5900-151 Producer Quarterly Report

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

Producer_ClassI

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: 6/30/15


U.S. Environmental Protection Agency

stratospheric ozone protection program

class i controlled substance

producer quarterly report

(Sec 82.13)

SECTION 1 PRODUCING COMPANY IDENTIFICATION


1.1 Date of Submission

     

1.2 Original Submittal Re-submittal

1.3 Producing Company

Company Name      

Street Address      












City      




State      


Zip Code      


1.4 Company Contact Identification

Reporting Company Contact Person

     


Phone Number

     

Fax Number

     

E-mail Address      

1.5 Quarter and Year to Which This Report Applies

1st

2nd

3rd

4th

Year      

1.6 Importer Information

Is your company an Importer of Class I substances?

If yes, is the Importer Quarterly Report attached?

Yes

Yes

No

No

1.7 Exporter Information

Is your company an Exporter of Class I 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:

U.S. EPA
Stratospheric Protection Division
Office of Atmospheric Programs
Mail Code: 6205T
1200 Pennsylvania Avenue, N.W.
Washington, DC 20460

For Private Courier:

U.S. EPA

Tracking System Program Manager

Stratospheric Protection Division
William Clinton East Building, Room 1340

1201 Constitution Avenue, N.W.

Washington, DC 20004

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 2.1 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
producer quarterly report

(Sec 82.13)

SECTION 2 COMPANY PRODUCTION DATA

2.1 Company Name

     

2.2 Company Production Totals



A

B

C

D

E

F

G

Chemical Name

Essential-Uses

In-House Transformation (kg)

Second-Party Transformation (kg)

In-House Destruction (kg)

Second-Party Destruction (kg)

Gross Production of Class I Substance

(B + C + D + E + F = G) (kg)

Global Laboratory Exemption (kg)

Other Essential-Uses (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 # 5900-151, Revised 5/15

File Typeapplication/msword
AuthorGrace Lange
Last Modified ByJette, Gabrielle
File Modified2015-07-10
File Created2015-07-10

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