South Coast Air Quality Management District 

21865 Copley Drive 

Diamond Bar, CA 91765 

909.396.2000 

Rule 1415 

Registration Form

FACILITY INFORMATION AQMD ID # OR New Business

FACILITY 

NAME 

LOCATION 

ADDRESS 

CITY 

 STATE 

CA

ZIP 

CODE CONTACT PHONE 

CONTACT 

PERSON TITLE OF CONTACT PERSON 

TYPE OF 

BUSINESS BUSINESS TYPE CODE (SEE 

INSTRUCTIONS) 

ANNUAL 

ENERGY USE 2008 kWh/year 2009 kWh/year

FACILITY 

AREA square feet 

FOR THIS PROJECT, HAS A CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) DOCUMENT 

BEEN REQUIRED BY ANOTHER GOVERNMENT AGENCY? YES NO 

IF YES, ENTER NAME OF AGENCY: 

DO YOU CLAIM CONFIDENTIALITY OF DATA? 

 YES NO 

EQUIPMENT INFORMATION 

FOR EACH REFRIGERATION SYSTEM AT THE ABOVE FACILITY LOCATION THAT HOLDS

>50 LBS. OF CFC (CHLOROFLUOROCARBON) OR HCFC (HYDROCHLOROFLUOROCARBON) REFRIGERANT. 

PLEASE PROVIDE THE FOLLOWING INFORMATION: 

ANNUAL ADDITIONAL 

REFRIGERANT (lbs.) 

UNIT 

>50 

lbs. 

F/R/A 

TYPE MANUFACTURER MODEL 

YEAR SERIAL NUMBER 

REFRIGERANT 

TYPE 

STORAGE CAPACITY

(lbs. of refrigerant)

DATE OF LAST 

AUDIT/ 

MAINTENANCE 

USAGE YEAR

(2008) 

USAGE YEAR

(2009) 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

So that your account can be credited properly, please mail the completed form(s), along with a check for $114.66 to cover the Rule 1415 

Registration Plan fee for your facility, to the following address: 

Area Sources 

South Coast Air Quality Management District 

21865 Copley Drive 

Diamond Bar, CA 91765 

If there are more than 8 units please attach an additional form.

COMPANY INFORMATION

COMPANY 

NAME CONTACT PERSON 

MAILING 

ADDRESS CITY 

 STATE  ZIP 

CODE 

CONTACT 

PHONE E-MAIL

 FAX 

SIGNATURE DATE 

 

AQMD USE 

APPLICATION NO. DATE CHECK NO. AMOUNT 

$

ASSIGNMENT 

UNIT 

NUMBER 

OF 

FACILITIES 

EQUIP. CAT. NO. 

____ ____ ____ ____ ____ ____ 

ENGINEER 

A R DATE INITIAL 

Registration Form 1415; Rev 07/10 

 
Rule 1415 REGISTRATION FORM 

INSTRUCTIONS 

FACILITY INFORMATION 

FACILITY NAME 

For identification purposes, please enter the name of the 

facility which owns/operates the subject refrigeration 

equipment.

AQMD ID# OR New Business. 

This information is used for identification purposes. 

Please enter the AQMD company identification number. If 

you are a new business check that box and we will create 

an AQMD ID for your business.

LOCATION ADDRESS 

Please identify the address where the equipment or facility 

is located. If no street address is available, please provide 

a location description and zip code.

CONTACT PERSON, TITLE, AND PHONE NUMBER 

Please identify the name, title and phone number of the 

person who would be contacted at the equipment location.

TYPE OF BUSINESS 

This information is used by the AQMD for planning and 

statistical purposes. Please state the type of business you 

conduct in this facility (e.g. hotel, retail store, etc.). 

BUSINESS TYPE CODE 

This information is used by the AQMD for planning and 

statistical purposes. Referring to the provided list of 

business codes, please enter the code which best 

describes your business activity at this facility.

FACILITY AREA AND ANNUAL ENERGY USE 

Indicate the approximate square footage of the facility’s 

indoor area, and the total energy used over the course of 

the calendar year in kilowatt-hours (kWh/year). The 

energy use can be taken from utility bills or other 

available documentation. 

CALIFORNIA ENVIRONMENTAL QUALITY ACT 

A California Environmental Quality Act (CEQA) document 

(e.g., environmental impact report, negative declaration) 

is required for any project which results in significant 

effect on the environment. If such a document has been 

required by another governmental agency, please enter 

the name of that agency. A copy of this document is also 

required before the registration can be deemed complete. 

Therefore, please submit a copy of the approved 

document. In most cases the answer to this question is 

“no.”

CONFIDENTIALITY 

District records are subject to the California Public Records 

Act. To claim confidentiality of information submitted with 

this registration, check "yes." Please be sure that all 

submitted information that you wish to be kept 

confidential is clearly marked as such. Please also state 

the reason(s) for claiming confidentiality. Examples of 

acceptable reasons are trade secrets and production data. 

Please note that state law prevents emissions data and 

permit documents from being kept secret.

+EQUIPMENT INFORMATION 

F/R/A TYPE 

Please indicate whether the unit is a freezer (F), a refrigerator 

(R), or an air conditioner (A). 

MANUFACTURER 

Please identify the manufacturer of the unit.

MODEL YEAR 

Please identify the model year of the unit.

SERIAL NUMBER 

Please identify the serial number of the unit.

REFRIGERATION TYPE 

Please indicate the type of chlorofluorocarbon (CFC) or hydrochlorofluorocarbon (HCFC) used as refrigerant in each system. 

STORAGE CAPACITY 

Enter the total refrigerant storage capacity of each unit.

DATE OF LAST AUDIT/MAINTENANCE 

In accordance with Rule 1415 (d)(2), an annual audit/ 

maintenance inspection is required for all refrigeration systems 

subject to this rule. Indicate the last date the appropriate 

audit/inspection was conducted.

ANNUAL ADDITIONAL REFRIGERATION 

Usage Year 2008 

Indicate the total quantity of refrigerant (in pounds) that was 

added to each system during the 2008 calendar year. 

Usage Year 2009 

Indicate the total quantity of refrigerant (in pounds) that to date 

has been added to each system for the 2009 calendar year.

COMPANY INFORMATION

COMPANY NAME

For identification purposes, please enter the name of the entity 

responsible for the submittal of the registration, typically the 

owner/operator of the equipment. The information in this section 

of the registration form will be used for all future correspondence, 

including information about subsequent registrations. In the 

event that the registration form is prepared and submitted by a 

party other than the equipment owner/operator, it is important 

that the AQMD be notified of any changes to this information. 

CONTACT PERSON, MAILING ADDRESS, PHONE, E-MAIL, 

FAX 

Please identify the person’s name that is responsible for the 

completion and submittal of the Rule 1415 Registration Form, 

include the appropriate mailing address information, telephone 

number, E-mail and fax number. 

QUESTIONS? 

If you have questions regarding this registration form or Rule 

1415, please contact Heather Farr at (909) 396-3672 or Rizaldy 

Calungcagin at (909) 396-2315. They may be reached by E-mail 

at hfarr@aqmd.gov or rcalungcagin@aqmd.gov.

DID YOU REMEMBER? 

1. To provide all requested information (business type code, last audit/maintenance and refrigerant added) 

2. To sign and date the registration form? 

3. To include the required filing fee with your hardcopy registration submittal?

4. To e-mail the registration form to R1415Reg@aqmd.gov

Rev. 07/10