Get Aqmd Rule 1415

South Coast Air Quality Management District Mail To SCAQMD Area Sources 21865 Copley Dr. Diamond Bar CA 91765 Form R1415 Registration Form for Rule 1415 Refrigerant Usage for Air Conditioning Systems Tel 909 396-2390 www. aqmd. gov For online instructions and current fees click here. Section A - Operator Information 1. Facility Name Business Name of Operator 2. South Coast Air Quality Management District Mail To SCAQMD Area Sources 21865 Copley Dr. Diamond Bar CA 91765 Form R1415 Registration Form for Rule 1415 Refrigerant Usage for Air Conditioning Systems Tel 909 396-2390 www. aqmd. gov For online instructions and current fees click here. Section A - Operator Information 1. Facility Name Business Name of Operator 2. Valid AQMD Facility ID Leave blank if a new business 3. Owner s Business Name If different from Business Name of Operator Section B - Equipment Location Address Section C - Business Mailing Address 4. Equipment Location Is 5. Correspondence Information Check here if same as equipment location address Street Address Address CA City Contact Name Zip Title Phone Ext. E-Mail State 6. For each air conditioning system at the above facility location that holds 50 lbs. of high global warming potential refrigerant e*g* CFC Chlorofluorocarbon HCFC Hydrochlorofluorocarbon HFC Hydrofluorocarbon PFC PERFLUOROCARBON etc please provide the following information Unit lbs. Manufacturer Model Number Serial Number Refrigerant Type Storage Capacity lbs. of Annually lbs. Date of Last Audit/ Maintenance Usage Year If there are more than 10 units please attach an additional form* Section E - Facility Business Information 7. What type of business is being conducted at this equipment location Section F - Authorization/Signature 9. Signature of Responsible Official I hereby certify that all information contained herein and information submitted with this application are true and correct. 10. Title of Responsible Official 11. Print Name 12. Date 13. Check List DATE Authorized Signature/Date APPLICATION TRACKING AQMD USE ONLY A 8. What is your business primary NAICS Code North American Industrial Classification System R ENG*A Fees Enclosed EQUIPMENT CATEGORY CODE CLASS I III FEE ASSIGNMENT Engineer CHECK/MONEY ORDER VALIDATION AMOUNT TRACKING Reset Print. aqmd. gov For online instructions and current fees click here. Section A - Operator Information 1. Facility Name Business Name of Operator 2. Valid AQMD Facility ID Leave blank if a new business 3. Owner s Business Name If different from Business Name of Operator Section B - Equipment Location Address Section C - Business Mailing Address 4. Valid AQMD Facility ID Leave blank if a new business 3. Owner s Business Name If different from Business Name of Operator Section B - Equipment Location Address Section C - Business Mailing Address 4. Equipment Location Is 5. Correspondence Information Check here if same as equipment location address Street Address Address CA City Contact Name Zip Title Phone Ext. Equipment Location Is 5. Correspondence Information Check here if same as equipment location address Street Address Address CA City Contact Name Zip Title Phone Ext. E-Mail State 6. For each air conditioning system at the above facility location that holds 50 lbs. of high global warming potential refrigerant e*g* CFC Chlorofluorocarbon HCFC Hydrochlorofluorocarbon HFC Hydrofluorocarbon PFC PERFLUOROCARBON etc please provide the following information Unit lbs.