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- c o n d i t i o n i n g e q u i p m e n t to c ert i f y

th a t t h e y h a v e a c q u i r ed re c o v e r y or r e c y c l i ng d e vi c es t h a t m e e t E P A s t a n d ards f or s u c h d e v i c e s

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E P A Regi o nal Off ic e

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P A RT 1: ES T A B L I S H M E NT INF O R M A T I O N

Na m e o f Est a b lis h me n t S t re e t

( A r e a C o d e ) T e l e p h o n e N u mb e r Ci t y S t a te Z ip C o d e

Nu m be r o f S e r vice E qu ip m en t B a s e d a t E st a b lis h me n t Co u n t r y

P A RT 2: REGU L A

T O RY C L A S S IF I C A

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P A RT 3: D E V I C E I D E N T IFI C A T I O N

P A RT 4: CER T IFI C A

T I O N S I G N A

T U R E

I c e r ti f y t h a t t h e e s t ab lis h m en t i n P a r t 1 h a s a c qu i r e d t h e re f r i g er a n t re c o v er y o r re c y cl i n g d e vic e ( s) li s t e d in P ar t 2

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, a n d t e l e p h o n e n u m b e r of t h e e s ta bl i s h m e n t w h ere t h e

r e f r i g e r a n t re c o v e r y or r e c y c li ng d e vi c e( s ) i s (are) l o c a t e d

. P l e a s e co m p l ete o n e f orm f or ea c h l o c a t i o n

. S ta t e t h e n u m b e r of v e h i cl e s b a s ed a t t h i s l o c a t i o n t h at are used to t r a n s p o r t t e c h n i c i a n s a n d e q u i p m e n t

to a n d fr om s er vi c e s i t e s

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e m p l o y e e s of t h e e s t a b l i s h m e n t. T he t e r m “ s m a l l a p p l i a n c e” r e f ers to an y of t h e f o l l o w i ng products t at are

f u l l y m a n u f a c tured, c h arg e d, a n d h er m et i c a l l y se a l ed i n a f a c to r y w i th f iv e p o u n ds or l e s s of re f r i g e r a n t:

r e f r i g e r at o rs

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c o n d i t i o n e r s a n d p a c k a g ed ter m i n a l a i r c o n d i t i o n er s )

, p a c k a g ed t e r m i n a l h e a t p u m p s

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P a r t 3: For ea c h re c o v e r y or r e c y c l i ng d e vi c e a c q u i r e d, p l e a s e li s t the n a m e o f t h e m a n u f a c turer

of t h e d e v i c e, a nd ( i f a p p l i c a b l e) i ts m o d el n u m b e r a n d s eri a l n u m b e r

.

If m ore th a t s e v en d e vi c es h a v e b e e n a c q u i r e d

, p l e a s e f il l o u t an a d d i t i o n al f orm a n d at t a c h i t t o

th i s o n e

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c h e c k i ng t h e b ox i n t h e l a s t c o l u m n o n t h e r i g ht. S e l f

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r e c o v e r y or r e c y c li n g e q u i p m e n t t h at i s c a p a b l e o f re m o v i ng the re f r i g erant fr om an a p p l i a n c e w i t h o u t t h e

a ss i s ta n c e o f c o m p o n e nts c o n ta i n e d i n t h e a p p l i a n c e

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i n a n a p p l i a n c e t o r e m o v e t he re f r i g e r a nt f r om t h e a p p l i a n c e.

If t h e e s ta b li s h m e n t h as b e en l i s ted as T y pe B a n d /or T y pe D i n P art 2, th e n t h e f i rs t d e v i c e l i s ted

i n P art # m u s t b e a s e l f

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the r i g h t.

If a n y of t h e d ev i c es are ho m e m a d e, th e y s h o u l d b e i d e n t i f i e d b y w r i t i ng “h o m e m a d e ” i n t h e

c o l u m n p r o v i d e d f or li s t i ng t he n a m e o f t h e d e vi c e m a n u f a c ture r

. T y p e A or T y pe B est a b l i s h m e n ts c an

u s e h o m e m a d e d e v i c es m a n u f a c tured b e f ore N o v e m b e r 1 5

, 1 9 9 3. T y pe C or T y p e D e s t a b l i s h m e n ts c an

u s e h o m e m a d e m a n u f a c tured a n y t i m e. I f

, h o w e v er, a T y pe C or T y p e D e s t a b l i s h m e n t i s us i ng

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Reg i on V II; M a i l Co d e A P C O A W MD; 9 01

11201 Renner Boulevard

Lenexa, Kansas 66219

De l a ware, D i s tr i c t o f C o l u m b i a, M a r y l a n d,

P e n n s y lv a n i a, Vi r g i n i a, W e s t Vi r g i n i a

C A A 6 0 8 E n f or c e m e n t Co n tact: E P A

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C A A 6 0 8 E n f or c e m e n t Co n tact: E P A

