Document GbXkr9224rK59q0vp0Yvoww7

version 12.03.2024 Inspection Number: Insp. Date: Insp. Time Start/End: Refrigeration, Air Condition, and Heat Pump (RACHP) Field Inspection Worksheet for products subject to 40 CFR Part 84, Subpart B Use this form for: All RACHP Products (not all fields will be applicable for every product) General Inspection Information CT-2-13-25-01 2/13/2025 8:30 am / 10:30 am Inspector(s): Photographer(s): Photograph # Range: Christine Tokarz Christine Tokarz IMG_0203 to IMG_0238 Facility Name: Address: Location of Inspection ATS Logistics 4033 W Montague Ave, North Charleston, South Carolina 29418 Facility Type: CBP POC Information: CES Warehouse Officer Bonnie Tupper, bonnie.s.tupper@cbp.dhs.gov Entry Summary: Bill of Lading: Other (Please Describe): Check all that Apply Packing List: Invoice: Import Documents Collected Original Shipping/Targeting documents Describe "Other" Documents: Name: Address: City/State/Zip: POC Name & Title: Email & Phone: Shipment Information (from Entry Docs) Entry/Shipment No: CDY-03572451 Arrival/Import Date: 28-Jan-25 Entry File Date: Importer Information (from Entry Docs) Florim USA 300 International Boulevard Clarksville, Tennessee 37040 Greg Haupt, Purchasing Manager GHaupt@FlorimUSA.com Name: Address: City/State/Zip: POC Name & Title: Email & Phone: Check box if entry was not filed at time of inspection Consignee Information (from Entry Docs) Check box if the same as Importer: Other Contacts (optional): Other CBP Officers that assisted: TOMMASINI, JOSEPH J <JOSEPH.J.TOMMASINI@cbp.dhs.gov> , Shipper was General Noli USA Inc., 154-89 146th Avenue, 3rd Floor, Jamaica New York, New York 11434 Item # 1 2 Contents of Shipment from Import Documents (Add additional lines in separate sheet as needed) Product Description/Subsector Indicated HFC(s) Air Conditioner ANL 100H6 (product) R410A Compressor Tecumseh TAG4534Y 230 V R134A Listed Quantity 12Kg per product none Item # 1 Product Manufacturer Aermec Physical Inspection and Label Information required by 84.58(a) Product Name on Package SKU HFC or GWP Indication on label DOM Single Wall Heat Exchanger ANL100HA R-410A 2024 (no day or month) Listed Charge 12.7 Units kg Quantity 4 2 Tecumseh TAG4537Y R-134A none listed none listed 3 3 Aermec Rectangular Filters none none listed none listed g oz. 4 4 Ducts none none listed none listed g oz. various g lb Comments (include areas of concern (e.g., no label observed)) Shipping Documents prior to entry had the following cargo description, "Dangerous Goods==1 pkg GW 3114,00 KG NW 2200,00 KG UN 2857, REF Refrigerating Machines, Class 22, EMS: F-C, S-V 1 X Wooden Box Containing 4 Refrigerating Machines X 550 KG Each (Gas R410A12.7 KG Each) Air Conditioner/Compressor HS Code 841510". The Heat Exchangers were each charged with 12.7 kg of R410A (>700GWP). Compressors were empty and label included "R-134a". Inspector Signature & Date: CHRISTINE TOKARZ Digitally signed by CHRISTINE TOKARZ Date: 2025.03.03 13:22:36 -07'00' Supervisor Signature & Date: AMELIE ISIN Digitally signed by AMELIE ISIN Date: 2025.03.03 15:28:07 -05'00' Page 1 of 1