| OMB Control Number: 2060-XXXX | ||||||
| Expiration Date: X/XX/202X | ||||||
| American Innovation and Manufacturing Act - HFC Process Agent Use One-Time Reporting Form | ||||||
| Worksheet Instructions: | ||||||
| Version: | ||||||
| r0.1 | ||||||
| Updated: | ||||||
| 9/24/2021 | ||||||
| External Links: | ||||||
| Reporting Form Navigation: | ||||||
| Section 1 - Facility Identification | ||||||
| Section 2 - Process Agent Use Information | ||||||
| Section 1 - Facility Identification | ||||||
| Instructions: Complete the following facility information. | ||||||
| Company Name: | ||||||
| Facility Name: | ||||||
| AIMRS Facility ID: | ||||||
| Section 2 - Process Agent Use Information | ||||||
| Instructions: Provide the following information on the process agent use at the facility. Information on only one facility may be reported per reporting form. Provide supporting documentation, as needed, to respond to these reporting requirements. | ||||||
| Product and Byproduct Information | ||||||
| 1 | 2 | 3 | 4 | 5 | 6 | |
| HFC | Name of Product Manufactured §84.31(g)(1)(iii) |
Name of Byproduct (1) Manufactured §84.31(g)(1)(iii) |
Name of Byproduct (2) Manufactured §84.31(g)(1)(iii) |
Name of Byproduct (3) Manufactured §84.31(g)(1)(iii) |
Anticipated Ratio of Process Agent Emissions to End Product Manufactured §84.31(g)(1)(iv) |
|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| Provide a description of the process agent use that includes details of the percentages of process agent retained within the process, recovered after the process, and emitted or entrained in the final product. §84.31(g)(1)(i) | ||||||
| Provide a description of all technologies and actions taken to minimize emissions of regulated substances. §84.31(g)(1)(ii) | ||||||
| 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 # 5900-544 | ||||||
| Chemical Name | [Common Name] |
| CHF3 | HFC-23 |
| CH2F2 | HFC-32 |
| CH3F | HFC-41 |
| CF3CHFCHFCF2CF3 | HFC-43-10mee |
| CHF2CF3 | HFC-125 |
| CHF2CHF2 | HFC-134 |
| CH2FCF3 | HFC-134a |
| CH2FCHF2 | HFC-143 |
| CH3CF3 | HFC-143a |
| CH2FCH2F | HFC-152 |
| CH3CHF2 | HFC-152a |
| CF3CHFCF3 | HFC-227ea |
| CH2FCF2CF3 | HFC-236cb |
| CHF2CHFCF3 | HFC-236ea |
| CF3CH2CF3 | HFC-236fa |
| CH2FCF2CHF2 | HFC-245ca |
| CF3CH2CF3 | HFC-245fa |
| CF3CH2CF2CH3 | HFC-365mfc |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |