Form 5900-405 Small Can Test Data Form

National Refrigerant Recycling and Emissions Reduction Program (Proposed Rule)

5900-405 Small Can Form

National Refrigerant Recycling and Emission Reduction Program

OMB: 2060-0256

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OMB Control Number: 2060-0256

Expiration Date: MM/DD/YYYY

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ENVIRONMENTAL PROTECTION AGENCY

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EPA requires manufacturers of small cans of automotive refrigerant to keep records of test data and log forms that demonstrate compliance with the allowable leakage rate (40 CFR §82.154(c)(2)).

The recordkeeping and recording burden for this collection of information is estimated at 0.3 hours per year. Send comments on EPA’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden to [email protected] or by mail to: Section 608 Program Manager; Stratospheric Protection Division; Mail Code: 6205T; U.S. Environmental Protection Agency; 1200 Pennsylvania Avenue, NW; Washington, DC 20460. Include the OMB control number in any correspondence.


PART 1: ESTABLISHMENT INFORMATION

Name of Establishment



Street



(Area Code) Telephone Number




City State Zip Code






PART 2: SMALL CAN TEST DATA FORM

Enforcement Lot ID:


Full:


Upright:


T= 73 F:



Half full:


Inverted:


T= 130 F:




Date:


Date:






Can ID

Initial time (hour)

Initial weight (g)

Final time (hour)

Final weight (g)

Delta

days

Delta weight (g)

Adjusted annual rate (g/yr)


















































































Number of Samples:


Average Loss Rate:


Technician:


Standard Deviation:


Comments:





SMALL CAN TEST DATA FORM

PART 3: BALANCE DATA LOG FORM


Rec #

Date

Time

Proj.

Prot.

Tech.

QC

Code

Can

Recorded

Grams

Comment

Type

ID#

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EPA FORM 5900-405

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