          ENVIRONMENTAL PROTECTION AGENCY 

          REFRIGERANT RECOVERY OR RECYCLING DEVICE 

          ACQUISITION CERTIFICATION FORM

EPA regulations require establishments that service or dispose of
refrigeration or air-conditioning equipment to certify that they have
acquired recovery or recycling devices that meet EPA standards for such
devices.  To certify that you have acquired equipment, please complete
this form according to the instructions and mail it to the appropriate
EPA Regional Office.  BOTH THE INSTRUCTIONS AND MAILING ADDRESSES CAN BE
FOUND ON THE REVERSE SIDE OF THIS FORM.





PART 1: ESTABLISHMENT INFORMATION

	

					City		State 		Zip Code





PART 2: REGULATORY CLASSIFICATION

	Identify the type of work performed by the establishment.  Check all
boxes that apply.

	( Type A - Service small appliances

	( Type B - Service refrigeration or air-conditioning equipment other
that small appliances

	( Type C- Dispose of small appliances

	( Type D - Dispose of refrigeration or air-conditioning equipment other
than small appliances





PART 3: DEVICE IDENTIFICATION

	





PART 4: CERTIFICATION SIGNATURE

 I certify that the establishment in Part 1 has acquired the refrigerant
recovery or recycling device(s) listed in Part 2, that the establishment
is complying with Section 608 regulations, and that the information
gives is true and correct.

Signature of Owner/Responsible Officer                 Date             
                          Name (Please Print)                           
              Title 	

	



INSTRUCTIONS

Part 1: Please provide the name, address, and telephone number of the
establishment where the refrigerant recovery or recycling device(s) is
(are) located.  Please complete one form for each location.   State the
number of vehicles based at this location that are used to transport
technicians and equipment to and from service sites.

Part 2: Check the appropriate boxes for the type of work performed by
technicians who are employees of the establishment.  The term “small
appliance” refers to any of the following products tat are fully
manufactured, charged, and hermetically sealed in a factory with five
pounds or less of refrigerant: refrigerators, and freezers designed for
home use, room air conditioners (including window air conditioners and
packaged terminal air conditioners), packaged terminal heat pumps,
dehumidifiers, under-the-counter ice makers, vending machines, and
drinking water coolers.

Part 3: For each recovery or recycling device acquired, please list the
name of the manufacturer of the device, and (if applicable) its model
number and serial number.

If more that seven devices have been acquired, please fill out an
additional form and attach it to this one.  Recovery devices that are
self-contained should be listed first and should be identified by
checking the box in the last column on the right.  Self-contained
recovery equipment means refrigerant recovery or recycling equipment
that is capable of removing te refrigerant from an appliance without the
assistance of components contained in the appliance.  On the other hand,
system-dependent recovery equipment means refrigerant recovery equipment
that requires the assistance of components contained in an appliance to
remove the refrigerant from the appliance.

If the establishment has been listed as Type B and/or Type D in Part 2,
then the first device listed in Part # must be a self-contained device
and identifies as such by checking the box in the last column on the
right.  

If any of the devices are homemade, they should be identified by writing
“homemade” in the column provided for listing the name of the device
manufacturer.  Type A or Type B establishments can use homemade devices
manufactured before November 15, 1993.  Type C or Type D establishments
can use homemade manufactured anytime.  If, however, a Type C or Type D
establishment is using homemade equipment manufactured after November
15, 1993, then it must not use these devices for service jobs.

EPA REGIONAL OFFICES

Send your form to the EPA office listed under the state or territory in
which the establishment is located.

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

CAA 608 Enforcement Contact:  EPA Region I; Mail Code OES04-2; 5 Post
Office Square; Boston, MA 02109

Arkansas, Louisiana, New Mexico, Oklahoma, Texas

CAA 608 Enforcement Contact:  EPA Region VI; Mail Code 6EN-AA; 1445 Ross
Ave., Suite 1200; Dallas, TX 75202

New York, New Jersey, Puerto Rico, Virgin Islands

CAA 608 Enforcement Contact:  EPA Region II; Mail Code 2DECA-AC; 290
Broadway; New York, NY 10007-1866

Iowa, Kansas, Missouri, Nebraska

CAA 608 Enforcement Contact:  EPA Region VII; Mail Code APCOAWMD; 901
North 5th Street; Kansas City, KS 66101

Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West
Virginia

CAA 608 Enforcement Contact: EPA Region III-Wheeling Office; Mail Code
3AP20; 1060 Chapline Street, Suite 303 Wheeling, WV 26003-2995

Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

CAA 608 Enforcement Contact:  EPA Region VIII; Mail Code 8ENF-T; 999
18th Street, Suite 500; Denver, CO 80202

Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South
Carolina, Tennessee

CAA 608 Enforcement Contact:  EPA Region IV; Mail Code APT-AE; 61
Forsyth Street, SW; Atlanta, GA 30303-8960

 

American Samoa, Arizona, California, Guam, Hawaii, Nevada

CAA 608 Enforcement Contact: EPA Region IX; Mail Code AIR-5; 75
Hawthorne Street; San Francisco, CA 94105 

Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

CAA 608 Enforcement Contact:  EPA Region V; Mail Code AE-17J; 77 West
Jackson Blvd.; Chicago, IL 60604-3507

Alaska, Idaho, Oregon, Washington

CAA 608 Enforcement Contact: EPA Region X; Mail Code OAQ-107; 1200 Sixth
Ave.; Seattle, WA 98101 





PUBLIC BURDEN

The purpose and need of this renewed collection request is to facilitate
compliance with and enforcement of Section 608 of the Act by reducing
emissions of class I and class II ozone-depleting refrigerants to the
lowest achievable level during the service, maintenance, repair, and
disposal of appliances.  EPA has used and will continue to use these
records and reports to ensure that refrigerant releases are minimized
during the recovery and recycling of ozone-depleting refrigerants during
the service, maintenance, repair, and disposal of appliances. 
Collection of this information is mandated  by EPA regulations, in
accordance with 40 CFR 82.162.  This information is not shared with
parties outside of the Federal government.  EPA's confidentiality
regulations (40 CFR 2.201 et seq.) assure computer data security,
disclosure prevention, proper handling, proper storage, and proper
disposal of the submitted information.

The public reporting and recordkeeping burden for this collection of
information is estimated to average one (1) hour per response per
respondent annually.  Burden means the total time, effort, or financial
resources expended by persons to generate, maintain, retain, or disclose
or provide information to or for a Federal agency.  This includes the
time needed to review instructions; develop, acquire, install, and
utilize technology and systems for the purposes of collecting,
validating, and verifying information, processing and maintaining
information, and disclosing and providing information; adjust the
existing ways to comply with any previously applicable instructions and
requirements; train personnel to be able to respond to a collection of
information; search data sources; complete and review the collection of
information; and transmit or otherwise disclose the information.  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.  

To comment on the Agency's need for this information, the accuracy of
the provided burden estimates, and any suggested methods for minimizing
respondent burden, including the use of automated collection techniques,
EPA has established a public docket for this ICR under Docket ID No.
OAR-2003-0018, which is available for public viewing at the Air and
Radiation Docket and Information Center in the EPA Docket Center
(EPA/DC), EPA West, Room B102, 1301 Constitution Ave., NW, Washington,
DC. The EPA Docket Center Public Reading Room is open from 8:30 a.m. to
4:30 p.m., Monday through Friday, excluding legal holidays.  The
telephone number for the Reading Room is (202) 566-1744, and the
telephone number for the OAR Docket is (202) 566-1742.  An electronic
version of the public docket is available through EPA Dockets (EDOCKET)
at http://www.epa.gov/edocket.  Use EDOCKET to submit or view public
comments, access the index listing of the contents of the public docket,
and to access those documents in the public docket that are available
electronically.  Once in the system, select “search,” then key in
the docket ID number identified above.  Also, you can send comments to
the Office of Information and Regulatory Affairs, Office of Management
and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk
Office for EPA.  Please include the EPA Docket ID No.  (OAR-2003-0018)
and OMB control number (2060-0256) in any correspondence. 

Form Approved

OMB No. 2060-0256

Expires:  04/30/2014	

EPA FORM 7610-31		

Form Approved

OMB No. 2060-0256

Expires:  04/30/2014	

( PAGE  iii (

EPA FORM 7610-31		

(Area Code) Telephone Number

Number of Service Equipment Based at Establishment

Name of Establishment

Street

City                                     State                     Zip
Code

Country

