1.1 Why do the Federal Halocarbon Regulations, 2003 exist?.............................................................1

1.4 What are Halocarbons? ..................................................................................................................2

2.1 Does the Federal Halocarbon Regulations, 2003 apply to me? .....................................................2

2.2 Does the Federal Halocarbon Regulations, 2003 apply to small air conditioning systems

and small refrigeration systems? ....................................................................................................3

2.3 Am I subject to inspections?..........................................................................................................3

2.4 What happens if I don’t comply with the Federal Halocarbon Regulations, 2003?.........................3

3.1 Are halocarbon releases permitted under the Federal Halocarbon Regulations, 2003? ................3

3.2 Am I allowed to install a refrigeration or air-conditioning system containing halocarbons? ............3

3.3 What are my requirements with respect to purchasing, transporting or storing halocarbon

refrigerants? ..................................................................................................................................3

3.4 What are my requirements for disposing of air-conditioning or refrigeration systems

containing halocarbons?.................................................................................................................4

4.1 What are my requirements for servicing refrigeration or air-conditioning systems?......................4

4.2 What are my requirements for leak testing refrigeration or air-conditioning systems?..................4

4.3 How is the halocarbon emission limit of 0.1 kg/ kg of air achieved for purge systems? ................5

4.4 What are my requirements when charging a refrigeration or air-conditioning system?................5

of Practice)?...................................................................................................................................6

5.1 What are the most common CFC refrigerants? ..............................................................................6

5.2 Is it prohibited to charge an air conditioning system contained in a motor vehicle with

CFCs?............................................................................................................................................6

5.3 Is it prohibited to charge a mobile refrigeration system with CFCs?.............................................6

5.4 Is it prohibited to charge an air conditioning or a refrigeration system with CFCs?......................6

5.5 Is it prohibited to charge a chiller with CFCs?...............................................................................6

5.6 Is it prohibited to charge an air conditioning or refrigeration system with HCFCs or HFCs? ..........6

6.1 When are service logs required to be kept for air conditioning and refrigeration systems?.........7

6.2 Are service logs required to be kept for small air conditioning systems or small refrigeration

systems?........................................................................................................................................7

7.1 Am I required to keep records, reports and notices?.....................................................................7

7.2 Where are records, reports and notices required to be kept?.........................................................7

8.1 When do I require a permit from Environment Canada for air conditioning and refrigeration

applications?..................................................................................................................................8

9.1 Am I required to report releases to Environment Canada?.............................................................8

9.2 Whom do I contact to report a halocarbon release of 100 kg or greater?.......................................9

9.3 Whom do I contact to report halocarbon releases of between 10 kg and 100 kg? .........................9

9.4 Whom do I contact in the event a leaking system is charged to prevent an immediate

danger to human life or health?......................................................................................................9

9.5 Whom do I send notification of charging a chiller with CFCs following on overhaul to?...............9

9.6 Where do I send reports for systems located at unoccupied premises? ........................................9

9.7 Where can I get additional information?.......................................................................................9

Appendix 1A List of Notification Numbers for Halocarbon Release Reports

Appendix 1B List of Regional Environment Canada Contacts for Written

Release Reports

Appendix 1C List of Environment Canada Contacts

Appendix 2A Suggested Dismantling, Destruction or Decommissioning Notice for a System

Appendix 2B Suggested Leak Test Notice for Refrigeration and Air Conditioning Systems

Appendix 2C Suggested Notice of Charging a Chiller with Items 1 to 9 of  Schedule 1 of the Regulations Following an Overhaul

Appendix 2D Suggested Refrigeration and Air Conditioning System Service Log

Appendix 2E Suggested Report for Systems Located on Unoccupied Sites or Premises

Appendix 2F Suggested Release Reporting Log for Halocarbon Refrigeration, Air Conditioning, Fire Extinguishing and Solvent Systems 1

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

The Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) is an

international treaty designed to control the production, importation and use of certain ozone-depleting substances (ODS). Since 1987, Canada has promulgated regulations to meet its Montreal Protocol commitments. To ensure a harmonized approach the federal, provincial and territorial governments have taken action to ensure that Canada’s national objectives and all obligations under the Montreal Protocol are met or exceeded.

