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OMB Control No.: 2060-0702 |
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Expiration Date: MM/DD/YYYY |
I. General Partner Information |
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Company Name: |
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Banners Included: |
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This Reporting Year: |
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Number of Stores: |
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2022 |
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Provide this data aggregated across all stores. |
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II. Corporate-Wide Installed Refrigerant |
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III. Corporate-Wide Refrigerant Emissions |
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Note: Report aggregate information for all retail stores under the same Partner and/or banner name. Include offices, break-rooms, etc. co-located inside retail stores. Do not include separate office buildings, distribution centers, warehouses, etc. Do not include refrigerant stored in cylinders on or off site. Include other refrigerants not listed by using extra lines at the bottom of the table. |
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Note: Report aggregate information for all retail stores under the same Partner and/or banner name. Include offices, break-rooms, etc. co-located inside retail stores. Do not include separate office buildings, distribution centers, warehouses, etc. Do not include refrigerant recovered/recycled from equipment retired, but do include known emissions from those systems. Do not include first-fill charging when installing new systems or after remodels. Include other refrigerants not listed by using extra lines at the bottom of the table. |
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Refrigerant |
Commercial Refrigeration |
Air-Conditioning |
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Refrigerant |
Commercial Refrigeration |
Air-Conditioning |
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Charge > 50 Pounds |
Charge < 50 Pounds |
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Charge > 50 Pounds |
Charge < 50 Pounds |
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REQUIRED |
OPTIONAL |
OPTIONAL |
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REQUIRED |
OPTIONAL |
OPTIONAL |
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R-11 |
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R-11 |
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R-12 |
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R-12 |
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R-13 |
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R-13 |
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R-123 |
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R-123 |
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R-134a |
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R-134a |
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R-143A |
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R-143A |
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R-22 |
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R-22 |
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R-290 (Propane) |
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R-290 (Propane) |
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R-401A (MP 39) |
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R-401A (MP 39) |
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R-401B (MP 66) |
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R-401B (MP 66) |
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R-402A (HP 80) |
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R-402A (HP 80) |
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R-402B (HP 81) |
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R-402B (HP 81) |
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R-404A (HP 62) |
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R-404A (HP 62) |
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R-407A (Klea 60) |
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R-407A (Klea 60) |
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R-407C (Klea 66; Suva 9000) |
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R-407C (Klea 66; Suva 9000) |
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R-407D |
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R-407D |
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R-407F (Gen. Performax LT) |
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R-407F (Gen. Performax LT) |
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R-408A (FX-10) |
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R-408A (FX-10) |
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R-409A (FX-56) |
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R-409A (FX-56) |
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R-410A (AZ-20, Puron) |
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R-410A (AZ-20, Puron) |
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R-413A |
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R-413A |
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R-414A (GHG-X4) |
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R-414A (GHG-X4) |
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R-414B (Hot Shot) |
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R-414B (Hot Shot) |
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R-416A (FR 12) |
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R-416A (FR 12) |
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R-417A (NU-22, Isceon MO29) |
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R-417A (NU-22, Isceon MO29) |
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R-417C (Hot Shot 2) |
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R-417C (Hot Shot 2) |
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R-420A |
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R-420A |
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R-421A (Choice R421A) |
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R-421A (Choice R421A) |
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R-422A (Isceon 79) |
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R-422A (Isceon 79) |
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R-422B (XAC1) |
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R-422B (XAC1) |
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R-422C (XLT1) |
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R-422C (XLT1) |
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R-422D (Isceon MO29) |
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R-422D (Isceon MO29) |
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R-427A (Forane 427A) |
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R-427A (Forane 427A) |
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R-437A (ISCEON MO49 Plus) |
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R-437A (ISCEON MO49 Plus) |
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R-438A (ISCEON MO99) |
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R-438A (ISCEON MO99) |
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R-441A (HC blend) |
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R-441A (HC blend) |
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R-448A (Solstice N-40) |
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R-448A (Solstice N-40) |
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R-449A (Opteon XP 40) |
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R-449A (Opteon XP 40) |
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R-449B (Forane 449B) |
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R-449B (Forane 449B) |
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R-450A (Solstice N-13) |
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R-450A (Solstice N-13) |
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R-453A (RS-70) |
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R-453A (RS-70) |
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R-500 |
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R-500 |
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R-502 |
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R-502 |
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R-507A (AZ-50) |
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R-507A (AZ-50) |
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R-513A (Opteon XP 10) |
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R-513A (Opteon XP 10) |
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R-600a (Isobutane) |
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R-600a (Isobutane) |
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R-717 (NH3) |
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R-717 (NH3) |
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R-744 (CO2) |
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R-744 (CO2) |
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R-407H |
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R-407H |
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R-452A |
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R-452A |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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Total |
0 |
0 |
0 |
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Total |
0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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Reported values are in (select one): |
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Kilograms |
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Reported values are in: |
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Pounds |
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Pounds |
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Pounds |
