HVAC Technician Refrigerant Forms.pdf
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- Solicitation number
- N4008521R0071
About this file
This document contains a federal contract opportunity solicitation for an Indefinite Delivery/Indefinite Quantity (IDIQ) Multiple Award Construction Contract (MACC) and HVAC technician refrigerant disposal forms. The solicitation is for minor construction, renovation, and repair projects at NSA Crane, IN and Glendora Test Facility in Sullivan, IN. It is being solicited as a total small business set-aside. The IDIQ MACC will utilize both design-build and design-bid-build project delivery methods. The refrigerant disposal forms require HVAC technicians to record information such as the type and amount of refrigerant recovered from appliances, its disposition, and certification that all refrigerant was removed prior to appliance disposal in accordance with EPA regulations. Technicians must retain original forms for 5 years and provide copies to supervisors weekly. Supervisors must maintain copies for 5 years.
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Last Updated: 28-February-2020
Pg 16/16
Form CAA 40-82F-3 Disposal Invoice - All Appliances DISPOSAL - ALL
Technician Name PWD
Technician's Office Location (Building or Street Address) Work Order No.
(or Contract PO No.)
Equipment Location (Building) Additional location (room, roof, N side, etc.)
Equipment Asset No. Model No.
(if Asset No. unknown)
Appliance Description (industry or MAXIMO UNIFORMAT name)
Serial No.
(if Asset No. unknown)
Refrigerant Recovery Date Refrigerant No. (Type) Removed (example: R-22)
Refrigerant Amount Removed (indicate ‘pounds’ or ‘ounces’)
Refrigerant Disposition:
[R] Recovered for re-use or [D] Recovered for disposal
If [D], Refrigerant Disposal Date
If [D], what entity took possession of refrigerant?
(example: tool room, VRS)
Oil Type Removed Oil Amount Removed
Technician Signature (certifies that all refrigerant and oil that had not leaked was removed from appliance prior to disposal in accordance with 40 CFR 82 and that a weatherproof label has been affixed to the appliance stating the same)
Technician shall keep original forms on work truck for 5 years, make available upon request for inspection, and provide copies to supervisor weekly. Supervisor shall maintain copies for 5 years.
File details come from the government source that posted it. Updated .