The Federal Halocarbon Regulations, 2003 (FHR 2003) were published in August of 2003 under

the authority of the Canadian Environmental Protection Act, 1999 (CEPA 1999). The purpose of

these Regulations is to reduce and prevent emissions of ozone-depleting substances and of

their halocarbon alternatives to the environment from federal land, aboriginal land, federal

departments, boards, agencies, Crown corporations and federal works or undertakings. In

addition, the Regulations will assist in the development of strategic plans for the use, control

and phase-out of ODS and their halocarbon alternatives.

The purpose of replacing the Federal Halocarbon Regulations with the FHR 2003 was to

implement new initiatives under Canada’s Ozone Layer Protection Program and to address

various administrative issues in the Federal Halocarbon Regulations. The FHR 2003 is similar

to the repealed Federal Halocarbon Regulations, with the exception of the implementation of

new regulatory measures to achieve an orderly transition from CFCs and Halons to alternative

Surplus Stocks (Phase-Out Strategy) is part of the on-going process to fulfill Canada’s

commitment to protect the Earth’s ozone layer. Parties to the Montreal Protocol have agreed to

develop life-cycle management strategies for CFCs and Halons. The Phase-Out Strategy

consists of specific approaches to phase out the use of CFCs and Halons and to dispose of the

surplus of these substances. The Canadian Council of Ministers of the Environment (CCME)

approved the Phase-Out Strategy on May 1, 2001. A copy of the Phase-Out Strategy is available

The Phase-Out Strategy is the framework on which the various Canadian jurisdictions (federal,

provincial and territorial) will be basing their regulations. The FHR 2003 was developed, in part, to

implement the sector specific phase-out approaches outlined in the Phase-Out Strategy. The

provincial and territorial governments will be implementing similar control measures.

2

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

The term "halocarbon" encompasses most of the commonly known ozone-depleting substances

(ODS), as well as certain alternatives. The Regulations define a halocarbon as one or more of

the substances in Schedule 1 of the Regulations, as listed below, whether existing alone or in a

mixture, and including isomers of any such substance.

Item Halocarbon

1 Tetrachloromethane (carbon tetrachloride)

2 1,1,1-trichloroethane (methyl chloroform), not including 1,1,2-trichloroethane

3 Chlorofluorocarbons (CFCs)

4 Bromochlorodifluoromethane (Halon 1211)

5 Bromotrifluoromethane (Halon 1301)

6 Dibromotetrafluoroethane (Halon 2402)

7 Other Bromofluorocarbons

8 Bromochloromethane (Halon 1011)

9 Hydrobromofluorocarbons (HBFCs)

10 Hydrochlorofluorocarbons (HCFCs)

11 Hydrofluorocarbons (HFCs)

12 Perfluorocarbons (PFCs)

The FHR 2003 apply to halocarbon refrigeration, air conditioning, fire extinguishing and solvent

cleaning systems - as well as any associated containers or devices - that are

• located on federal land or aboriginal land (including systems which are owned by

tenants). The Regulations do not apply to public real property under the administration

and control of the Commissioner of Yukon pursuant to the Yukon Act;

• owned, as per the meaning of the Regulations, by the Federal Government (a department, an agency, a board);

• owned, as per the meaning of the Regulations, a Crown corporation; or

• owned, as per the meaning of the Regulations, a federal work or undertaking.

Companies and their personnel servicing these systems are also subject to these Regulations.

3

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

Yes. The FHR 2003 applies to all halocarbon air conditioning and refrigeration systems regardless

of the size or refrigeration capacity of the system.

Yes. Under CEPA 1999, designated enforcement officers are authorized to conduct inspections to

verify compliance with CEPA 1999 and its regulations. CEPA 1999 also requires the owner or

person in charge to give the enforcement officer reasonable assistance in their duties and to

provide any information that the enforcement officer may reasonable require.

CEPA 1999, every person who is found guilty of contravening or failing to comply with CEPA 1999

The FHR 2003 strictly prohibits any person from releasing into the environment any halocarbon

contained in a refrigeration or air conditioning system, or any associated containers or devices.

This also means that halocarbons may not be released into the atmosphere when using any

containers, devices or systems for the reuse, recycling, reclamation or storage of a halocarbon.

