5900-590 GreenChill Advanced Refrigeration Partnership Bulk Appli

Green Chill Advanced Refrigeration Partnership (Renewal)

5900-590, Bulk Application for GreenChill Store Certification_6.12.2022.xlsx

GreenChill Advanced Refrigeration Store Certification Program

OMB: 2060-0702

Document [xlsx]
Download: xlsx | pdf

Overview

Introduction
New - Newly Constructed
New - Leak Tightness
New - Operational
Recertification

Sheet 1: Introduction















GreenChill Bulk Application Form
Purpose: This spreadsheet can be used to apply for GreenChill store certification
for multiple stores in bulk. To apply for multiple types of stores at once,
please submit the required information on all applicable worksheets.

Date: June 10, 2022

OMB Control No.: 2060-0702

Expiration Date: March 31, 2023
EPA Form No.: 5900-590





Worksheet Contents
New - Newly Constructed Stores that are not yet operational, or have been operational for less than 6 months, are classified as “Newly Constructed” and should input their data in this tab.
New - Leak Tightness Stores classified as “Newly Constructed” and must also submit Installation Leak Tightness Testing information on this tab for each store included in the "New - Newly Constructed" application tab.
New - Operational Stores that have been in operation for at least 12 months are classified as “Operational" an should input their data in this tab.
Recertification Stores that have previously been certified but require a renewal are classified as “Recertifications" and should input their data in this tab.













Sheet 2: New - Newly Constructed



































































































































1. Store Information 2. Refrigeration System Type and Manufacturer 3. Refrigerant Type and Charge Size 4. Predicted Refrigerant Emissions 5. Refrigeration Load 6. Certification Other Attachments

Store Name Store Number Unique ID Date of Store Opening Street Address City State Zip If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "Self Contained Equipment Only" Medium Temperature System
(or self-contained system)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Low Temperature System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Type in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Charge in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Secondary Refrigeration Charge in Commercial Refrigeration System
(as applicable)		 Refrigerant Type(s) in Self-Contained Equipment Refrigerant Charge(s) in Self-Contained Equipment
Required for stores using self-contained equipment (e.g., micro-distributed systems) as the primary refrigeration system		 Including “personal” AC units in staff offices. Primary Refrigerant Type in HVAC Equipment Predicted Refrigerant Annual Emissions
(If the store has been open for 6-12 months, provide the actual amount of refrigerant emitted since the store’s opening.)		 DO NOT include the load from the store’s HVAC system (split systems or self-contained), sub-cooling, heat of rejection, or pump heat. Total Remote Commercial Refrigeration Load Initials Date Notes Legend Included? Refrigerant Charge Documentation Included? Predicted Annual Emissions Documentation Included? Leak Tightness Testing Documentation Included?

System Type System Manufacturer System Type System Manufacturer Medium Temperature Low Temperature Medium Temperature Low Temperature Medium Temperature Low Temperature

Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Selection.
If "other" please specify in column z.		 lbs. lbs. lbs. lbs. Selection.
If "other" please specify in column z.		 Selection 2.
If "other" please specify in column z.		 lbs. lbs. Selection.
If "other" please specify in column z.		 lbs. MBTUS/hour Please have an authorized representative of the store seeking certification initial and date this application to attest that all information contained is true and correct. Text Required for all stores Required for all stores Required for systems using HFCs Required for systems using HFCs.
Please attach the GreenChill Installation Leak Tightness Testing Verification Form or complete the "New - Leak Tightness" tab
































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































For assistance on completing the form, please refer to the GreenChill Store Certification Program Guidance. Please direct any questions and send completed forms and attachments to Kersey Manliclic ([email protected], 202-566-9981).
































































GreenChill reserves the right to deny store certification based on a company's Clean Air Act Title 6 enforcement issues































Note: When referring to any EPA Award, please include the year in which the award was received.
































































OMB Control No.: 2060-0702 Expiration Date: MM/DD/YYYY































EPA Form No.: 5900-590































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 7 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.































If you do not receive an email confirming receipt of your application within 2 business days, please notify EPA.
































































www.epa.gov/greenchill































Chillin' for the environment




















































































































































































































































Sheet 3: New - Leak Tightness























































































The following form must be completed by an authorized installation company representative to verify that remote commercial refrigeration systems using HFCs or HFC blends were tested for leaks at the time of installation in accordance with GreenChill’s Best Practices Guideline for Leak Tightness at Installation. Please refer to the Guideline for more detail, available online at: http://www2.epa.gov/greenchill/greenchill-best-practices-guideline-ensuring-leak-tight-installations-commercial

















1. Store Information 2. Leak Testing Information 3. Singnature/Certification by Authorized Company Representative

Store Name Store Information Installation Company Information Pressure Testing for Leaks Stairstep Evacuation Procedure Initials Date

Store Number Unique ID City State Company Name Representative's Name Representative's Title Telephone Email Tracer Gas Used System Pressure Hours Successfully Held First Vacuum Pull Hours Successfully Held Second Vacuum Pull Hours Successfully Held Third Vacuum Pull Hours Successfully Held Please have an authorized representative of the store seeking certification initial and date this application to attest that all information contained is true and correct.

