|
|
|
OMB Control Number: 2060-XXXX |
|
|
|
Expiration Date: X/XX/202X |
|
|
|
|
| American Innovation and Manufacturing Act - HFC Destruction One-Time Reporting Form |
|
|
|
|
|
|
|
| Worksheet Instructions: |
|
| Version: |
| r0.2 |
|
|
|
| Updated: |
| 9/21/2021 |
|
|
|
| External Links: |
|
|
|
|
| Reporting Form Navigation: |
| Section 1 - Facility Identification |
|
|
|
| Section 2 - Destruction Facility Information |
|
|
|
|
|
|
|
| Section 1 - Facility Identification |
|
|
|
| Instructions: Complete the following facility information. |
|
|
|
| Company Name: |
|
|
|
| Facility Name: |
|
|
|
| AIMRS Facility ID: |
|
|
|
|
|
|
|
| Section 2 - Destruction Facility Information |
|
|
|
| Instructions: Provide the following information on the destruction facility. Information on only one destruction facility may be reported per reporting form. Provide supporting documentation, as needed, to respond to these reporting requirements. Any changes to this information must be reflected in a revision to be submitted to EPA within 60 days of the changes (§84.31(f)(1)(v)). |
|
|
|
|
|
|
|
|
Destruction Unit's Destruction Efficiency
§84.31(f)(1)(i) |
|
|
|
|
|
|
|
| List and describe the methods used to determine destruction efficiency §84.31(f)(1)(ii): |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| List and describe the methods used to record volume destroyed §84.31(f)(1)(iii): |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| List the relevant Federal or State regulations that apply §84.31(f)(1)(iv): |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-XXXX). Responses to this collection of information are mandatory (40 CFR 84.31). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 100 hours per response. Send comments on the Agency’s need this formation, 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, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 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 # 5900-541 |
|
|
|