FCA Certification Application

Please complete one form per item or item family.

Fireworks Certification Agency
Application

1 |Item Name/Part number

The item name and part number needs to be consistent throughout the application and supporting documentation.

2 |This is a Series application (y/n): Yes No

3 |Applicant Information

Name: / Title:
Company Name: / Email:
Phone: / Fax:
Address:
City: / State/Prov: / Zip Code:

4 |Foreign Applicant

A foreign Applicant must provide a designated U.S. agent of service (name of contact person, email address, and phone number required).

Name: / Affiliation:
U.S. Responsible Party: / Email:
Phone: / Fax:
Address:
City: / State: / Zip Code:

5 |Manufacturer of Firework Information

Name: / Title:
Company Name: / Email:
Phone: / Fax:
Address:
City: / State/Prov: / Zip Code:

6 |Description of Device

Fill out the information below. If the question does not apply to your item, please check the N/A box.

Number of Tubes: / N/A / Measurements of Device:
Tube Separation (over 200 g device): / N/A
Maximum Powder Weight per Tube (g): / N/A
For Mine/Shell Devices: Max. Propellant/Tube (g): / N/A
For Mine/Shell Devices: Max. Effect/Tube (including burst): / N/A
Total Powder Weight of Fuse in Device (g): / N/A
Total Powder Weight in Device (g): / N/A
Are Tubes Fused in Sequence (if UN0336 multiple-tube item) / Yes No
Does Item have a Report? If yes, fill out below / Yes No
Number of Tubes: / Number of Reports per Tube:
Maximum Weight per Individual Report (mg):
Total Weight of Report Powder in Item (g):

Briefly describe the effect your item produces.

Effects Produced (e.g., Shoots Red Star in Air):

7 |Category of Device (under APA 87-1)

Contact APT for definitions on the types of consumer fireworks listed below or reference APA 87-1

Ground and Hand-Held Sparkling Devices (“Sparklers”): / Cylindrical Fountain
Cone Fountain
Illuminating Torch
Wheel
Ground Spinner
Fitted Sparkler
Toy Smoke Device
Wire Sparkler/Dipped Stick
Aerial Devices: / Sky Rockets and Bottle Rockets
Missile-Type Rocket
Helicopter, Aerial Spinner
Roman Candle
Mine and Shell Devices
Aerial Shell Kit, Reloadable Tube
Audible Ground Devices: / Firecracker
Chaser
Novelties / Party Popper
Snapper
Toy Smoke Devices
Snakes, Glow Worms
Wire Sparklers, Dipped Sticks
Other:

8 |For Reloadable Shell Kits

(Note: Reloadable shell kits are limited to 400 grams of pyrotechnic composition and must be packaged in a ratio not to exceed 12 shells to 1 tube). If your item does not have reloadable shell kits check N/A.

Maximum number of shells per kit:
Maximum weight of pyrotechnic composition per shell: / grams
Maximum total weight of pyrotechnic composition per kit: / grams
Each kit contains at least one launching tube: / Yes No

9 |Diagram/Drawing of the Device

Attach diagram/drawing and photograph of the device as a separate file. Must identify all internal components. Indicate dimensions, fuse location, clay plugs, lift charge or propellant, stars, etc. Certifications will not be processed if diagrams are not clear. Component tables are helpful. For the photograph, include a scaled reference (ruler, or other object of a known size).

Note: Diagram must be representative drawing of the complete device including, as necessary, drawings of the individual tubes. If device is produced in more than one size, indicate dimensions for each size. If application covers a series of devices, show a typical representative diagram for the largest item in the series.

10 |Chemical Composition

  • Must list all chemicals used. For a series of items, list maximum total weight used in largest item.
  • List name of each type of chemical composition and its respective maximum weight, i.e., black powder propellant, 10g; Potassium Nitrate, 8g; etc.
  • Particle size in microns or mesh size is required for Aluminum, Magnalium, and Titanium metals.
  • Be aware of restricted and prohibited chemicals.

Chemical Composition List for (item name):
Total Weight (g) of Pyrotechnic Composition in item:
Effect and total weight for each composition (e.g., red star – 21 g; propellant – 18 g):
1. / g / 3. / g / 5. / g
2. / g / 4. / g / 6. / g
Chemicals / Acronym / % Weight
1 / 2 / 3 / 4 / 5 / 6

11 |Thermal Stability Test Results

A Thermal Stability Test of this Device was Performed on:
Date (dd/mm/yyyy): / Name of Tester:
Job Title: / Company:

The test was performed on: finished item component chemical mixtures, as present together in the device. The device did not ignite, explode, or undergo any significant decomposition during heating at 75º C (167º F) for 48 hours.

12 |Certification

This is to certify that the device for which certification is requested conforms to APA Standard 87-1 and that the description and technical information contained in this application are complete and accurate.

Date: / 10/6/2018
Signature of Applicant Named Above:
Typed Name of Applicant, in English

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