5900-153 Class 1 Lab Supplier Quarterly Report

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

Copy of Class I Lab Supplier_v5.0.xlsm

Reporting of the Production, Import, Export, Recycling, Destruction, Transhipment, and Feedstock Use of Ozone-Depleting Substances

OMB: 2060-0170

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Section 1
Section 2
Section 3
Summary
Reference List

Sheet 1: Instructions




OMB Control Number: 2060-0170

Expiration Date: 4/16/2023

U.S. Environmental Protection Agency

Stratospheric Ozone Protection Program




Class I Lab Supplier Quarterly Report (Sec 82.13)

Version 5.0

Last Updated: April 2020




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.

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0170). Responses to this collection of information are mandatory (40 CFR 82.13). 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 number and expiration date are displayed in the upper right corner of the form. The public reporting and recordkeeping burden for this collection of information is estimated to be 4 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 #5900-153




Sheet 2: Section 1









U.S. Environmental Protection Agency






Class I Lab Supplier 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




x






Original Submission






Re-Submittal





Sheet 3: Section 2
















U.S. Environmental Protection Agency










Class I Lab Supplier Quarterly Report





















Company Name:








Reporting Period:





















Section 2: Amounts Purchased/Received










In the table below, enter data for each transaction in which a class I controlled substance was purchased or received under the global essential laboratory and analytical use exemption from a producer, importer, and/or distributor during the reporting period. If no controlled substances were purchased or received under the global essential laboratory and analytical use exemption during the reporting period, the table may be left blank. For each transaction, all fields are required.






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





The transaction number is autopopulated. Transaction Number Enter the name of the company from which the material was received or purchased during the reporting period. Source Company Enter the street address of the source company. Source Company Street Address Enter the city of the source company. Source Company City Select the state of the source company. If copying and pasting data into the table, please refer to the Reference List for the valid list of states. Source Company State Enter the postal code of the source company. Source Company Postal Code Select the name of the class I chemical purchased or received from the producer, importer, or distributor. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name of Class I Chemical Purchased or Received Enter the total quantity (kg) of the chemical purchased or received from the producer, importer, or distributor. Quantity of Class I Chemical Purchased or Received





Autopopulated Text Text Text Selection Text Selection kg





1 Company A 1 Main Street Washington District of Columbia 20006 CFC-13 5,000.00



1st






















































































































































































































x
x










Alaska
CBM










Alabama
CCL4










Arkansas
CFC-11










Arizona
CFC-12










California
CFC-13










Colorado
CFC-111










Connecticut
CFC-112










District of Columbia
CFC-113










Delaware
CFC-114










Florida
CFC-115










Georgia
CFC-211










Hawaii
CFC-212










Iowa
CFC-213










Idaho
CFC-214










Illinois
CFC-215










Indiana
CFC-216










Kansas
CFC-217










Kentucky
CH3Br










Louisiana
CH3CCL3










Massachusetts
Halon 1202










Maryland
Halon 1211










Maine
Halon 1301










Michigan
Halon 2402










Minnesota
HBFCs










Missouri












Mississippi












Montana












North Carolina












North Dakota












Nebraska












New Hampshire












New Jersey












New Mexico












Nevada












New York












Ohio












Oklahoma












Oregon












Pennsylvania












Puerto Rico












Rhode Island












South Carolina












South Dakota












Tennessee












Texas












Utah












Virginia












US Virgin Islands












Vermont












Washington












Wisconsin












West Virginia












Wyoming






Sheet 4: Section 3




















U.S. Environmental Protection Agency














Class I Lab Supplier Quarterly Report





























Company Name:













Reporting Period:





























Section 3: Amounts Supplied to Laboratories














In the table below, identify the name and quantity of each class I controlled substance supplied to a laboratory customer during the reporting period. Up to three chemicals may be entered per row. You may enter more than one row of data per laboratory customer, as needed. If no controlled substances were supplied to laboratory customers under the global essential laboratory and analytical use exemption during the reporting period, the table may be left blank.





