5900-199 Class II Exporter Quarterly Report

Production, Import, Export, Recycling, Destruction, Transhipment, and Feedstock Use of Ozone-Depleting Substances (Proposed Rule)

class_ii_exporter_v3.0.xlsm

Production, Import, Export, Destruction, Transhipment, and Exempted Uses of Ozone-Depleting Substances (Renewal)

OMB: 2060-0170

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Section 1
Section 2
Summary
Blend Breakout
Reference List


Sheet 1: Instructions





U.S. Environmental Protection Agency

Stratospheric Ozone Protection Program




Class II Exporter Quarterly Report (Sec 82.24)

Version 3.0

Last Updated: March 2019




Instructions

Complete this form by filling in the data fields that are highlighted in blue. Guidance on how to complete individual data fields are provided in comment bubbles. Use the arrows to navigate between the tabs. Once completed, use the 'prepare submission' button in the Summary tab to generate your CSV file.

Copying and Pasting Data: If data are pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be

accepted into EPA’s ODS Tracking System. Refer to the Reference List to identify the valid naming scheme for specific data fields. Additionally, select "Paste As Values" when pasting data into the form.

Report Submission: This Excel file, the generated CSV file, and all supporting attachments should be submitted to EPA through the Central Data Exchange (CDX). Refer to EPA's website for additional information on form submission:

https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting




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 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 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 #5900-199

OMB Control Number: 2010-0170

Expiration Date: 8/31/2021





Sheet 2: Section 1










U.S. Environmental Protection Agency






Class II Exporter Quarterly Report












Date Prepared:













Section 1: Report Identification Information






Complete all fields below. No fields may be left blank.





The company name must match the organization name under which this report is submitted to EPA through CDX. Company Name:

1



Submission Type:

1



Reporting Year:

1



Reporting Quarter:

1



Enter your company's Employer Identification Number (EIN). Employer Identification Number (EIN):

1












Original Submission






Re-Submittal






Sheet 3: Section 2































U.S. Environmental Protection Agency


























Class II Exporter Quarterly Report



















































Company Name:























Reporting Period:



















































Section 2: Export Transaction Data


























In the table below, enter data for each export transaction containing a class II controlled substance that took place during the reporting period. If no controlled substances were exported, the table may be left blank. For all controlled substances that are exported, all fields are required.





If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.





If blends were exported, refer to the table of HCFC blends provided in the Blend Breakout tab, as needed.





The transaction number is autopopulated. Transaction Number Enter the date for when the shipment exited the United States. Date of Export Enter the name of the company that received or purchased material during the reporting period. Recipient Company Enter the street address of the recipient company. Recipient Company Street Address Enter the city of the recipient company. Recipient Company City Select the country to which the shipment was exported. If copying and pasting data into the table, please refer to the Reference List for the valid list of countries. Recipient Company Country Enter the postal code of the recipient company. Recipient Company Postal Code Enter the name of the contact for the recipient company. If this information is not available, enter "Not Available." Recipient Company Contact Name Enter the phone number of the contact from the recipient company. If this information is not available, enter "Not Available." Recipient Company Phone Number Select the name of the chemical exported. If the chemical is a blend, select the name of the blend. A table of HCFC blends is provided in the 'Blends Breakout' tab for reference. If the export is a blend and the name of the blend is not listed in the dropdown list, select 'Other' and manually enter the name and quantity of each Class II chemical contained within the blend in columns O-T. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name of the Chemical Exported Enter the total quantity (kg) of the chemical exported. If the chemical is a blend, the quantity should equal the total quantity of the blend. Quantity of the Chemical Exported Enter the 10-digit commodity code of the chemical exported as it appears on Customs documentation. Refer to the Reference List for a list of commonly used commodity codes for class II chemicals. Commodity Code These fields will automatically populate unless the name of the chemical imported is identified as 'Other'. Summary of Class II Controlled Substances Exported Enter the name of the port where the shipment exited the United States. Port of Exit from the United States Enter the Employer Identification Number (EIN) shown on the Shipper's Export Declaration Form. This number may or may not refer to the exporter as defined by EPA. If a shipping agent is acting on behalf of the exporter as defined by the regulation, the EIN of the agent shown on the U.S. Customs Form 7525 should be reported here. Your company's EIN as entered in Section 1 of this report will automatically populate for each transaction entered. Revise the number if the EIN for the shipment is different from your company's EIN. The number entered should have no dashes. Shipment EIN Select the transaction type of the material. The transaction type can be New or Used. If copying and pasting data into the table, please refer to the Reference List for the valid list of transaction types. Transaction Type Select the intended use of the material. Note that the Transaction Type in Column W must be selected prior to completing this field. - If the material is New, the intended use can be Produced/Imported for Consumption, Produced with Article 5 Allowances, Transformation, or Destruction. - If the material is Used, the intended use can be Transformation, Destruction, or Other. If copying and pasting data into the table, please refer to the Reference List for the valid list of intended uses. Intended Use