Reg i on I X ; M a i l C o d e A IR

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O M B N o

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T he p u r p o s e a nd n e e d o f t h i s re n e wed c o l l e c t i on r e q u e s t i s to f a ci li t ate c o m p li a n c e w i t h a nd

e n f or c e m e n t o f S e c t i on 6 0 8 of t h e A c t b y r e d u c i ng e m i ss i o n s of c l a s s I a nd c l a s s I I o z o n e

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r e f r i g e r a n ts to t he l o we s t ac h i e v a b l e l e v e l d uri n g t h e ser vi c e, m a i nt e n a n c e, r e p ai r

, a nd d i s p o s al of

a p p li a n c e s

. E P A h as used a n d w i l l c o n t i n ue t o u s e t h e s e re c ords a n d r e p orts to e n s ure th a t re f r i g e r a n t

r e l e a s es are m i n i m iz ed d ur i ng t h e re c o v e r y a n d re c y cli ng of o z o n e

- d e p l e t i n g re f r i g erants d u r i ng t h e

s er vi c e, m a i nt e n a n c e

, re p a ir

, a nd d i s p o s al of a p p l i a n c e s

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, i n a cc or d a n c e w i th 40 CFR 8 2

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of t h e Fe d eral g o v ern m e n t. E P A 's c o n f i d e n t i a l i t y re g u l at i o n s (40 C F R 2. 2 01 et s e q.) a ss ure c o m p u ter

d a ta s e c u r i t y

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, a n d pro p er d i s p o s a l of t h e

s u b m i tt e d i n f or m at i o n

.

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a v er a ge o n e (1) h o ur per r e s p o n s e p er r e s p o n d e n t a nn u a ll y

. B urd e n m e a ns t h e t o tal t i m e, e ff ort, or

f i n a n c i a l re s o u rc es ex p e n d ed b y p er s o n s to g e n erate, m a i nt ai n, r e ta i n, or d i sc l o s e or pr o vi d e i n f o r m at i on

to or f or a Fe d eral a g e n c y

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, a c q ui r e, i n s ta l l

,

a n d ut i l i z e tech n o l o g y a n d s y s t e m s f or the p u r p o s es o f c o ll e c t i n g, v a l i d at i n g

, a n d v eri f y i ng i n f or m at i o n

, pro c e ss i ng a n d m a i n t a i n i n g i n f or m at i o n

, a n d d i sc l o si ng a n d pro v i d i n g i n f o r m at i o n ; a d j u s t t h e ex i s t i ng

w a y s t o co m p l y w i th a n y p r e v i o u s l y a p p li c a b l e i n s tru c t i o n s a n d re q u i r e m e n t s ; tra i n p e rs o n n el t o b e a b l e to

r e s p o nd t o a c o l l e c t i on of i nf o r m at i o n ; s e a rc h d ata s o ur c e s ; c o m p l ete a n d re v i e w t he c o l l e c t i on of

i n f or m at i o n ; a n d t r a n s m i t o r o t h e r w i s e d i sc l o s e t he i n fo r m at i o n

. A n a g e n c y m a y n ot c o n d u c t o r s p o n s or,

a n d a p er so n i s n ot r e q u i r e d t o re s p o n d to, a co l l e c t i on of i n f o r m at i on u n l e s s i t d i s p l a y s a c ur r e n t l y v a l i d

O MB c o n trol n u m b e r

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, the ac c ura c y of t h e pro v i de d b ur d en

e s t i m at e s

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c o ll e c t i on t e c h n i q u e s

, E P A h a s esta b li s h ed a p u b l i c d o c k et f or th i s ICR u n d er D o c k et ID No. O A R

- 2 0 0 3

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E P A Do c k et Cen t er (E PA / DC )

, E P A W e s t, R o om B 1 0 2, 1 3 01 C o n s t i tu t i on A v e., N W

, W a s h i n g to n , DC.

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. m

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. m

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i s ava i l a b l e thro u gh E P A D o c k ets ( E D O C KE T ) at h t tp : //www. e p a

. g o v /e d o c k et. U s e E D O C KE T to s u b m i t

or v i e w p u b li c c o m m e n t s

, a cc e s s t h e i n d ex l i s t i n g o f t h e co n t e nts of t h e p u b li c d o ck et, a n d t o a cc e s s

th o s e d o c u m e n ts i n t h e p u b li c d o c k et th a t a r e a v a il a b l e e l e c tro n i c a ll y

. On c e i n t h e s y s t e m

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“s e a rc h,” th e n k e y i n t he d o c k et ID n u m b e r i d e nt i f i e d a b o v e. Al s o, y o u c a n se n d c o m m e n ts to t h e O f f i c e

of I n f o r m at i on a n d R e g u l a t o r y A ff a i rs

, O ff i c e o f M a n a g e m e n t a nd B u d g e t, 7 2 5 1 7 t h S tr e et, N W

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. P l e a s e i n cl u d e t h e E P A Do c k et ID No. ( O A R

2003

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- 0 2 5 6 ) i n a n y c or r e s p o n d e n c e.

E P A FO R M 761 0

- 3 1 

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