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"I certify with my signature that the data reported herein represent the Reporting Party’s best estimates and are the result of a good faith effort to obtain and report accurate information." |
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Signature: |
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Date: |
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Name (please print): |
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Please return completed forms by March 31, 2023 by email to: |
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You may also send a copy of completed forms by email to EPA: |
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Marissa Hoer, Abt Associates |
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Kersey Manliclic, EPA GreenChill Partnership |
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[email protected] |
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[email protected] |
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Phone: 919-294-7923 |
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Phone: 202-566-9981 |
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EPA Form No.: 5900-213 |
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This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0702). Responses to this collection of information are voluntary (Clean Air Act). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 5 to 8 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. |
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CONFIDENTIAL BUSINESS INFORMATION |
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Corporate-Wide Installed Refrigerant and Emissions in Metric Tons of Carbon Dioxide Equivalent (CO2e) |
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Note: Installed refrigerant and emissions are automatically converted into metric tons of CO2e in this sheet by multiplying the absolute amount of a refrigerant installed or emitted by the GWP for that refrigerant. |
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Refrigerant |
Commercial Refrigeration |
Air-Conditioning |
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Refrigerant |
Commercial Refrigeration |
Air-Conditioning |
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Charge > 50 Pounds |
Charge < 50 Pounds |
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Charge > 50 Pounds |
Charge < 50 Pounds |
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REQUIRED |
OPTIONAL |
OPTIONAL |
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REQUIRED |
OPTIONAL |
OPTIONAL |
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R-11 |
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R-11 |
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R-12 |
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R-12 |
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R-13 |
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R-13 |
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R-123 |
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R-123 |
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R-134a |
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R-134a |
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R-143A |
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R-143A |
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R-22 |
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R-22 |
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R-290 (Propane) |
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R-290 (Propane) |
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R-401A (MP 39) |
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R-401A (MP 39) |
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R-401B (MP 66) |
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R-401B (MP 66) |
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R-402A (HP 80) |
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R-402A (HP 80) |
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R-402B (HP 81) |
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R-402B (HP 81) |
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R-404A (HP 62) |
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R-404A (HP 62) |
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R-407A (Klea 60) |
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R-407A (Klea 60) |
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R-407C (Klea 66; Suva 9000) |
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R-407C (Klea 66; Suva 9000) |
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R-407D |
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R-407D |
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R-407F (Gen. Performax LT) |
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R-407F (Gen. Performax LT) |
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R-408A (FX-10) |
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R-408A (FX-10) |
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R-409A (FX-56) |
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R-409A (FX-56) |
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R-410A (AZ-20, Puron) |
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R-410A (AZ-20, Puron) |
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R-413A |
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R-413A |
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R-414A (GHG-X4) |
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R-414A (GHG-X4) |
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R-414B (Hot Shot) |
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R-414B (Hot Shot) |
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R-416A (FR 12) |
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R-416A (FR 12) |
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R-417A (NU-22, Isceon MO29) |
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R-417A (NU-22, Isceon MO29) |
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R-417C (Hot Shot 2) |
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R-417C (Hot Shot 2) |
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R-420A |
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R-420A |
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R-421A (Choice R421A) |
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R-421A (Choice R421A) |
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R-422A (Isceon 79) |
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R-422A (Isceon 79) |
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R-422B (XAC1) |
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R-422B (XAC1) |
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R-422C (XLT1) |
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R-422C (XLT1) |
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R-422D (Isceon MO29) |
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R-422D (Isceon MO29) |
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R-427A (Forane 427A) |
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R-427A (Forane 427A) |
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R-437A (ISCEON MO49 Plus) |
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R-437A (ISCEON MO49 Plus) |
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R-438A (ISCEON MO99) |
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R-438A (ISCEON MO99) |
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R-441A (HC blend) |
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R-441A (HC blend) |
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R-448A (Solstice N-40) |
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R-448A (Solstice N-40) |
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R-449A (Opteon XP 40) |
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R-449A (Opteon XP 40) |
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R-449B (Forane 449B) |
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R-449B (Forane 449B) |
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R-450A (Solstice N-13) |
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R-450A (Solstice N-13) |
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R-453A (RS-70) |
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R-453A (RS-70) |
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R-500 |
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R-500 |
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R-502 |
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R-502 |
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R-507A (AZ-50) |
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R-507A (AZ-50) |
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R-513A (Opteon XP 10) |
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R-513A (Opteon XP 10) |
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R-600a (Isobutane) |
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R-600a (Isobutane) |
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R-717 (NH3) |
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R-717 (NH3) |
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R-744 (CO2) |
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R-744 (CO2) |
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R-407H |
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R-407H |
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R-452A |
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R-452A |
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|
|
[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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[INSERT OTHER] |
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Total Installed Refrigerant in Metric Tons of CO2e |
0 |
0 |
0 |
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|
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Total Emissions in Metric Tons of CO2e |
0 |
0 |
0 |
|
|
0 |
|
|
|
0 |
|
|
0 |
|
|
|
0 |
|
|
|
|
|
|
|
|
|
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CONFIDENTIAL BUSINESS INFORMATION |