5900-147 Second-Party Transformation Annual Report

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

2ndParty Trans ClassI 5900-147

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

OMB: 2060-0170

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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

second-party transformation

annual report (Sec 82.13)

SECTION 1 COMPANY IDENTIFICATION

1.1 Date of Submission

     

1.2 Year To Which This Report Applies

     

1.3 Original Submittal Re-submittal

1.4 Have you submitted an IRS certificate of intent to transform to the producer or importer (per Sec 82.13)?

Yes No

Date Submitted:

     

1.5 Company Information

Company Name      


Street Address      



City      



State      

Zip Code      

1.6 Company Contact Identification

Reporting Company Contact Person
     

Phone Number
     

Fax Number
     

E-mail Address      

1.7 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; 10th 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.


U.S. Environmental Protection Agency

stratospheric ozone protection program


class i controlled substance

second-party transformation

annual report (Sec 82.13)

SECTION 2 TRANSFORMATION SUMMARY

2.1 Company Name

     

2.2 Transformation Totals

A

B

Chemical Name

Second-Party Transformation of Class I Substance (kg)

CFC-11

     

CFC-12

     

CFC-13

     

CFC-111

     

CFC-112

     

CFC-113

     

CFC-114

     

CFC-115

     

Other CFCs (please specify)      

     

     

     

     

     

HBFCs (please specify)      

     

     

     

     

     

Halons (please specify)      

     

     

     

     

     

Carbon Tetrachloride

     

Methyl Chloroform

     

CBM

     


EPA Form # 5900-147, Revised 08/08

File Typeapplication/msword
AuthorMollie Barwis
Last Modified ByICF
File Modified2008-08-20
File Created2007-03-13

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