5900-404 Reclamation Report

National Refrigerant Recycling and Emissions Reduction Program (Final Rule)

5900-404 Reclamation Report.xlsm

National Refrigerant Recycling and Emission Reduction Program

OMB: 2060-0256

Document [xlsx]
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Overview

Section 1
Section 2


Sheet 1: Section 1












U.S. Environmental Protection Agency
OMB Control Number: 2060-0256

Stratospheric Protection Division
Expiration Date: MM/DD/YYYY

Reclamation Annual Report (Sec 82.166)








Instructions



Complete this form by filling in the data fields that are highlighted in blue. Use the arrows to navigate between the tabs.



To submit, please send your completed report to: [email protected].






Section 1: Report Identification Information



Date of Submission:



Reporting Year:








Company Name:


Street Address:


City:


State:


ZIP code:







Contact Person Name:


Email Address:


Phone Number:


Fax Number:







All information submitted to EPA will be treated as confidential in accordance with 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart.

The public reporting and recordkeeping burden for this collection of information is estimated to average 9.4 hours per year. 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 Avenue NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

EPA Form #5900-404




















Sheet 2: Section 2















U.S. Environmental Protection Agency




Stratospheric Protection Division




Reclamation Annual Report (Sec 82.166)










Company Name:



Reporting Year:









Section 2: Reclamation Data




Mass of Waste Products (kg)










Name of the Refrigerant Reclaimed Mass of Material Received (kg) Mass of Refrigerant Reclaimed (kg)


TOTAL 0.00 0.00
































































































































If "Other" is selected in the table above, please specify the refrigerant type below:












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