EMCOR Betlem Refrigerant Usage Report for National Grid

• Today's Date

  Date

• Tech's Name

• Customer Name

• Job Number

• Job Location
  Address

• Date Leak Found

  Date

• Location of Leak

Refrigerant Usage Report

• Unit Number

• Unit Description

• Model Number

• Serial Number

• Total System Charge

• Type of Refrigerant

• Glycol Type

• Amount Added

• Leak Rate Calculation Method (If over 50LBS for National Grid):
  
  Step 1: Divide the refrigerant added by the total system charge.
  Step 2: Take the number of days since the last time refrigerant was added and divide by 365 (if the number of days is unknown, use 365).
  Step 3: Divide step 1 by step 2
  Step 4: Multiply step 3 by 100 and this will be your leak rate percentage.
  
  Example:
  8lbs of refrigerant added divided by 25lbs system charge = .32
  365 divided by 365 = 1
  .32 divided by 1 = .32
  .32 X 100 = 32% leak rate

• Leak Rate

Important National Grid Information

• National Grid Personnel whom you informed regarding the leak (within 2 HOURS of leak discovery)

• Leak Location

• Date and Time Leak was Reported

  Date

• Name of National Grid Regional Facilities Manager whom the leak was reported to:

• Date and Time Regional Manager was made aware of the leak:

  Date