5900-202 Class Ii Controlled Substance Producer Quarterly Report

OMB Control Number: 2060-0498

Expiration Date: TBD

U.S. Environmental Protection Agency stratospheric ozone protection program

class ii controlled substance producer quarterly report (Sec 82.24)

SECTION 1 PRODUCING COMPANY IDENTIFICATION

1.1 Date of Submission

     

1.2 Original Submittal Re-submittal

1.3 Quarter and Year to Which This Report Applies

1st

2nd

3rd

4th

Year           

1.4 Producing Company

Company Name      

Street Address      

City      

State      

Zip Code      

1.5 Company Contact Identification

Reporting Company Contact Person      

E-mail Address      

Phone Number      

Fax Number      

1.6 Importer Information

Is your company an importer of class II substances? If yes, is the Importer Quarterly Report attached?

Yes Yes

No No

1.7 Exporter Information

Is your company an exporter of class II substances? If yes, is the Exporter Quarterly Report attached?

Yes Yes

No No

1.8 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 4.5 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 # 5900-202, Revised 10/12

OMB Control Number: 2060-0498

Expiration Date: TBD

U.S. Environmental Protection Agency stratospheric ozone protection program							class ii controlled substance producer quarterly report (Sec 82.24)
SECTION 2 COMPANY PRODUCTION DATA
2.1 Company Name		     
2.2 Company Production Totals
A	B		C	D	E	F	G	H	I
Chemical Name	Gross Production (kg)		In-House Transformation (kg)	Second-Party Transformation (kg)	In-House Destruction (kg)	Second-Party Destruction (kg)	HCFC-141b Exemption (kg)	Article 5 Production (kg)	Net Production (kg) (B- C- D- E- F- G- H = I)
HCFC-22	     		     	     	     	     	     	     	     
HCFC-123	     		     	     	     	     	     	     	     
HCFC-124	     		     	     	     	     	     	     	     
HCFC-141b	     		     	     	     	     	     	     	     
HCFC-142b	     		     	     	     	     	     	     	     
HCFC-225ca	     		     	     	     	     	     	     	     
HCFC-225cb	     		     	     	     	     	     	     	     
If needed, please write in HCFC not listed above     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     
     	     		     	     	     	     	     	     	     

EPA Form # 5900-202, Revised 10/12

OMB Control Number: 2060-0498

Expiration Date: TBD

U.S. Environmental Protection Agency stratospheric ozone protection program							class ii controlled substance producer quarterly report (Sec 82.24)
SECTION 3 ALLOWANCE EXPENDITURE TOTALS
3.1 Company Name		     
3.2 Allowance Balance Summary
A	B			C				D
Chemical Name	Total production allowances for year to date (as of the end of the quarter) that were:			Total consumption allowances for year to date (as of the end of the quarter) that were:				Total Article 5 allowances for year to date (as of the end of the quarter) that were:
	Expended		Unexpended	Expended		Unexpended		Expended	Unexpended
HCFC-22	     		     	     		     		     	     
HCFC-123	     		     	     		     		     	     
HCFC-124	     		     	     		     		     	     
HCFC-142b	     		     	     		     		     	     
HCFC-225ca	     		     	     		     		     	     
HCFC-225cb	     		     	     		     		     	     
If needed, please write in HCFC not listed above      	     		     	     		     		     	     
     	     		     	     		     		     	     
     	     		     	     		     		     	     
     	     		     	     		     		     	     
     	     		     	     		     		     	     
3.3 Name(s) of HCFC-141b Exemption Allowance Holder(s) from whom Orders were Received and Associated Quantity (kg) of HCFC-141b Requested and Produced
Company Name:      					HCFC-141b Requested and Produced (kg):      
Company Name:      					HCFC-141b Requested and Produced (kg):      
Company Name:      					HCFC-141b Requested and Produced (kg):      
Company Name:      					HCFC-141b Requested and Produced (kg):      
Company Name:      					HCFC-141b Requested and Produced (kg):      

EPA Form # 5900-202, Revised 10/12