3 -- 0 --8 ---4
(G) (H) (I) (J) OR North American Industrial Classification (NAICS). if known (e.g., 336212)

Number of Days Employment information

Total number of Total number of days of

days away from job transfer or restriction Annual average number of employees 40
\Ml"\rk
Total hours worked by all emptoyees last
o o year 47,963.00
(K) (l)

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Injury and Illness Types
~~~_~"",-"":,~",,,,, ·~·"'.'-.r', G • .....;.&,:, Sign here

Total number of... Knowingly falSifying this document may result in a flna.
(M)
(1) Injury o (4) POisoning o
(2) Skin Disorder o (5) Hearing Loss o ed this document and that to the best of my knowledge the entries are true, accurate, and
(3) Respiratory
Condition o (6) All Other Illnesses o
President
Title

910.395.6851 111212009
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date

pUblicreporting burdenfor this collectionof informationis estimatedto average58 minutes perresponse,includingtime to reviewthe instruction,searchand
-gatherthe data needed, andcompleteand reviewthe collectionof information. Personsare not requiredto respondto the collectionof informationunlessit
displaysa currenUyvalid OMScontrolrumber, If you haveany commentsaboutthese estimatesor any aspectsof thisdata collection,contact: USDepartmentof
L~bor.OSHA Office of Statistics.RoomN-3644. 200 ConstitutionAve.NW.Washinqton.DC 20210. Do not sendthe comoletedformsto this office.
 •
Attention: This form contains information relating
to employee health and must be used in a manner
OSHA's Form 300 (Rev. 01/2004) that protects the confidentiality of employees to the Year 2008
extent possible while the information is being used
u.s. Department
Log of Work-Related Injuries and Illnesses for occupational safety and health purposes.
Occupational
of Labor
Safety and Health Administration
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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 treatment Form approved OMB no. 1218-0176
beyond 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-related
injuries 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 an
injury 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 OSHA
Establishment name United Insulation Company, Inc
office for help.
City Wilmington State NC
. :IdEi6tifY t~e-persori Describe the case Classify the case
.- - ,•. - - - -,- - ~- .-- .. _._ . .. ~. .-

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 .
onset of person ill (e.g. Second degree burns on right (M) '"in
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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. Do
notsend the completed forms to this office. Page 1 of 1 (1) (2) (3) (4) (5) (6)
OSHA's Form 300A
Summary of Work-Related Injuries and Illnesses
·-;~"".:;J,;~,t'<~P'::_~~~,'?~-:tl'b.~'e;:""~~~-..j,;"',~:<;':"

All establishments
(Rev. 01/2004)

covered by Part 1904 must complete this Summary page, even if no injuries or
occupational
Year 2009
U,S. Department of Labor •
Safety and Health Administration

Form approved OMS no, 1218-0176

illnesses 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, Establishment information
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 in Your establishment name United Insulation Company, Ine
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35, in OSHA's Recordkeeping rule, for further details on the access provisions for these forms. Street 2010 N Kerr Ave

,"
City Wilmington State NC Zip 28405

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

Total number of Total number of Total number of cases Total number of Industrial Insulation Contractor
deaths cases with days with job transfer or other recordable
away from work restriction cases Standard Industrial Classification (SIC), if known (e.q, SIC 3715)
o o o o
--3 ---0 ---8 ---4
(G) (H) (I) (J) OR North American Industrial Classification (NAICS), if known (e.g., 336212)

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Number 'of D~ys";~i; Employment information

·~:::~;~{:gL~~ili~.~:.;'~:::1~~;f~~i~,~?
Total number of Total number of days of
days away from job transfer or restriction Annual average number of employees 18
\A/(')rk
Total hours worked by all employees last
o o year 27,356.00
(K) (L)

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

Total number of.._ Knowingly falsifying this document may result in a fine.
(M)
(1) Injury o (4) Poisoning o
(2) Skin Disorder o (5) Hearing Loss o d that to the best of my knowledge the entries are true, accurate, and
(3) Respiratory
Condition o (6) All Other Illnesses o
President
Title

910.395.6851 111112010
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date

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 informationunlessit
displays a curren~yvalid OMBconlro1number. Ifyou haveany commentsaboutthese estimatesor any aspectsof thisdsta collection,contact: US Departmentof
L~bor. OSHA Officeof Statistics.RoomN-3644.20D ConstitutionAve. NW.Washinaton.DC 20210. Do not send thecompletedformsto this office.
 •
Attention: This form contains information relating
to employee health and must be used in a manner
OSHA's Form 300 (Rev. 01/2004) that protects the confidentiality of employees to the Year 2009
extent possible while the information is being used

Log of Work-Related Injuries and Illnesses for occupational safety and health purposes. u.s. Department of Labor
Occupational Safety and Health Administration
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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 treatment Form approved OMB no. 1218-0176
beyond 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-related
injuries 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 an
injury 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 OSHA
Establishment name United Insulation Company, Inc
office for help,
City Wilmington State NC
-~"'::!~"jBenlify
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the person Describe the case Classify the case
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
onset of person ill (e.q. Second degree burns on right (M) '"
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illness forearm from acetylene torch)

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