If the chemical exported is identified as 'Other', enter the name of the class II chemical exported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical exported is identified as 'Other', enter the quantity of the class II chemical exported as part of the blend or mixture. Quantity Exported (kg) If the chemical exported is identified as 'Other' and the mixture or blend contains more than one class II chemical, enter the name of the second class II chemical exported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical exported is identified as 'Other' and the mixture or blend contains more than one class II chemical, enter the quantity of the second class II chemical exported as part of the blend or mixture. Quantity Exported (kg) If the chemical exported is identified as 'Other' and the mixture or blend contains more than two class II chemicals, enter the name of the third class II chemical exported as part of the blend or mixture. Please refer to the Reference List for the valid list of chemical names. Class II Chemical If the chemical exported is identified as 'Other' and the mixture or blend contains more than two class II chemicals, enter the quantity of the third class II chemical exported as part of the blend or mixture. Quantity Exported (kg)





Autopopulated Date Text Text Text Selection Text Text Text Selection kg Text Autopopulated Autopopulated Autopopulated Autopopulated Autopopulated Autopopulated Text Number Selection Selection





1 1/15/2018 Company A 1 Main Street Melbourne Australia 3000 John Smith 011 46 8 508 280 00 HCFC-22 100.00 2903.71.0000 HCFC-22 100.00



Miami, FL 12345678900 New Produced/Imported for Consumption























































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































1

































x


x









x x










Afghanistan


HCFC-21









New Transformation










Albania


HCFC-22









Used Destruction










Algeria


HCFC-31










Produced/Imported for Consumption










Andorra


HCFC-121










Produced with Article 5 Allowances










Angola


HCFC-122










Other










Antigua and Barbuda


HCFC-123






















Argentina


HCFC-123a






















Armenia


HCFC-123b






















Australia


HCFC-124






















Austria


HCFC-124a






















Azerbaijan


HCFC-131






















Bahamas


HCFC-132b






















Bahrain


HCFC-133a






















Bangladesh


HCFC-141b






















Barbados


HCFC-142b






















Belarus


HCFC-151






















Belgium


HCFC-221






















Belize


HCFC-222






















Benin


HCFC-223






















Bermuda


HCFC-224






















Bhutan


HCFC-225ca






















Bolivia (Plurinational State of)


HCFC-225cb






















Bosnia and Herzegovina


HCFC-226






















Botswana


HCFC-231






















Brazil


HCFC-232






















Brunei Darussalam


HCFC-233






















British Virgin Islands


HCFC-234






















Bulgaria


HCFC-235






















Burkina Faso


HCFC-241






















Burundi


HCFC-242






















Cambodia


HCFC-243






















Cameroon


HCFC-244






















Canada


HCFC-251






















Cape Verde


HCFC-252






















Central African Republic


HCFC-253






















Chad


HCFC-261






















Chile


HCFC-262






















China


HCFC-271






















Colombia


R-401A






















Comoros


R-401B






















Congo


R-401C






















Cook Islands


R-402A






















Costa Rica


R-402B






















Côte d'Ivoire


R-403A






















Croatia


R-403B






















Cuba


R-405A






















Cyprus


R-406A






















Czech Republic


R-408A






















Democratic Republic of the Congo


R-409A






















Denmark


R-409B






















Djibouti


R-411A






















Dominica


R-411B






















Dominican Republic


R-411C






















Ecuador


R-412A






















Egypt


R-414A






















El Salvador


R-414B






















Equatorial Guinea


R-415A






















Eritrea


R-415B






















Estonia


R-416A






















Ethiopia


R-418A






















European Union


R-420A






















Fiji


Other






















Finland


























France


























Gabon


























Gambia


























Georgia


























Germany


























Ghana


























Greece


























Grenada


























Guatemala


























Guinea


























Guinea-Bissau


























Guyana


























Haiti


























Holy See


























Honduras


























Hong Kong


























Hungary


























Iceland


























India


























Indonesia


























Iran (Islamic Republic of)


























