Click here: Commercial HVAC Sec 608    Automotive MVAC Sec 609
MVACs Recover/ Recycle
or Recover Equipment
Certification Form
1
Name of establishment
 
 		 Street
(Area Code) Telephone Number
 
 		 City
2
Qty Name of Device(s) Manufacturer Model Number Year Serial Number
(If any)
. Refrigerant Recovery Technology Inc./Timco Label 
(multiple listing)		 3000, 3000R, TC2,
Retro 2, 3000ihd		 97-99 .
. Refrigerant Recovery Technology Inc./Timco Label 
(multiple listing)		 6000, 6000h 95-98 .
. Refrigerant Recovery Technology Inc./Timco Label 
(multiple listing)		 4000, Retro 3 95-99 .
. . . . .
. . . . .
3: CERTIFICATION SIGNATURE
I certify that I have acquired approved recover/recycle or recover equipment under Section 609 of the Clean Air Act.
I certify that only properly trained and certified technicians operate the equipment and that the information given above is true and correct.
Signature of Owner/Operator
 
 		 Date  Name (Please Print)  Title 
Print and send this form to:
MVACs Recycling Program Manager
Stratospheric Ozone Protection Branch (6202J)
U.S.E.P.A.
401 M Street, S. W.
Washington, D.C. 20460

 
 
 

Instructions

Motor vehicle recover/recycle or recover only equipment must be acquired by January 1, 1992 and certified tom EPA on or before January 1, 1993 under Section 609 of the Clean Air Act. To certify that you have purchased approved equipment and that the technicians using it are properly trained and certified, please complete this according  to the following instructions and mail to EPA address on previous page.

1 - Please provide the name, address and telephone number of the establishment where the recover/recycle or recover only equipment is located.

2 - Please provide the make, model number, year, and serial number(s) of the recover/recycle or recover equipment acquired for use at the above establishment.

3 - The certification statement must be signed by the person who has acquired the recover/recycle or recover equipment (the person may be the owner of the establishment or another responsible officer) The person who signs is certifying that they have acquired the equipment, that each individual authorized to use the equipment is properly trained and certified, and that the information provided is true and correct.

This form was developed by the U. S. EPA and reproduce courtesy of TimcoUSA. timco@tipages.com