(H.A.C.) Company Name Project Sponsor Is a modification of H.A.C. Assessment and/or Yes No If answer in column A is please “Yes”, drawings required? Please answer the following: submit the following: 1. Is new process equipment to be installed? (e.g. Submit Form BHAC20 to Bath PSM pumps/compressors, hydrocarbon pressure vessels, vents to atmosphere, pig launcher, and filter pots.)Note: If equipment is replacement in kind, please note on BHAC20. 2. Is new/modified instrumentation to be installed? No Hazardous Area Classification re-evaluation Needed. Please submit BHAC10 Is new/modified piping to be installed and will be No Hazardous Area Classification Re-evaluation part of functional Leak Detection and Repair Needed. Please submit BHAC10 (LDAR) program? Is only new/modified piping to be installed and will Submit Form BHAC20 to Bath PSM not be part of functional LDAR program? 5. Is existing process equipment relocated or Submit Form BHAC20 to Bath PSM removed? (i.e. Is the plot plan changing?) 6. Is Out of Service process equipment going to be put Submit Form BHAC20 to Bath PSM back into normal operation? Is there a change? 7. process Submit Form BHAC20 to Bath PSM (e.g. changes in chemistry, flow, pressure, temperature, new area chemicals or new process equipment, new/modified vents to atmosphere) 8. Are analyzer rooms or buildings containing piped Submit Form BHAC20 to Bath PSM process streams of flammable liquid, vapor, or flammable gas being modified or added? Are being modified or added? 9. battery rooms Submit Form BHAC20 to Bath PSM 10. Is a building containing only electrical equipment Submit Form BHAC20 to Bath PSM being modified or added? Note: Once form is complete, please sign and submit form to psm@bathgroup.com Approved by: Project Name Project Manager For Requested By Date Project For Number Date Best Contact Number & Process Unit # & Best Contact Email HAC Drawings Impacted
(H.A.C.) Company Name Project Sponsor Project Name Project Manager Requested By Project Number Best Contact Number & Best Contact Email Process Unit # & HAC Drawings Impacted Is a modification of H.A.C. Assessment and/or drawings required? Please answer the following: Yes No If answer in column A is “Yes”, please submit the following: 1. Is new process equipment to be installed? (e.g. pumps/compressors, hydrocarbon pressure vessels, vents to atmosphere, pig launcher, and filter pots.)Note: If equipment is replacement in kind, please note on BHAC20. Submit Form BHAC20 to Bath PSM 2. Is new/modified instrumentation to be installed? No Hazardous Area Classification re-evaluation Needed. Please submit BHAC10 Is new/modified piping to be installed and will be part of functional Leak Detection and Repair (LDAR) program? No Hazardous Area Classification Re-evaluation Needed. Please submit BHAC10 Is only new/modified piping to be installed and will not be part of functional LDAR program? Submit Form BHAC20 to Bath PSM 5. Is existing process equipment relocated or removed? (i.e. Is the plot plan changing?) Submit Form BHAC20 to Bath PSM 6. Is Out of Service process equipment going to be put back into normal operation? Submit Form BHAC20 to Bath PSM 7. Is there a process change? (e.g. changes in chemistry, flow, pressure, temperature, new area chemicals or new process equipment, new/modified vents to atmosphere) Submit Form BHAC20 to Bath PSM 8. Are analyzer rooms or buildings containing piped process streams of flammable liquid, vapor, or flammable gas being modified or added? Submit Form BHAC20 to Bath PSM 9. Are battery rooms being modified or added? Submit Form BHAC20 to Bath PSM 10. Is a building containing only electrical equipment being modified or added? Submit Form BHAC20 to Bath PSM Note: Once form is complete, please sign and submit form to psm@bathgroup.com Approved by: For Date For Date
Bath_Form_BHAC10_10-30-15_rev_7.docx