You are not permitted to install any refrigeration or air conditioning system operating or intended

to operate with a chlorofluorocarbon (CFC) refrigerant.

The installation of an air conditioning or refrigeration system containing a

hydrochlorofluorocarbon (HCFC) or a hydrofluorocarbon (HFC) refrigerant is permitted.

The Regulations do not prevent the purchasing of refrigerants; however, this must be done in

accordance with existing provincial and federal regulations.

The Regulations prohibit you from storing, transporting, or purchasing a halocarbon unless it is

in an appropriate container.

4

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

Note: The term “appropriate container” refers to a container which is designed to be refilled

and intended to contain a specific halocarbon. Appropriate containers may be cylinders or

drums and should be properly colour coded for the substance it contains as per the American

Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE) Standard. It should

of Practice) as published by Environment Canada.

Before dismantling, destroying, or decommissioning a refrigeration or air conditioning system,

you must recover the halocarbons into an appropriate container. This includes recovery from

systems that were charged with a halocarbon and which were part of some other equipment or

system located on a vehicle, vessel or building, that is being decommissioned, dismantled or

destroyed. Recovery of a halocarbon must be performed by a certified person and in

accordance with the procedures outlined in the Refrigerant Code of Practice.

Furthermore, a dismantling, decommissioning or destruction notice must be affixed on the

system containing the information prescribed in Item 1 of Schedule 2 of the Regulations. This

notice must not be removed unless a new notice is issued for the same purpose or the system

has reached its final destination for destruction. The system owner must retain a copy of the

notice for at least five years. A suggested form for dismantling, decommissioning or destruction

notices is included in Appendix 2A.

If you are responsible for a refrigeration or air-conditioning system, you must maintain it by a

certified person* and according to the manufacturer’s instructions. When the certified person

does any work on a refrigeration or air-conditioning system that may result in the release of a

halocarbon, (such as installing, servicing, leak testing or charging a halocarbon to the system),

the work must be performed in accordance with the procedures outlined in the Refrigerant Code

of Practice.

When recovering halocarbons, the halocarbon must be recovered into an appropriate container.

* Note: The term “certified person” refers to a technician that has successfully completed an

environmental awareness course in halocarbon recycling, recovery and handling procedures

that is recognized in three or more provinces or in the province in which the work is being done.

The owner must ensure that all of the components of a refrigeration or air-conditioning system

that come into contact with a halocarbon are leak tested at least once every 12 months. Small

5

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

Refrigeration systems, small air-conditioning systems and air conditioning systems contained in

motor vehicles are excluded.

The leak testing on a refrigeration or air-conditioning system that may result in the release of a

halocarbon must be performed by a certified person. The person who leak tests the

components of these systems must do so in accordance with the Refrigerant Code of Practice.

The Regulations prohibit the certified person from using chlorofluorocarbons (CFCs) to perform

a leak test on an air conditioning or refrigeration system, unless recommended by the

Refrigeration Code of Practice. As well, when leak testing the system, the certified person must

affix a notice on the system containing the information prescribed in Item 2 Schedule 2 of the

Regulations. No person is permitted to remove this notice unless they are replacing it with a

new notice. A suggested form for leak test notices is included in Appendix 2B.

If a leak is found in a refrigeration or air conditioning system the owner must, as soon as

possible, no later than seven days after the leak is detected, ensure that the leak is repaired,

the leaking portion of the system is isolated and the halocarbon recovered, or the halocarbon is

recovered from the whole system until the leak is repaired. The only exception is in the case of

immediate danger to human life or health. In such a circumstance, if the refrigeration or air conditioning system is charged before a detected leak was repaired or the halocarbon in the

system was not recovered from the isolated leaking components or from the system, the owner

must be notified immediately and the owner may operate the system for up to seven calendar

days. The owner must submit a written record to Environment Canada within seven days,

describing the nature of the immediate danger, the circumstances that justify the charging of the

system in order to prevent the danger, the amount of halocarbon charged to the system and the

date of repair of the leak or recovery of remaining halocarbons.

You are not permitted to operate any purge system unless it emits less than 0.1 kg of refrigerant

per kg of air purged to the environment. To achieve this emission standard, purge systems and/or

add-on devices that meet this efficiency must be installed.

