"Weighing & Measuring Device/Individual Application for Registered Service Person" - Utah

Weighing & Measuring Device/Individual Application for Registered Service Person is a legal document that was released by the Utah Department of Agriculture and Food - a government authority operating within Utah.

Form Details:

  • Released on October 1, 2017;
  • The latest edition currently provided by the Utah Department of Agriculture and Food;
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APPLICATION FOR REGISTERED SERVICE PERSON
Utah Department of Agriculture and Food
REGULATORY SERVICES - WEIGHTS AND MEASURES PROGRAM
Box 146500 ● 350 NORTH REDWOOD ROAD ● SLC, UT. ● 84114-6500
INCOMPLETE APPLICATIONS WILL BE RETURNED / LATE FEES APPLY
Fax: 1-385-465-6023 Office: 1-801-982-2260 Email:
udaf-measures@utah.gov
Check One: New Application
Yearly Renewal_
2- Check mark all devices you will be calibrating:
Retail Motor Fuel
Small Scales
Large Scales
0-1000#
1000# & up
High Volume Meters
Check Stand Scanners
Vehicle Scale
Vehicle tank meters
Propane Meters
Rack Meters __________
D E F
LNG
CNG________________
3-- Applicants Name: ____________________________ 4 –Applicant phone______________________________
5 – Employer Name:
6 – Employer Email
7-- Employer Address_________________________________________________________________________
Applicants security seal: Each applicant must provide a physical sample of Security Seals
8--
(i.e. sticker, lead and wire, etc.) each year for approval. NO EXEPTIONS. They may or may not
be approved, regardless of any previous approval.
9—Type of security seal enclosed:
Lead Wire
Plastic
sticker
other (describe)______________________
Record identification marks on security seals________________________________________________________
List all “Calibration Certificate” numbers for test standards to be used.
11-
:
___________________________________
TEST WEIGHTS
CERTIFICATION NUMBERS
: ___________________________________
LIQUID MEASURE CERTIFICATION NUMBERS
C
12- $50
:
Registration
heck Number
_________
$25 LATE FEE AFTER JANUARY 1
Please complete the attached page 2.
The basic knowledge required for renewal completion reasserts your understanding. Read the
statements on page 2 and initial that you understand this crucial part of your professional
knowledge. Also you are aware that this information is part of our Utah code and other
requirements. It is expected that this basic knowledge is already understood.
Page 1
rev 10/2017
APPLICATION FOR REGISTERED SERVICE PERSON
Utah Department of Agriculture and Food
REGULATORY SERVICES - WEIGHTS AND MEASURES PROGRAM
Box 146500 ● 350 NORTH REDWOOD ROAD ● SLC, UT. ● 84114-6500
INCOMPLETE APPLICATIONS WILL BE RETURNED / LATE FEES APPLY
Fax: 1-385-465-6023 Office: 1-801-982-2260 Email:
udaf-measures@utah.gov
Check One: New Application
Yearly Renewal_
2- Check mark all devices you will be calibrating:
Retail Motor Fuel
Small Scales
Large Scales
0-1000#
1000# & up
High Volume Meters
Check Stand Scanners
Vehicle Scale
Vehicle tank meters
Propane Meters
Rack Meters __________
D E F
LNG
CNG________________
3-- Applicants Name: ____________________________ 4 –Applicant phone______________________________
5 – Employer Name:
6 – Employer Email
7-- Employer Address_________________________________________________________________________
Applicants security seal: Each applicant must provide a physical sample of Security Seals
8--
(i.e. sticker, lead and wire, etc.) each year for approval. NO EXEPTIONS. They may or may not
be approved, regardless of any previous approval.
9—Type of security seal enclosed:
Lead Wire
Plastic
sticker
other (describe)______________________
Record identification marks on security seals________________________________________________________
List all “Calibration Certificate” numbers for test standards to be used.
11-
:
___________________________________
TEST WEIGHTS
CERTIFICATION NUMBERS
: ___________________________________
LIQUID MEASURE CERTIFICATION NUMBERS
C
12- $50
:
Registration
heck Number
_________
$25 LATE FEE AFTER JANUARY 1
Please complete the attached page 2.
The basic knowledge required for renewal completion reasserts your understanding. Read the
statements on page 2 and initial that you understand this crucial part of your professional
knowledge. Also you are aware that this information is part of our Utah code and other
requirements. It is expected that this basic knowledge is already understood.
Page 1
rev 10/2017
*I fully understand Utah is a National Type Evaluation State. This means that only NTEP
approved weighing and measuring devices and their auxiliary components are lawful.
https://www.ncwm.net/ntep
Applicant initial___________
* A
CERTIFICATE OF CONFORMANCE,
Issued by NTEP will contain extensive technical
information about NTEP Certified devices including
SECURITY SEALING REQUIREMENTS!
https://www.ncwm.net/ntep/cert_search
Applicant initial
___________
___________________________________________________________________________________________________
*The National Conference Weights and Measures
NCWM
Is the national organization that
can provide the latest versions of NATIONAL INSTITUTE OF STANDARDS AND
TECHNOLOGY Like
NIST HANDBOOK 44
and other related publications. It is recommended
that each professional service person that sells and services weighing and measuring devices
obtain membership with NCWM.
http://www.ncwm.net/
Applicant initial: _________
*I HEARBY MAKE APPLICATION TO
: LEGALLY PLACE ANY WEIGHING OR MEASURING DEVICE INTO
Upon Performing any
----
ACCORDANCE WITH ALL UTAH CODE AND REQUIREMENTS
COMMERCE IN
‘A
calibration work.
PLACED IN SERVICE REPORT FORM’
WILL BE SUBMITTED FOLLOWING ANY
AND ALL INSTALATION OR CALIBRATION OF ANY DEVICES
APPLICANTS SIGNATURE______________________ Date________________
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