Jason Russo

REFRIGERANT USE FORM

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Use this Template

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Title Page

TECHNICIAN NAME
EPA CERTIFICATION NUMBER
LOCATION OF CUSTOMER
JOB NUMBER
DISPATCH DATE
UNIT TYPE AND NUMBER
REFRIGERANT TYPE
SYSTEM DESIGN CHARGE
REFRIGERANT AMOUNT RECOVERED (LBS/OZ)
REFRIGERANT AMOUNT ADDED (LBS/OZ)
LEAK LOCATION
POSSIBLE CAUSE OF LEAK
ACTION TAKEN TO REPAIR
METHOD OF REPAIR VERIFICATION

Jason Russo

REFRIGERANT USE FORM

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.