SEWS 9.1.2 (1 of 4) Sheet 1 of \_\_\_\_\_\_

+------------------------------------+----------------+----------------+
| **SCREENING EVALUATION WORK SHEET  |                |                |
| (SEWS)**                           |                |                |
+------------------------------------+----------------+----------------+
| **Equipment ID No.:**              | **Equipment    |                |
|                                    | Class:         |                |
|                                    | Horizontal     |                |
|                                    | Tanks and**    |                |
|                                    |                |                |
|                                    | **Heat         |                |
|                                    | Exchangers**   |                |
+------------------------------------+----------------+----------------+
| Equipment description:             |                |                |
+------------------------------------+----------------+----------------+
| Equipment Location: Bldg.          | Floor El.      | Room, Row/Col. |
+------------------------------------+----------------+----------------+
| Manufacturer, model, etc.:         |                |                |
+------------------------------------+----------------+----------------+
| Approximate weight:                |                |                |
+------------------------------------+----------------+----------------+
| Drawing No.:                       | Performance    |                |
|                                    | Category:      |                |
+------------------------------------+----------------+----------------+
| ***Functionality Requirement***    |                |                |
+------------------------------------+----------------+----------------+
| q Contact Lead Relay Reviewer to   |                |                |
| determine if item contains         |                |                |
| Essential Relays                   |                |                |
|                                    |                |                |
| q For components whose function or |                |                |
| structural integrity is required,  |                |                |
| complete all sections of this      |                |                |
| form.                              |                |                |
|                                    |                |                |
| q For all other components, only   |                |                |
| anchorage evaluation is required.  |                |                |
+------------------------------------+----------------+----------------+
| ***Caveats (Section 9.1.2)***      |                |                |
+------------------------------------+----------------+----------------+
| (Identify with an asterisk (\*)    |                |                |
| those steps which are met by       |                |                |
| intent without meeting the         |                |                |
| specific wording of the step and   |                |                |
| explain the reason for this        |                |                |
| conclusion in the COMMENTS section |                |                |
| below)                             |                |                |
|                                    |                |                |
| Step 1 Parameters and values       |                |                |
| within range of applicable         |                |                |
| parameters Y N U N/A               |                |                |
|                                    |                |                |
| Step 2 Anchor bolt tension and     |                |                |
| shear load allowables determined Y |                |                |
| N U N/A                            |                |                |
|                                    |                |                |
| Step 3 Base plate bending strength |                |                |
| reduction factor (RB) determined Y |                |                |
| N U N/A                            |                |                |
|                                    |                |                |
| Step 4 Base plate weld strength    |                |                |
| reduction factor (RW) determined Y |                |                |
| N U N/A                            |                |                |
|                                    |                |                |
| Step 5 Anchorage tension allowable |                |                |
| determined using strength\         |                |                |
| reduction factors Y N U N/A        |                |                |
|                                    |                |                |
| Step 6 Ratios and values           |                |                |
| calculated Y N U N/A               |                |                |
|                                    |                |                |
| Step 7 Acceleration capacity of    |                |                |
| tank anchorage determined Y N U    |                |                |
| N/A                                |                |                |
|                                    |                |                |
| Step 8 Flexibility of tank in      |                |                |
| transverse and vertical directions |                |                |
| determined Y N U N/A               |                |                |
|                                    |                |                |
| Step 9 Flexibility of tank in      |                |                |
| longitudinal direction determined  |                |                |
| Y N U N/A                          |                |                |
|                                    |                |                |
| Step 10 Capacity acceleration      |                |                |
| exceeds seismic demand             |                |                |
| acceleration Y N U N/A             |                |                |
|                                    |                |                |
| Step 11 Saddle stresses checked Y  |                |                |
| N U N/A                            |                |                |
+------------------------------------+----------------+----------------+

