MDA Webforms | Technical-Registration-Form

Applicant Information

Prefix

Last Name *

First Name *

Middle Initial

Suffix

Company Employed By*

Company's E-mail

Address 1*

Address 2

City*

State *

Zip Code *

Ext. -

Primary Phone*

* x

Phone Type * Ext.

Alternate Phone 1

* x

Phone Type * Ext.

Alternate Phone 2

* x

Phone Type * Ext.

Alternate Phone 3

* x

Phone Type * Ext.

Technician E-mail Address*

Confirm E-mail Address

Registration areas selection

Validate Registration Area check at least one type of registration area

Scales

Class I and II scales

Retail Computing Scales

Small Capacity Scales <= 300 lb

Medium Capacity Scales <= 3,000 lb

All Capacity Scales

Railroad Track Scales

Fuel Devices

Retail Fuel Dispensers (gpm < 20 gal)

Retail Fuel Dispensers High Flow (gpm > 20 gal)

Bulk Delivery Fuel Meters (gpm >= 50 gal)

Mass Flow Meters

Other Devices

Grain moisture meters

Electric Vehicle Charging Devices

Taxi Meters

Other

Required Materials for Registration

Fuel Dispensers Bulk

Certificate of Calibration
Most Current NIST HB 44 Available
NFPA 30, 30A, NEC70 all 1996 editions available
If you are registering to replace remove, or install motor fuel dispensers that involve any disconnection below the shear valve, see “AST Financial Responsibility Registration" Financial Responsibility Form

Mass Flow Meters

Certificate of Calibration
Most Current NIST HB 44 Available
NFPA 30, 30A, NEC70 all 1996 editions available

LPG Meters

Certificate of Calibration
Most Current NIST HB 44 Available
NFPA 30, 30A, NEC70 all 1996 editions available

Scales

Certificate of Calibration
Most Current NIST HB 44 Available

Grain Moisture Meters

Certificate of Calibration (Moisture Meters)
Most Current NIST HB 44 Available
Constants Updated (May and/or August)

Electric Vehicle Charging Devices

Please upload proof of current equipment calibration and/or certification in compliance with RSMO chapter 413 & 414*

Upload Name
JPEG , JPG , PDF

Upload Calibration Certificates is required.

Company Security Seal Type*

Company Security Seal ID*

I have read this list and have the required materials readily available. * required

State Statutes

Contact Information

Device and Commodity Program (573) 751-5639

Petroleum Program (573) 751-5635

Metrology/Moisture Meter Program: (573) 751-3105

Fax: (753) 751-0281

Signature

I certify this information is correct

Legal Name*

Date 04/26/2024

Serviceman Registration Application for Installation and Service of Weighing and Measuring Devices