J-1502000-10A Refrigerant Appliance Disposal.pdf
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Text version
Jan 2015 Retain for 5 years
(if known skip to Refrigerant Information)
Refrigerant Appliance
Disposal
Naval Submarine Base New London
Instructions: Complete for each refrigeration unit or circuit being disposed.
Disposal Information
Date of Removal ___________________________________
Work Order / Contract / PO Number No. _____________________________
Equipment Information
Equipment Type ______________________________ Roof Unit Ground Unit Other _________________
Building ______________ Floor ______________ Room ______________ MAXIMO Asset No. ________________
Manufacturer _____________________________________________________
Model No. ______________________ Serial No. ______________________ Circuit No. _______________________
Refrigerant Information
Normal Refrigerant Capacity (lbs refrigerant) _____________________
Type of Refrigerant Removed ______________________ Quantity Removed (lbs refrigerant) ____________________
Refrigerant Recovered to (Cylinder ID) _________________________
Recovery Equipment Model No. _____________________________ Serial No. ______________________________
An “EMPTY” label is attached to the appliance (mandatory)
Service Technician Name ___________________________________
Comments ____________________________________________________________________________________________
MAXIMO Asset Management - This section is to be completed by NAVFAC Facility Operation Specialist.
Date removed from MAXIMO ___________________ POC _________________________________
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