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Print Form REFRIGERANT REMOVAL VERIFICATION STATEMENT (Prescribing Authority: 40 CFR 82.156(f)(2) & DoD 4160.21M) THE REFRIGERANT HAS BEEN REMOVED FROM THE ITEM(S) LISTED BELOW, IN COMPLIANCE WITH
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How to fill out refrigerant removal verification statement

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How to fill out refrigerant removal verification statement:

01
Start by correctly identifying the type and amount of refrigerant that was removed. This information can usually be found on the equipment or in the service records.
02
Clearly state the date and location where the refrigerant removal took place. This is important for recordkeeping and compliance purposes.
03
Include the name and contact information of the technician or company responsible for the refrigerant removal. This allows for easy communication or verification if needed.
04
If there were any leak checks or repairs performed during the removal process, provide details about these actions. This helps to ensure proper maintenance and safety standards were followed.
05
Indicate whether the refrigerant was recovered, recycled, reclaimed, or destroyed. This information shows the eco-friendly practices implemented during the removal process.
06
Finally, make sure to sign and date the verification statement to validate its authenticity.

Who needs refrigerant removal verification statement:

01
HVAC technicians: Refrigerant removal verification statements are frequently needed by HVAC technicians who are responsible for refrigerant handling and disposal. This statement serves as proof that they followed proper procedures and can demonstrate compliance with regulations.
02
Equipment owners or managers: Owners or managers of equipment that requires refrigerant removal may need to provide a verification statement to regulatory authorities or inspectors. This helps to show that the necessary steps were taken for safe and legal refrigerant disposal.
03
Environmental agencies or authorities: Environmental agencies or authorities may require the submission of refrigerant removal verification statements to ensure compliance with environmental regulations. These statements provide evidence of responsible refrigerant handling practices.
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A refrigerant removal verification statement is a document that confirms the proper removal and handling of refrigerants from equipment, ensuring compliance with environmental regulations.
Technicians and companies that handle refrigerants during repair, maintenance, or disposal of air conditioning and refrigeration equipment are required to file a refrigerant removal verification statement.
To fill out a refrigerant removal verification statement, one must provide details such as the type and amount of refrigerant removed, the date of removal, the technician's information, and any relevant certification numbers.
The purpose of the refrigerant removal verification statement is to ensure that refrigerants are safely and correctly removed to prevent environmental harm and to document compliance with applicable regulations.
The statement must report the type of refrigerant, the quantity removed, the date of removal, the technician's name and certification details, and the equipment from which the refrigerant was removed.
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