DOCUMENT NO: ASAP 5010 VERSION: 2005-09-12 Page 1 of 3
       TITLE: Application Procedure for Acceptance of Non-Asbestos Packing Material
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1.0 PURPOSE
This document establishes the Standard Application Procedure (SAP) to be followed by applicants when applying for acceptance of a non-asbestos packing material.
2.0 SCOPE
This application procedure applies to all applications for the Mine Safety and Health Administration (MSHA) acceptance of non-asbestos packing material.
3.0 REFERENCES
This document may be used in conjunction with the following documents:
a. Design and Performance Requirements for Non-Asbestos Packing Material" (ACRI5002).
b. "Standard Test Procedure for Non-Asbestos Packing Material" (ASTP5006).
c. "Standard Operating Procedure for Non-Asbestos Packing Material" (ASOP5027).
d. "Approval and Certification Center Cancellation Policy" (APOL1009).
4.0 DEFINITIONS
None
5.0 APPLICATION PROCEDURE
5.1. An application for acceptance of non-asbestos packing material shall be submitted to:
Chief, Approval and Certification Center
RR#1, Box 251,
Industrial Park Road
Triadelphia, WV 26059
5.2. The application form (see Attachment No.1) shall be used and may be reproduced. All entries on the form shall be completed by typing or printing.
5.2.1. The "Company Application Code Number" is a six (6) digit or less numeric character assigned by the applicant to identify the application.
5.2.2. Incomplete entries will be returned in accordance with APOL1009.
5.3. Thirty-five feet of each diameter packing material, for which acceptance is requested, shall be submitted.
5.4. A completed "TOXICITY AND QUALITY ASSURANCE STATEMENT” shall be submitted (see Attachment No. 2). The authorized representative"s name must appear in type or printing as well as a written signature.
5.5. A specification sheet/drawing shall be submitted that lists the following characteristics:
a. Operating Temperature Range
b. Chemical Resistivity
c. Dielectric Properties
d. Moisture Absorbency
All specification sheets shall contain the company name and be titled, dated, numbered, and include the latest revision level.
5.6. Fees:
5.6.1. Applicants for testing, evaluation, and acceptance of non-asbestos packing material manufactured for use in underground mines may submit with their applications a preauthorization notice. The preauthorization notice is a statement by the applicant authorizing MSHA to expend a stated amount of money in evaluating/testing the applicant"s material prior to the preparation and issuance of the MSHA fee estimate. This notice permits immediate evaluation work to begin.
5.6.2. In the interim, the A&CC will provide an estimate of the total anticipated charges and continue with processing or cancel the action depending upon the applicant"s response to the estimate letter. If the applicant chooses to cancel, fees will be charged for work performed up to the cancellation. If total charges are less than the preauthorization amount, the lesser amount will be charged.
5.7. Conditions of Acceptance:
5.7.1. Upon request by MSHA, but no more than once a year except for cause, the manufacturer shall supply to MSHA at no cost, up to thirty-five feet of each diameter of accepted non-asbestos packing material.
5.7.2. Non-asbestos packing material covered under this standard may be advertised as "Accepted by MSHA," but such terms as "recommended," "sanctioned," "approved," or "certified" by MSHA shall not be used.
5.7.3. All material formulations and test results or any other information that is designated as proprietary and/or confidential shall be regarded as such. The manufacturer"s name, address, phone number, product name, and acceptance number is not considered proprietary and/or confidential.
5.7.4. An MSHA-accepted non-asbestos packing material shall be legibly and permanently marked with the assigned MSHA acceptance number on all shipping spools or containers.
5.7.5. An MSHA-accepted non-asbestos packing material shall be marketed only under the name and identification nomenclature that has been furnished to and accepted by MSHA.
5.7.6. MSHA reserves the right to rescind for cause, an acceptance, and requite its removal from underground mines.
5.8. Discrepancies/Cancellation:
Discrepancies/cancellations will be conducted in accordance with the APOL1009.

    ASAP5010.doc                                                       Print Date: 9/15/2005
PRINTED AND ELECTRONIC COPIES OF THIS DOCUMENT ARE
UNCONTROLLED. VERIFY CORRECT VERSION PRIOR TO USE. TSAP0001, Rev 01

Attachment No.1
NON-ASBESTOS PACKING MATERIAL APPLICATION FORM
Chief, Approval and Certification Center Date: ________
RR #1, Box 251
Industrial Park Road
Triadelphia, West Virginia 26059
APPLICANT NAME AND ADDRESS
__________________________
__________________________
__________________________
__________________________
COMPANY APPLICATION CODE NUMBER: __________________
Subject: Test and evaluation of non-asbestos packing material
designated as ______________________, ________________________
(Trade Name) (Type/Style)
Manufactured by: ____________________________________________
These diameters are being submitted (check block): 3/16 _____, 1/4 _____, 3/8 _____,
½ _____, Round _____, Square _____.
Enclosed is 35 feet of each size. Also, included are all applicable drawings and specifications that will identify the size, construction, and material of the subject packing.
You may contact ____________________ at ______________________
(Company Representative) (Telephone Number)
for further information.

Attachment No.2
U.S. DEPARTMENT OF LABOR
Mine Safety and Health Administration
Approval and Certification Center
Quality Assurance and Materials Testing Division
TOXICITY AND QUALITY ASSURANCE STATEMENT
I ______________________ certify, as a representative
(print or type name)
of ______________________, that the non-asbestos packing
(company name)
material identified as _____________________, in its final form
(Trade Name/Type)
presents no known toxic hazard under normal use conditions.
Furthermore, I certify that we will assure product compliance for this material, with respect to all specifications submitted to the Mine Safety and Health Administration, Approval and Certification Center.
Company Application Code Number ________________________________
(same as on the application form)
Signed: _______________________________ Date: _______________
(Authorized Representative)