Form 5900-149 Exporter Annual Report and Article 5 Exporter Quarterly

Recordkeeping and Periodic Reporting of the Production, Import, Export, Recycling, Destruction, Transhipment, and Feedstock Use of Ozone-Depleting Substances (Renewal)

Exporter ClassI 5900-149

Recordkeeping and Periodic Reporting of the Production, Import, Export, Recycling, Destruction, Transhipment, and Feedstock Use of Ozone-Depleting Substances (Renewal)

OMB: 2060-0170

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2060-0170 can be found here:

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OMB Control Number: 2060-0170

Expiration Date: 12/31/11

U.S. Environmental Protection Agency

stratospheric ozone protection program

class i controlled substance

exporter - annual report (Sec 82.13) and

a5 exporter - quarterly report (Sec 82.11)

SECTION 1 EXPORTING COMPANY IDENTIFICATION

1.1 Date of Submission

1.2 Number of Transact  ions Reported

1.2 Original Submittal Re-submittal

1.3 Number of Transactions Reported

 

1.4 Number of Pages Submitted

 

1.5 Quarter to Which This Report Applies
(A5 only)

1^st

2^nd

3^rd

4^th

1.6 Year to Which This Report Applies:

Year  

1.7 Exporting Company Information

Company Name  

Street Address  

City  

State  

Zip Code  

1.8 Company Contact Identification

Reporting Company Contact Person

 

Phone Number
 

Fax Number
 

E-mail Address

1.9 Signature of Reporting Company Representative

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment.

Name  

Title  

Signature  

Date  

SEND COMPLETED FORMS TO:

For U.S. Postal Service:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1200 Pennsylvania Avenue, NW

Washington, DC 20460

For Private Courier:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1310 L Street, NW; 10^th Floor

Washington, DC 20005

Information in reports submitted in compliance with the final rule may be claimed as confidential. A company may assert a claim of confidentiality for information submitted by clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public without further notice to the company (40 CFR 2.203).

The public reporting and recordkeeping burden for this collection of information is estimated to average 2.4 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

EPA Form # 5900-149, Revised 08/08

OMB Control- Number: 2060-0170

Expiration Date: 12/31/11

U.S. Environmental Protection Agency stratospheric ozone protection program								class i controlled substance exporter - annual report (Sec 82.13) and a5 exporter - quarterly report (Sec 82.11)
SECTION 2.B	TRANSACTION RECORDS FOR QUARTERLY A5 EXPORTER REPORT (For Exports of Class I ODS Produced with A5 Allowances to A5 Countries) (Reproduce additional sheets as needed)
2.1 Company Name
2.2 Transaction Summaries

TRANSACTION #
Recipient Company Name					Street Address
City				Country					Postal Code
Company Contact Person					Phone Number				Fax Number
Quantity of Commodity Exported (kg)
Class I Substance Exported							Quantity of Class I Substance Exported (kg)
Source Company of Class I Substance Exported							Date Purchased (if applicable)
Date of Export (mm/dd/yy)			Port of Export from the U.S.					Exporter EIN from Customs Form 7525
TRANSACTION #
Recipient Company Name						Street Address
City				Country					Postal Code
Company Contact Person						Phone Number			Fax Number
Quantity of Commodity Exported (kg)
Class I Substance Exported							Quantity of Class I Substance Exported (kg)
Source of Class I Substance Exported							Date Purchased (if applicable)
Date of Export (mm/dd/yy)			Port of Export from the U.S.					Exporter EIN from Customs Form 7525
TRANSACTION #
Recipient Company Name					Street Address
City				Country					Postal Code
Company Contact Person					Phone Number				Fax Number
Quantity of Commodity Exported (kg)
Class I Substance Exported							Quantity of Class I Substance Exported (kg)
Source of Class I Substance Exported							Date Purchased (if applicable)
Date of Export (mm/dd/yy)			Port of Export from the U.S.					Exporter EIN from Customs Form 7525

File Type	application/msword
Author	Mollie Barwis
Last Modified By	ICF
File Modified	2008-08-20
File Created	2007-03-13