Iraq


























Ireland


























Israel


























Italy


























Jamaica


























Japan


























Jordan


























Kazakhstan


























Kenya


























Kiribati


























Kuwait


























Kyrgyzstan


























Lao People's Democratic Republic


























Latvia


























Lebanon


























Lesotho


























Liberia


























Libya


























Liechtenstein


























Lithuania


























Luxembourg


























Madagascar


























Malawi


























Malaysia


























Maldives


























Mali


























Malta


























Marshall Islands


























Mauritania


























Mauritius


























Mexico


























Micronesia (Federated States of)


























Monaco


























Mongolia


























Montenegro


























Morocco


























Mozambique


























Myanmar


























Namibia


























Nauru


























Nepal


























Netherlands


























New Zealand


























Nicaragua


























Niger


























Nigeria


























Niue


























North Korea (Democratic People's Republic of Korea)


























Norway


























Oman


























Pakistan


























Palau


























Panama


























Papua New Guinea


























Paraguay


























Peru


























Philippines


























Poland


























Portugal


























Qatar


























Republic of Moldova


























Romania


























Russian Federation


























Rwanda


























Saint Kitts and Nevis


























Saint Lucia


























Saint Vincent and the Grenadines


























Samoa


























San Marino


























Sao Tome and Principe


























Saudi Arabia


























Senegal


























Serbia


























Seychelles


























Sierra Leone


























Singapore


























Slovakia


























Slovenia


























Solomon Islands


























Somalia (Federal Republic of)


























South Africa


























South Korea (Republic of Korea)


























South Sudan


























Spain


























Sri Lanka


























Sudan


























Suriname


























Swaziland


























Sweden


























Switzerland


























Syrian Arab Republic


























Tahiti


























Taiwan


























Tajikistan


























Thailand


























The Former Yugoslav Republic of Macedonia


























Timor-Leste


























Togo


























Tonga


























Trinidad and Tobago


























Tunisia


























Turkey


























Turkmenistan


























Tuvalu


























Uganda


























Ukraine


























United Arab Emirates


























United Kingdom of Great Britain and Northern Ireland


























United Republic of Tanzania


























#NAME?


























Uruguay


























Uzbekistan





















Sheet 4: Summary









U.S. Environmental Protection Agency



Class II Exporter Quarterly Report






Company Name:


Reporting Period:










Export Totals




The values in the table below are calculated based on data entered in Section 2. If the totals appear to be incorrect, please return to Section 2 to review your data.


Chemical Name Country Total Exported (kg)




























































































































































































Sheet 5: Blend Breakout










U.S. Environmental Protection Agency






Class II Exporter Quarterly Report






Blend Breakout Table









Chemical Name HCFC-22 HCFC-124 HCFC-142b



R-401A 53% 34%




R-401B 61% 28%




R-401C 33% 52%




R-402A 38%





R-402B 60%





R-403A 75%





R-403B 56%





R-405A 45%
5.5%



R-406A 55%
41%



R-408A 46%





R-409A 60% 25% 15%



R-409B 65% 25% 10%



R-411A 87.5%





R-411B 94%





R-411C 95.5%





R-412A 70%
25%



R-414A 51% 28.5% 16.5%



R-414B 50% 39% 9.5%



R-415A 82%





R-415B 25%





R-416A
39%




R-418A 96%





R-420A

12%



















Sheet 6: Reference List












U.S. Environmental Protection Agency








Class II Exporter Quarterly Report







Reference List

















Copying and Pasting Data: If data is pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be accepted into EPA’s ODS tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the lists provided below.

Chemical Name List: The table below lists the valid chemical names that may be used when entering data into Section 2 of this form.
Country List: The table below lists the valid country names that may be used when entering data into Section 2 of this form.











Class II Chemicals (including blends)
Source Country

HCFC-21 HCFC-142 HCFC-241 R-405A
Afghanistan Greece Papua New Guinea

HCFC-22 HCFC-142a HCFC-242 R-408A
Albania Grenada Paraguay

HCFC-31 HCFC-142b HCFC-243 R-409A
Algeria Guatemala Peru

HCFC-121 HCFC-151 HCFC-244 R-409B
Andorra Guinea Philippines

HCFC-122 HCFC-221 HCFC-251 R-411A
Angola Guinea-Bissau Poland

HCFC-123 HCFC-222 HCFC-252 R-411B
Antigua and Barbuda Guyana Portugal

HCFC-123a HCFC-223 HCFC-253 R-411C
Argentina Haiti Qatar

HCFC-123b HCFC-224 HCFC-261 R-412A
Armenia Holy See Republic of Moldova

HCFC-124 HCFC-225ca HCFC-262 R-414A
Australia Honduras Romania

HCFC-124a HCFC-225cb HCFC-271 R-414B
Austria Hong Kong Russian Federation

HCFC-131 HCFC-226 R-401A R-415A
Azerbaijan Hungary Rwanda

HCFC-132b HCFC-231 R-401B R-415B
Bahamas Iceland Saint Kitts and Nevis

HCFC-133a HCFC-232 R-401C R-416A
Bahrain India Saint Lucia

HCFC-141 HCFC-233 R-402A R-418A
Bangladesh Indonesia Saint Vincent and the Grenadines

