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Run: Refrigerant Section 609 Certification Verification Log

Log each small-can refrigerant sale with the purchaser’s Section 609 status, product details, and staff attestation in one place. Use it to document complian...

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Transaction Details

Date of Sale (required)

Date the refrigerant was sold or dispensed at the counter.

Time of Sale (required)

Approximate time of the counter transaction.

Store / Location Name (required)

Retail location where the sale occurred.

Transaction / Receipt Number

Optional POS receipt or invoice number for cross-reference.

Purchaser Information

Purchaser Full Name (required)

Name as it appears on the certification card or government-issued ID.

Business / Employer Name

Name of the shop or employer the purchaser represents, if applicable.

Purchaser Phone Number

Optional contact number for follow-up if a discrepancy is identified.

Government-Issued ID Type Presented (required)

Type of photo ID used to confirm purchaser identity.

Last 4 Characters of ID Number

Record only the last 4 characters of the ID number — do not record the full ID number.

EPA Section 609 Certification Verification

Was a valid EPA Section 609 certification card presented? (required)

Certifying Organization Name

Name of the EPA-approved organization that issued the Section 609 certification.

Certification Card Number

Record the certification number exactly as printed on the card.

Certification Expiration Date (if shown)

Note: EPA Section 609 certifications do not expire, but some organizations issue cards with dates. Record if present.

Certification Type / Scope

Select all certification categories listed on the card, if specified.

Reason Sale Was Refused

Required if certification was not verified. Document the reason for refusal for your records.

Exemption Basis

Describe the specific regulatory basis for the exemption under 40 CFR Part 82 Subpart F.

Refrigerant Product Details

Refrigerant Type / Designation (required)

Select the ASHRAE refrigerant designation of the product sold.

Product Brand / Trade Name

Commercial brand name as labeled on the container.

Container Size (oz) (required)

Net weight of refrigerant per container in ounces. Containers ≤2 lbs (32 oz) trigger Section 609 verification requirements.

Number of Containers Sold (required)

Total number of containers sold in this transaction.

UPC / SKU

Product UPC or internal SKU for inventory cross-reference.

Staff Attestation

Staff Member Name (required)

Name of the employee who conducted the verification and completed this log.

Employee ID / Badge Number

Optional employee identifier for internal audit trail.

Staff Attestation (required)

Check to confirm your attestation before submitting.

Yes No N/A

Additional Notes

Use this field to document unusual circumstances, unreadable cards, verbal certifications pending written proof, or any other relevant detail.

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