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









This field is autopopulated. Transaction Number Enter the name of the laboratory company to which the material was supplied during the reporting period. Lab Company Name Enter the street address of the laboratory company. Lab Company Street Address Enter the city of the laboratory company. Lab Company City Select the state in which the laboratory company is located. If copying and pasting data into the table, please refer to the Reference List for the valid list of states. Lab Company State Enter the postal code of the laboratory company. Lab Company Postal Code Class I Chemical Supplied to Lab Class I Chemical Supplied to Lab Class I Chemical Supplied to Lab





Select the name of the chemical supplied to the laboratory company. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name Enter the total quantity (kg) of the chemical supplied to the laboratory company. Note that if the quantity is less than 0.00049 and appears in the cell as 0.000, it will still be accurately captured by the form. Quantity Select the name of the chemical supplied to the laboratory company. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name Enter the total quantity (kg) of the chemical supplied to the laboratory company. Note that if the quantity is less than 0.00049 and appears in the cell as 0.000, it will still be accurately captured by the form. Quantity Select the name of the chemical supplied to the laboratory company. If copying and pasting data into the table, please refer to the Reference List for the valid list of chemical names. Name Enter the total quantity (kg) of the chemical supplied to the laboratory company. Note that if the quantity is less than 0.00049 and appears in the cell as 0.000, it will still be accurately captured by the form. Quantity





Autopopulated Text Text Text Selection Text Selection kg Selection kg Selection kg





1 Company A 1 Main Street Washington District of Columbia 20006 CFC-11 2.567 CFC-113 0.006











































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































x
x
x
x










Alaska
CBM
CBM
CBM










Alabama
CCL4
CCL4
CCL4










Arkansas
CFC-11
CFC-11
CFC-11










Arizona
CFC-12
CFC-12
CFC-12










California
CFC-13
CFC-13
CFC-13










Colorado
CFC-111
CFC-111
CFC-111










Connecticut
CFC-112
CFC-112
CFC-112










District of Columbia
CFC-113
CFC-113
CFC-113










Delaware
CFC-114
CFC-114
CFC-114










Florida
CFC-115
CFC-115
CFC-115










Georgia
CFC-211
CFC-211
CFC-211










Hawaii
CFC-212
CFC-212
CFC-212










Iowa
CFC-213
CFC-213
CFC-213










Idaho
CFC-214
CFC-214
CFC-214










Illinois
CFC-215
CFC-215
CFC-215










Indiana
CFC-216
CFC-216
CFC-216










Kansas
CFC-217
CFC-217
CFC-217










Kentucky
CH3Br
CH3Br
CH3Br










Louisiana
CH3CCL3
CH3CCL3
CH3CCL3










Massachusetts
Halon 1202
Halon 1202
Halon 1202










Maryland
Halon 1211
Halon 1211
Halon 1211










Maine
Halon 1301
Halon 1301
Halon 1301










Michigan
Halon 2402
Halon 2402
Halon 2402










Minnesota
HBFCs
HBFCs
HBFCs










Missouri
















Mississippi
















Montana
















North Carolina
















North Dakota
















Nebraska
















New Hampshire
















New Jersey
















New Mexico
















Nevada
















New York
















Ohio
















Oklahoma
















Oregon
















Pennsylvania
















Puerto Rico
















Rhode Island
















South Carolina
















South Dakota
















Tennessee
















Texas
















Utah
















Virginia
















US Virgin Islands
















Vermont
















Washington
















Wisconsin
















West Virginia
















Wyoming










Sheet 5: Summary








U.S. Environmental Protection Agency




Class I Lab Supplier Quarterly Report









Company Name:



Reporting Period:










The values in the table below are calculated based on data entered in Section 2 and Section 3. If the totals appear to be incorrect, please return to Section 2 or Section 3 to review your data.


Chemical Name Total Quantity of Class I Chemical Purchased or Received (kg) Total Quantity of Class I Chemical Supplied (kg)
































































































































Sheet 6: Reference List








U.S. Environmental Protection Agency



Class I Lab Supplier 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 list below.

Chemical Name List: The table below lists the valid chemical names that may be used when entering data into Section 2 and Section 3 of this form.








Class I Chemicals

CBM CFC-111 CFC-211 CFC-216 Halon 1211

CCL4 CFC-112 CFC-212 CFC-217 Halon 1301

CFC-11 CFC-113 CFC-213 CH3Br Halon 2402

CFC-12 CFC-114 CFC-214 CH3CCL3 HBFCs

CFC-13 CFC-115 CFC-215 Halon 1202









State List: The table below lists the valid state names that may be used when entering data into Section 2 and Section 3 of this form.








States

Alaska Hawaii Michigan Nevada Texas

Alabama Iowa Minnesota New York Utah

Arkansas Idaho Missouri Ohio Virginia

Arizona Illinois Mississippi Oklahoma US Virgin Islands

California Indiana Montana Oregon Vermont

Colorado Kansas North Carolina Pennsylvania Washington

Connecticut Kentucky North Dakota Puerto Rico Wisconsin

District of Columbia Louisiana Nebraska Rhode Island West Virginia

Delaware Massachusetts New Hampshire South Carolina Wyoming

Florida Maryland New Jersey South Dakota


Georgia Maine New Mexico Tennessee








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