Document n9NBogwwv8k00ypxdZEYqn5Yw

version 9.27.2022 HFC Import Inspection Worksheet Insp. No: 20231206-0810 Insp. Date: 12/6/2023 This workskeet is for inspection of Imported Hydrofluorocarbons (HFCs) subject to 40 CFR Part 84 Inspector(s): E. Felix N. Dancher Start Time/Stop Time: Start 8:03am, End 9:00am A. Isin J. Iatropulos Facility Name: Price 3 Address: 1119 E 230th St, Carson, CA 90745 Indicate here if entry was not filed at time of inspection Importer Name: Mexichem Fluor Inc. Importer Address: 4990B ICI Road, PO Box 30, St. Gabriel, LA 70776 Importer No : 27-178566700 Location of Inspection Facility Type: Customs and Border Protection (CBP) Warehouse CBP POC Contact Information: Kent Koike, 310-971-2700 Importer Information (from Entry Documents) Indicate here if consignee is the same as importer Consignee Name: Consignee Address: POC Contact Information: sean.cunningham@mexichem.com Product Description: HFC-134A Chemical name/formula: 1,1,1,2-Tetrafluoroethane Container Type: Service Can Ton Tank ISO Tank Refillable Cylinder Disposable Cylinder Visual Inspection HFC #1 Shipment/ Entry No: 916-5041625-7 Shipping Container No: INFL1001123 Arrival Date: 11/27/2023 Listed Qty: 1 Listed Mass: see below Actual Mass: N/A lb kg ton On tank: Max Gross: 36,000 kg, Tare: 6,340 kg, Capacity: 21,500 Liters Entry summary form and invoice list 17,880 kg. Product Description: Chemical name/formula: Container Type: Visual Inspection Notes: Service Can Ton Tank ISO Tank Refillable Cylinder Disposable Cylinder Visual Inspection HFC #2 Shipment/ Entry No: Shipping Container No: Arrival Date: Listed Qty: Listed Mass: Actual Mass: lb kg ton Product Description: Chemical name/formula: Container Type: Visual Inspection Notes: Service Can Ton Tank ISO Tank Refillable Cylinder Disposable Cylinder Visual Inspection HFC #3 Shipment/ Entry No: Shipping Container No: Arrival Date: Listed Qty: Listed Mass: Actual Mass: lb kg ton Evidence/Samples taken and Description: None Inspection Summary Potential Follow-Up/Areas of Concern (e.g. potential deficiencies, actions taken by facility (if applicable)): N/A Inspection photo numbers: PC060001.jpg-PC060022.jpg Camera Information: Nikon Coolpix WD300 Sony Olympos Other: Photographer: E. Felix Lead Inspector Signature: Digitally signed by AMELIE ISIN Date: 2023.12.22 AMELIE ISIN 13:39:36 -05'00' Supervisor Signature: MARK PALERMO Guidance for Inspectors: Inspector should obtain copies of the following when conducting inspections for CBP: Entry documents Invoice/Packing lists Bill of lading Inspector should obtain the following key photographs: All sides of container to include any labels. N. Dancher A. Isin Digitally signed by MARK PALERMO Date: 2024.01.01 09:46:53 -05'00' J. Iatropulos