A purge unit on a refrigeration or air-conditioning system means the actual unit, including any

associated exhaust recovery equipment.

The charging of a refrigeration or air-conditioning system with a halocarbon must be performed

by a certified person in accordance with the Refrigerant Code of Practice. Charging is

prohibited unless the system has been leak tested, the owner was notified if any leaks were

found and all found leaks were repaired.

The Regulations also prohibit the charging of certain air conditioning and refrigeration systems

with chlorofluorocarbons (CFCs). The prohibitions are outlined in section 5.0 of this document.

6

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

The Refrigerant Code of Practice is available on Environment Canada’s Stratospheric Ozone

request.

The most common CFC refrigerants are CFC-11 (R-11) and CFC-12 (R-12), as well as

refrigerant blends containing CFCs, such as R-500 and R-502.

Yes. It has been prohibited to charge an air-conditioning system designed for occupants in a

motor vehicle with CFCs since January 1, 2000.

It is prohibited to charge a mobile refrigeration system with CFCs effective 90 days after the

coming into force of the Regulations. Chillers and systems used on a military ship are excluded.

Mobile refrigeration systems refer to systems that are installed in with a means of transportation,

including, but not limited to ships, aircraft, trains and trucks.

It is prohibited to charge an air conditioning or a refrigeration system with CFCs effective

January 1, 2005. Small air conditioning systems, small refrigeration systems, chillers and

systems used on a military ship are excluded.

Effective January 1, 2005, it is prohibited to charge, with CFCs, a chiller following an overhaul.

An overhaul refers to the procedure or repairs that

• required the replacement of any internal sealing devices;

• required the replacement of any internal mechanical parts, other than oil heaters, oil pumps,

float assemblies, and vane assemblies in the case of chillers with single-stage compressors;

or

• resulted from the failure of an evaporator or condenser heater exchanger tubes.

An exemption to allow for the charging of a chiller and its continued operation with CFCs

following an overhaul is available on the condition that the system is converted, replaced or

removed from service no later than 12 months from the date of the charge. This exemption also

requires certain information, prescribed in Item 3 of Schedule 2 of the Regulations, to be

reported to Environment Canada within 14 days of the date of charge. A suggested form for

7

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

notification of charging a chiller with CFCs following an overhaul is included in Appendix 2C and

contact information is presented in Section 9.5 of this document.

No. The charge prohibitions apply only to air conditioning and refrigeration systems containing

CFCs. Therefore, systems operating with HCFC or HFC refrigerants are not subject to the

charge prohibitions.

Service logs are required to be maintained whenever a halocarbon refrigeration or air conditioning

system is installed, serviced, leak tested, charged or has any other work done on it

that may result in the release of a halocarbon. These records must be maintained in a written

format or in an electronic format if it is approved by the Minister of the Environment. Service

logs must include the information prescribed in Item 5 of Schedule 2 of the Regulations. A

suggested form for service logs is included in Appendix 2D.

Yes. Service logs are required to be maintained for all halocarbon-containing air conditioning

and refrigeration systems regardless of the size or refrigeration capacity of the system.

Yes. All records, reports, service logs and notices required by the FHR 2003 must be kept for a

period of at least five years from the date that they are prepared or submitted, respectively.

All records, reports, service logs and notices for halocarbon systems are required to be kept at

the location where the system is located.

For mobile and unoccupied locations, the records, reports, service logs and notices must be

kept at a single location occupied by the owner. Furthermore, the owner of systems located at

unoccupied premises or sites, is required to submit a report, containing the information

prescribed in Item 11 of Schedule 2 of the Regulations, to Environment Canada no later than

January 1, 2004. Any change to this information must also be reported to Environment Canada.

A suggested form for reports of systems located on unoccupied sites or premises is included in

Appendix 2E.

8

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

Permits are not available for air conditioning or refrigeration applications.

