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Standards Division

Notification of Breaking North Carolina Seal on Propane Meter

Complete the form below and click on the SUBMIT button to transmit a report to this office to meet the requirement for notification of breaking an official seal.

All fields must be completed with significant information. Failure to provide significant information in every field invalidates submission.

Name of company operating meter:

Email Address of (Limited) Petroleum Device Technician:

Location (city and state) of operating company:

Date of seal break (mm/dd/yy):

Date of resealing (mm/dd/yy):

Truck number:

Cargo tank serial number:

Brief description of work done (Such as stuck ticket removed, measuring chamber replaced, as appropriate):

The calibration of the meter ( was) ( was not) affected.
(select one)

The gear shifter settings are identical for replacement registers. ( Yes) ( No) (For Neptune mechanical registers only.) NEW QUESTION

The meter ( was) ( was not) put back into use or released to be put back in use. (select one)

Name of (Limited) Petroleum Device Technician:

Technician's company:

Telephone number:

(Limited) Petroleum Device Technician license number:

Note: Submitting your number on this form will officially identify you as someone authorized to break a seal and reseal a meter. Protect your number from unauthorized users.

IMPORTANT: Print this form and place a copy of this notification in the truck or in the office (for dispensers).

Last updated August 11, 2004


NCDA&CS Standards Division, Stephen Benjamin, Director
Mailing Address:1050 Mail Service Center Raleigh, NC 27699-1050
Physical Address: 2 West Edenton Street, Raleigh, NC 27601
Phone: (919) 707-3225; FAX: (919) 715-0524

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