J-1502000-10C Refrigerant Appliance Service.pdf

Jan 2015 Retain for 5 years

(if known skip to Refrigerant Information)

Refrigerant Appliance

Service

Naval Submarine Base New London

Instructions: Complete when refrigerant is added or removed from an appliance, including leaks.

Service Information

Date of Service ___________________ Repair Scheduled Maintenance Seasonal Startup

Service Description __________________________________________________________________________________

Service Technician _________________________ 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 ________________________

Pounds of Refrigerant: Removed ________________ Added ___________________ Leaked ___________________

Refrigerant Source (Cylinder ID) _____________________

Leak Test Information

Leak Test Performed? Yes No (Refrigerant leak repairs require initial and follow-up leak tests)

Initial Test Date ____________ Pass Fail Method ____________________ Technician Initials ___________

Follow-up Test Date ____________ Pass Fail* Method ____________________ Technician Initials ___________

*ACTION REQUIRED – If follow-up leak test failed provide this log to the designated NAVFAC representative within 7 business days of original leak discovery for leak rate calculation.

Comments _____________________________________________________________________________________________

Leak Rate Calculation - This section is to be completed by NAVFAC Facility Operation Specialist.

Note: Contact Environmental Division at 860-694-5159 within 3 days of any leak from an appliance containing 50 lbs or more of ODS when annualized leak rate is greater than 15 % for comfort cooling or greater than 35 % for industrial/commercial refrigeration.

Annualized Leak Rate

Lbs of refrigerant added (past 365 days or since last repair)

Lbs of refrigerant at full charge X 100 =

X 100

Annualized Leak Rate