There are three possible situations in which reporting of releases are necessary for air

conditioning or refrigeration systems:

within 24 hours of the detecting the release. This report must be submitted to the persons

providing regional 24-hour emergency telephone service at the numbers listed in Appendix

1A. The report must indicate the name of the owner, the type of halocarbon released as well

as the type of system from which it was released. In addition, within 14 days of detecting the

release, the owner must submit a written report to the Environment Canada regional release

reporting contact listed in Appendix 1B, which includes the information prescribed in Item 8 of

Schedule 2 of the Regulations.

written report is submitted to Environment Canada no later than 30 calendar days after

January 1st and July 1st for each calendar half-year. That is, releases between 10 kg and

100 kg that occur between January 1st and June 30th must be reported no later than July 30th

and releases that occur between July 1st and December 31st must be reported no later than

January 30th.of the following calendar year. This report must be submitted to the

Environment Canada regional release reporting contact listed in Appendix 1B, and must

include the information prescribed in Item 8 of Schedule 2 of the Regulations.

record to the Minister of the Environment within seven days. The record must be submitted

to the Environment Canada regional release reporting contact listed in Appendix 1B. The

record must describe the nature of the immediate danger, the circumstances that justify the

charging of the system in order to prevent the danger, the amount of halocarbon charged to

the system and the date of repair of the leak or recovery of remaining halocarbons.

9

This document explains some of the requirements of the Federal Halocarbon Regulations, 2003.

Environment Canada contact information to report a halocarbon release of 100 kg or greater is

presented Appendix 1A (24-hour report) and Appendix 1B (14-day report). A suggested form

for halocarbon release reports is included in Appendix 2F.

Environment Canada contact information to report halocarbon releases of between 10 kg and

100 kg is presented Appendix 1B. A suggested form for halocarbon release reports is included

in Appendix 2F.

Environment Canada contact information to report charging a leaking system to prevent an

immediate danger to human life or health is presented Appendix 1B.

Environment Canada contact information to report the charging of a chiller following an overhaul

is as follows:

Ozone Protection Programs Section

Chemicals Control Division

Environment Canada

351 St. Joseph Blvd., 12th Floor

Gatineau, Quebec

K1A 0H3

Tel: (819) 997-1640

Fax: (819) 994-0007

Environment Canada contact information to submit a report for systems located at unoccupied

premises is presented in Appendix 1B.

To obtain a copy of the Federal Halocarbon Regulations, 2003, the FAQs, or for further information

on the Federal Halocarbon Regulations, 2003, please contact:

Ozone Protection Programs Section

Chemicals Control Division

Environment Canada

351 St. Joseph Blvd., 12th Floor

Gatineau, Quebec

K1A 0H3

Telephone: (819) 997-1640

Fax: (819) 994-0007

Nova Scotia, PEI, and New Brunswick 1-800-565-1633

Newfoundland and Labrador 1-800-563-9089

Pacific and Yukon Region 604-666-6100

British Columbia and the Yukon Territory

Alberta 780-499-2432

Manitoba 204-981-7111

Saskatchewan 306-536-9991

Northwest Territories 867-920-8130

Nunavut 867-920-8130

Ontario Region 416-346-1971

Quebec Region 1-866-283-2333

*Please note that some of these numbers are not toll-free, but they will likely accept such charges.