Text psig Hours microns Hours microns Hours microns Hours

































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































www.epa.gov/greenchill




















Chillin' for the environment














































































































































Sheet 4: New - Operational































































































































1. Store Information 2. Refrigeration System Type and Manufacturer 3. Refrigerant Type and Charge Size 4. Refrigerant Emissions 5. Refrigeration Load 6. Certification by Authorized Company Representative Other Attachments

Store Name Store Number Unique ID Date of Store Opening Street Address City State Zip If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "Self Contained Equipment Only" Medium Temperature System
(or self-contained system)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Low Temperature System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Type in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Charge in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Secondary Refrigeration Charge in Commercial Refrigeration System
(as applicable)		 Refrigerant Type(s) in Self-Contained Equipment Refrigerant Charge(s) in Self-Contained Equipment
Required for stores using self-contained equipment (e.g., micro-distributed systems) as the primary refrigeration system		 Including “personal” AC units in staff offices. Primary Refrigerant Type in HVAC Equipment Refrigerant Annual Emissions DO NOT include the load from the store’s HVAC system (split systems or self-contained), sub-cooling, heat of rejection, or pump heat. Total Remote Commercial Refrigeration Load Initials Date Notes Legend Included? Refrigerant Charge Documentation Included? Annual Emissions Documentation Included?

System Type System Manufacturer System Type System Manufacturer Medium Temperature Low Temperature Medium Temperature Low Temperature Medium Temperature Low Temperature

Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Selection.
If "other" please specify in column z.		 lbs. lbs. lbs. lbs. Selection.
If "other" please specify in column z.		 Selection 2.
If "other" please specify in column z.		 lbs. lbs. Selection.
If "other" please specify in column z.		 lbs. MBTUS/hour Please have an authorized representative of the store seeking certification initial and date this application to attest that all information contained is true and correct. Text Required for all stores Required for all stores Required for all stores

































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































www.epa.gov/greenchill






























Chillin' for the environment




















































































































































































































Sheet 5: Recertification































































































































1. Store Information 2. Refrigeration System Type and Manufacturer 3. Refrigerant Type and Charge Size 4. Refrigerant Emissions 5. Refrigeration Load 6. Certification by Authorized Company Representative Other Attachments

Store Name Store Number Unique ID Date of Store Opening Street Address City State Zip If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "Self Contained Equipment Only" Medium Temperature System
(or self-contained system)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Low Temperature System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Type in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Primary Refrigerant Charge in Commercial Refrigeration System
(as applicable)		 If the store is using self contained equipment as its primary refrigeration system (e.g., through a micro-distributed system), select "NA" Secondary Refrigeration Charge in Commercial Refrigeration System
(as applicable)		 Refrigerant Type(s) in Self-Contained Equipment Refrigerant Charge(s) in Self-Contained Equipment
Required for stores using self-contained equipment (e.g., micro-distributed systems) as the primary refrigeration system		 Including “personal” AC units in staff offices. Primary Refrigerant Type in HVAC Equipment Refrigerant Annual Emissions DO NOT include the load from the store’s HVAC system (split systems or self-contained), sub-cooling, heat of rejection, or pump heat. Total Remote Commercial Refrigeration Load Initials Date Notes Legend Included? Refrigerant Charge Documentation Included? Annual Emissions Documentation Included?

System Type System Manufacturer System Type System Manufacturer Medium Temperature Low Temperature Medium Temperature Low Temperature Medium Temperature Low Temperature

Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Text Selection.
If "other" please specify in column z.		 Selection.
If "other" please specify in column z.		 lbs. lbs. lbs. lbs. Selection.
If "other" please specify in column z.		 Selection 2.
If "other" please specify in column z.		 lbs. lbs. Selection.
If "other" please specify in column z.		 lbs. MBTUS/hour Please have an authorized representative of the store seeking certification initial and date this application to attest that all information contained is true and correct. Text Required for all stores Required for all stores Required for all stores

































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































www.epa.gov/greenchill






























Chillin' for the environment




















































































































































































































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