HCFC-141a HCFC-234 R-402B R-420A
Barbados Iran (Islamic Republic of) Samoa

HCFC-141b HCFC-235 R-403A Other
Belarus Iraq San Marino






Belgium Ireland Sao Tome and Principe

Transaction Type List: The table below lists the valid transaction types that may be used when entering data into Section 2 of this form.
Belize Israel Saudi Arabia


Benin Italy Senegal






Bermuda Jamaica Serbia

Transaction Type


Bhutan Japan Seychelles

New Used


Bolivia (Plurinational State of) Jordan Sierra Leone






Bosnia and Herzegovina Kazakhstan Singapore

Intended Use Lists: The tables below list the valid intended uses that may be used when entering data into Section 2 of this form.
Botswana Kenya Slovakia


Brazil Kiribati Slovenia






Brunei Darussalam Kuwait Solomon Islands

Intended Uses - If Transaction Type = New

British Virgin Islands Kyrgyzstan Somalia (Federal Republic of)

Transformation Produced/Imported for Consumption

Bulgaria Lao People's Democratic Republic South Africa

Destruction Produced with Article 5 Allowances

Burkina Faso Latvia South Korea (Republic of Korea)






Burundi Lebanon South Sudan

Intended Uses - If Transaction Type = Used

Cambodia Lesotho Spain

Transformation Destruction Other

Cameroon Liberia Sri Lanka






Canada Libya Sudan

Commodity Code List: The table below lists the commonly used class II commodity codes that may be used when entering data into Section 2 of this form. A complete list of commodity codes can be found in the Official Harmonized Tariff Schedule.
Cape Verde Liechtenstein Suriname


Central African Republic Lithuania Swaziland


Chad Luxembourg Sweden






Chile Madagascar Switzerland

Class II Commodity Codes/Description
China Malawi Syrian Arab Republic

2903.71.0000 Chlorodifluoromethane (HCFC-22)
Colombia Malaysia Tahiti

2903.72.0020 Dichlorotrifluoroethane (HCFC-123)
Comoros Maldives Taiwan

2903.72.0050 Other Dichlorotrifluoroethanes (HCFC-123a, HCFC-123b)
Congo Mali Tajikistan

2903.73.0000 Dichlorofluoroethanes (HCFC-141b)
Cook Islands Malta Thailand

2903.74.0000 Chlorodifluoroethanes (HCFC-142b)
Costa Rica Marshall Islands The Former Yugoslav Republic of Macedonia

2903.75.0000 Dichloropentafluoropropanes (HCFC-225ca, HCFC-225cb)
Côte d'Ivoire Mauritania

2903.79.9030 Monochlorotetrafluoroethane (HCFC-124)
Croatia Mauritius Timor-Leste

2903.79.9070 Other HCFCs
Cuba Mexico Togo

3824.74.0000 Mixtures containing hydrochlorofluorocarbons (HCFCs) but not containing chlorofluorocarbons (CFCs)
Cyprus Micronesia (Federated States of) Tonga



Czech Republic Monaco Trinidad and Tobago






Democratic Republic of the Congo Mongolia Tunisia






Denmark Montenegro Turkey






Djibouti Morocco Turkmenistan






Dominica Mozambique Tuvalu






Dominican Republic Myanmar Uganda






Ecuador Namibia Ukraine






Egypt Nauru United Arab Emirates






El Salvador Nepal United Kingdom of Great Britain and Northern Ireland






Equatorial Guinea Netherlands






Eritrea New Zealand United Republic of Tanzania






Estonia Nicaragua Uruguay






Ethiopia Niger Uzbekistan






European Union Nigeria Vanuatu






Fiji Niue Venezuela (Bolivarian Republic of)






Finland North Korea (Democratic People's Republic of Korea) Viet Nam






France Yemen






Gabon Norway Zambia






Gambia Oman Zimbabwe






Georgia Pakistan







Germany Palau







Ghana Panama











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