Atlantic Region Head, Pollution Control Section

Office of Enforcement

Environment Canada

16th Floor, Queen Square 45 Alderney Drive Dartmouth, Nova Scotia B2Y 2N6

Pacific and Yukon Region Head, Inspections Section

Enforcement and Emergencies Division

Environment Canada

4th Floor, #201 - 401 Burrard Street Vancouver, BC V6C 3S5

Prairie and Northern Region Manager

Regional Enforcement and Emergencies

Division

Twin Atria 2 #200-4999-98th Ave. Edmonton, Alberta

T6B 2X3

Ontario Region Manager

Environmental Protection Branch – Ontario

Region

Emergencies and Enforcement Division

Environment Canada

4905 Dufferin St. Downsview, Ontario M3H 5T4

Quebec Region Director

Environment Canada

Environmental Protection Branch

105 Rue McGill, 4th Floor Montreal, Quebec H2Y 2E7

Mr. William H. Moores

Environment Canada

Queen Square, 45 Alderney Drive Dartmouth, Nova Scotia

B2Y 2N6

Phone: .(902) 426-2004

Fax: (902) 426-3897

E-mail: William.Moores@ec.gc.ca

Linda Bily

Environment Canada

Suite 201 - 401 Burrard Street Vancouver, BC V6C 3S5

Phone: (604) 666-2732

Fax: (604) 666-6800

E-mail: Linda.Bily@ec.gc.ca

Kate Spencer

Environmental Protection Service

Twin Atria No. 2 200-4999-98th Avenue Edmonton, Alberta T6B 2X3

Phone: (780) 951-8766

Fax: (780) 495-2758

E-mail: Kate.Spencer@ec.gc.ca

Heather Strathearn

Environmental Protection Service

Environment Canada

49 Camelot Drive Nepean, Ontario K1A 0H3

Phone: (613) 952-7598

Fax: (613) 952-8995

E-mail: Heather.Strathearn@ec.gc.ca

Federal Works and Undertakings Christine Brunski

Ontario Region, EPB

4905 Dufferin St.

Downsview, Ontario

M3H 5T4

Phone: (416) 739-5877

Fax: (416) 739-4405

E-mail: Christine.Brunski@ec.gc.ca

Quebec Region Daniel Ekoualla

Direction de la protection de l’environnement

Environnement Canada

4th floor, 105 McGill St. Montréal, Québec

H2Y 2E7

Ph: (514) 283-0245

Fax: (514) 283-5836

E-mail: daniel.ekoualla@ec.gc.ca

Headquarters Greg Carreau

Ozone Protection Programs Section

Chemicals Control Division

Environment Canada

351 St. Joseph Blvd., 12th Floor Gatineau, Quebec K1A 0H3

Phone: (819) 953-6072

Fax: (819) 994-0007

E-mail: greg.carreau@ec.gc.ca

*This form is provided purely as a guide. The design of your form must contain the information prescribed in Item 1 of Schedule 2 of the Regulations.

_______________________ Type of Halocarbon: _______________________

_______________________

Charging capacity: ________________________

_______________________

_________________________________________

_________________________________________

*This form is provided purely as a guide. The design of your form must contain the

information prescribed in Item 2 of Schedule 2 of the Regulations.

Date of Leak Test:______________

Date of previous Leak Test: :______________

Technician/Contractor Name __________________________________

Technician’s Certificate Number __________________________________

Service company/Technician employer __________________________________

Name of Owner ____________________________________________

Address of Owner ____________________________________________

Operator Name (if different from owner) __________________________________

Location of System ____________________________________________

Type of halocarbon _________________

Charging Capacity of the System ____________kg

Equipment Serial Number: __________________________________

Equipment Model Number: __________________________________

Signature of Service Technician_________________________

*This form is provided purely as a guide. The design of your form must contain the

information prescribed in Item 3 of Schedule 2 of the Regulations.

Name of Owner ________________________________________

Address of Owner ________________________________________

Specific Location of the System _______________________________________

Type of Halocarbon Charged _________________

Quantity of Halocarbon Charged ____________kg

Charging Capacity of the System ____________kg

Equipment Serial Number: __________________________________

Equipment Model Number: __________________________________

Date of Overhaul ____________

Date of Charge: ____________

Date of Conversion of Removal from Service: _________________

*This form is provided purely as a guide. The design of your form must contain the information prescribed in Item 5 of Schedule 2 of the Regulations.

*This form is provided purely as a guide. The design of your form must contain the

information prescribed in Item 11 of Schedule 2 of the Regulations.

Name of Owner ____________________________________________

Address of Owner ____________________________________________

Type of System (circle one) solvent refrigeration/air conditioning fire extinguishing

Equipment Serial Number: __________________________________

Equipment Model Number: __________________________________

Street Address of Unoccupied Premise or Site: _____________________________________

_____________________________________

_____________________________________

Street Address of the Location of Records, Reports and Notices: _____________________________

_____________________________

_____________________________

*This form is provided purely as a guide. The design of your form must contain the information prescribed in Item 8 of Schedule 2 of the Regulations.

Name of Owner ____________________________________________

Address of Owner ____________________________________________

Location of the system ____________________________________________

Type of System (circle one) solvent refrigeration/air conditioning fire extinguishing

Equipment Serial Number: __________________________________

Equipment Model Number: __________________________________

Date of

release

Type of

halocarbon

released

Quantity of

release

(kg)

Circumstances leading to

the release

Corrective action and actions to

prevent subsequent releases

taken

Signature ____________________________

Name ____________________________

Title ____________________________