SEWS 9.1.2 (2 of 4) Sheet 2 of \_\_\_\_\_\_

+------------------------------------+---------------------------------+
| **SCREENING EVALUATION WORK SHEET  |                                 |
| (SEWS) (Cont.)**                   |                                 |
+------------------------------------+---------------------------------+
| **Equipment ID No.:**              | **Equipment Class: Horizontal   |
|                                    | Tanks and**                     |
|                                    |                                 |
|                                    | **Heat Exchangers**             |
+------------------------------------+---------------------------------+
| Equipment description:             |                                 |
+------------------------------------+---------------------------------+
| ***Anchorage (Chapter 6)***        |                                 |
+------------------------------------+---------------------------------+
| 1\. Type of anchorage:             |                                 |
|                                    |                                 |
| q expansion anchor                 |                                 |
|                                    |                                 |
| q cast-in-place bolt or headed     |                                 |
| stud anchor                        |                                 |
|                                    |                                 |
| q cast-in-place J-bolt             |                                 |
|                                    |                                 |
| q grouted-in-place bolt            |                                 |
|                                    |                                 |
| q welds to embedded steel on       |                                 |
| exposed steel                      |                                 |
|                                    |                                 |
| q lead cinch anchors               |                                 |
|                                    |                                 |
| q Other                            |                                 |
|                                    |                                 |
| q N/A (no further anchorage        |                                 |
| considerations)                    |                                 |
|                                    |                                 |
| 2\. Appropriate characteristics    |                                 |
| for anchorage type checked         |                                 |
|                                    |                                 |
| (size, location, equipment         |                                 |
| characteristics) Y N U             |                                 |
|                                    |                                 |
| 3\. Gap at threaded anchor less    |                                 |
| than 1/4 inch Y N U N/A            |                                 |
|                                    |                                 |
| 4\. Base stiffness and no          |                                 |
| significant prying action          |                                 |
| requirements met Y N U             |                                 |
|                                    |                                 |
| 5\. Equipment base strength and    |                                 |
| structural load path adequate Y N  |                                 |
| U                                  |                                 |
|                                    |                                 |
| 6\. Embedment steel and pads       |                                 |
| requirements met Y N U N/A         |                                 |
|                                    |                                 |
| 7\. Embedment length requirements  |                                 |
| met Y N U                          |                                 |
|                                    |                                 |
| 8\. Anchor spacing requirements    |                                 |
| met Y N U                          |                                 |
|                                    |                                 |
| 9\. Edge distance requirements met |                                 |
| Y N U                              |                                 |
|                                    |                                 |
| 10\. Concrete strength             |                                 |
| requirements met Y N U             |                                 |
|                                    |                                 |
| 11\. Concrete crack requirements   |                                 |
| met Y N U                          |                                 |
|                                    |                                 |
| 12\. Equipment with essential      |                                 |
| relays requirements met Y N U N/A  |                                 |
|                                    |                                 |
| 13\. Installation adequacy         |                                 |
| requirements met Y N U N/A         |                                 |
|                                    |                                 |
| 14\. No other concerns Y N U       |                                 |
|                                    |                                 |
| Does anchorage capacity exceed     |                                 |
| demand? Y N U                      |                                 |
|                                    |                                 |
| Reference:                         |                                 |
+------------------------------------+---------------------------------+
| ***Interaction Effects (Chapter    |                                 |
| 7)***                              |                                 |
+------------------------------------+---------------------------------+
| 1\. Soft targets free from impact  |                                 |
| by nearby equipment                |                                 |
|                                    |                                 |
| or structures Y N U N/A            |                                 |
|                                    |                                 |
| 2\. If equipment contains          |                                 |
| sensitive essential relays,        |                                 |
| equipment free                     |                                 |
|                                    |                                 |
| from all impact by nearby          |                                 |
| equipment or structures Y N U N/A  |                                 |
|                                    |                                 |
| 3\. Attached lines have adequate   |                                 |
| flexibility Y N U N/A              |                                 |
|                                    |                                 |
| 4\. No collapse of overhead        |                                 |
| equipment, distribution systems,\  |                                 |
| or masonry walls Y N N/A           |                                 |
|                                    |                                 |
| 5\. Equipment is free from         |                                 |
| credible and significant\          |                                 |
| seismic-induced flood and spray    |                                 |
| concerns Y N N/A                   |                                 |
+------------------------------------+---------------------------------+

SEWS 9.1.2 (3 of 4) Sheet 3 of \_\_\_\_\_\_

+------------------------------------+---------------------------------+
| **SCREENING EVALUATION WORK SHEET  |                                 |
| (SEWS) (Cont.)**                   |                                 |
+------------------------------------+---------------------------------+
| **Equipment ID No.:**              | **Equipment Class: Horizontal   |
|                                    | Tanks and**                     |
|                                    |                                 |
|                                    | **Heat Exchangers**             |
+------------------------------------+---------------------------------+
| Equipment description:             |                                 |
+------------------------------------+---------------------------------+
| ***Interaction Effects (Cont.)***  |                                 |
+------------------------------------+---------------------------------+
| 6\. No credible seismic-induced    |                                 |
| fire concerns Y N N/A              |                                 |
|                                    |                                 |
| 7\. No other "two over one"        |                                 |
| concerns as defined in             |                                 |
| DOE-STD-1021 Y N N/A               |                                 |
|                                    |                                 |
| 8\. No other concerns Y N U N/A    |                                 |
|                                    |                                 |
| Is equipment free of interaction   |                                 |
| effects? Y N U                     |                                 |
+------------------------------------+---------------------------------+
| ***Comments***                     |                                 |
+------------------------------------+---------------------------------+
|                                    |                                 |
+------------------------------------+---------------------------------+

SEWS 9.1.2 (4 of 4) Sheet 4 of \_\_\_\_\_\_

+------------------------------------+---------------------------------+
| **SCREENING EVALUATION WORK SHEET  |                                 |
| (SEWS) (Cont.)**                   |                                 |
+------------------------------------+---------------------------------+
| **Equipment ID No.:**              | **Equipment Class: Horizontal   |
|                                    | Tanks and**                     |
|                                    |                                 |
|                                    | **Heat Exchangers**             |
+------------------------------------+---------------------------------+
| Equipment description:             |                                 |
+------------------------------------+---------------------------------+
| ***Comments (Cont.)***             |                                 |
+------------------------------------+---------------------------------+
| Screening Walkdown(s):             |                                 |
|                                    |                                 |
| [Date]{.underline}                 |                                 |
| [Time]{.underline} [Team           |                                 |
| Members]{.underline}               |                                 |
+------------------------------------+---------------------------------+
| ***Recommend Resolution***         |                                 |
+------------------------------------+---------------------------------+
| q Maintenance action:              |                                 |
|                                    |                                 |
| q Further evaluation:              |                                 |
|                                    |                                 |
| q Retrofit design:                 |                                 |
|                                    |                                 |
| q Other:                           |                                 |
|                                    |                                 |
| q No further action required.      |                                 |
| Equipment is seismically adequate. |                                 |
+------------------------------------+---------------------------------+
| All aspects of the equipment\'s    |                                 |
| seismic adequacy have been         |                                 |
| addressed.                         |                                 |
|                                    |                                 |
| Evaluation by: Date:               |                                 |
|                                    |                                 |
| (All team members)                 |                                 |
+------------------------------------+---------------------------------+