Chiller ITB - Attachment F - DMS Refrigerant Activity Form - 6-16-23.pdf
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- Attached to
- ITB DMS-2223-124 Chiller Inspection Services
- Solicitation number
- ITB-05679
- Issued by
- Leon County, Florida
About this file
This document is a Refrigerant Activity Form for the State of Florida's Department of Management Services related to the ITB DMS-2223-124 Chiller Inspection Services contract opportunity. The form provides details on the specific chiller appliances, including the service ID, facility, work order, location, technicians, manufacturer, model, serial number, refrigerant type and charge. The form also captures information on the type of service performed, whether it was a seasonal variance, non-major maintenance, refrigerant conversion, leak isolation, or major maintenance. Details are provided on any refrigerant recovered, disposed, or added during the service.
The pricing and other contract terms are not included in this document. However, the related State and Local Contract Opportunity indicates this is an Invitation to Bid (ITB) for Chiller Inspection Services, issued by the State of Florida's Department of Management Services' Division of Real Estate Development and Management. The contract term and any renewal options are not specified.
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Text version
Refrigerant Activity Form
Service ID#: Facility:
Work Order: Location:
Date Issued: Completed: Appliance ID:
Contractor: Specific Location: f Model:
Technicians: Manufacturer: Serial#:
Signature: Refrigerant Type: Charge:
Reason for Dis"atch
Service Descri"tion
D Seasonal Variance D Non-Major Maintenance D Refrigerant Conversion D Leak Isolated D Major Maintenance From: To:
D Disposed Unit Recovery Unit:
If dispose• unit then complete the following boxes: Vacuum Level:
Refrigerant Recovered n Unit Tagged - "Refrigerant Recovered" no n10 n1s n 25mm D Recovery Terminated (Air) D Transferred to Receiver/Condenser, or Pump Out Unit D Unit Flat at "0" psi Could Not Recover
Service Descri"tion Notes
Refrigerant Cylinder ID Type Condition Quantity
Recovered
Total Recovered:
Added
D Startup Charge Total Added:
□ Accidental Release Occurred Estimated Amount Released:
Description:
Leaks Leak N2tes:
Leak Found Date:
□ Mothballed Unit Date:
□ Leak Repaired Date:
□ Initial Leak Verification Test Date:
Method:
D Follow-up Verification Test Date:
Method:
D Trace Gas Used Refrigerant:
□ Leak Inspection Date: Cylinder ID: Quantity:
Method:
Oil Quantity Removed: Choose Yes or No Oil Type: Drum:
ATTACHMENT F
File details come from the government source that posted it. Updated .