5900-205 Class Ii Controlled Substance Transfers Of Production Al

OMB Control Number: 2060-0498

Expiration Date: 2/28/2013

U.S. Environmental Protection Agency stratospheric ozone protection program				class ii controlled substance transfers of production allowances, consumption allowances, or article 5 allowances (Sec 82.23)
SECTION 1 TRANSFEROR IDENTIFICATION
1.1 Date of Submission	     		1.2 Number of Transactions Reported			     
1.3 Number of Pages Submitted	     		1.4 Original Submittal Re-submittal
1.5 Company Information
Company Name      
Street Address      
City      				State      	Zip Code      
1.6 Company Contact Identification
Reporting Company Contact Person      			Phone Number      		Fax Number      
E-mail Address      
1.7 Signature of Reporting Company Representative
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment.
Name       Title       Signature      					Date      

SEND COMPLETED FORMS TO:

For U.S. Postal Service: Tracking System Program Manager Stratospheric Protection Division U.S. EPA (6205J) 1200 Pennsylvania Avenue, NW Washington, DC 20460

For Private Courier: Tracking System Program Manager Stratospheric Protection Division U.S. EPA (6205J) 1310 L Street, NW, 10th Floor Washington, DC 20005

Information in reports submitted in compliance with the final rule may be claimed as confidential. A company may assert a claim of confidentiality for information submitted by clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public without further notice to the company (40 CFR 2.203).

The public reporting and recordkeeping burden for this collection of information is estimated to average 4.5 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 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 # 5900-205, Revised 2/10

OMB Control Number: 2060-0498

Expiration Date: 2/28/2013

U.S. Environmental Protection Agency stratospheric ozone protection program

class ii controlled substance transfers of production allowances, consumption allowances, or article 5 allowances (Sec 82.23)

SECTION 2 TRANSACTION RECORD (Reproduce additional sheets as needed)

TRANSACTION #

     

2.1 Transferee Identification

Transferee Company Name      

Transferee Contact Person      

Street Address      

City      

State      

Zip Code      

Phone Number      

Fax Number      

Type of Allowance Being Transferred (check only one)

Production

Consumption

Article 5

2.2 Type of Allowances Transferred (check only one)

Current Year Allowances

Baseline Year Allowances

2.3 HCFC Transferring From

     

2.4 ODP

     

2.5 Quantity of HCFC Allowances in Section 2.3 Being Transferred (kg)

     

2.6 Calculated Level of HCFC in Section 2.3 Being Transferred (Section 2.4 x Section 2.5)*

     

2.7 HCFC Transferring To

     

2.8 ODP

     

2.9 Amount of Offset (0.001 x Section 2.5) (kg)*

     

2.10 Number of Allowances Subtracted from Transferor’s Balance of HCFC Allowances (Section 2.5 + Section 2.9) (kg)*

     

2.11 Quantity of HCFC Allowances in Section 2.7 Being Received (Section 2.6 / Section 2.8) (kg)*

     

*When calculating 2.6 and 2.9, please note that these values should not be rounded. Only the quantities calculated in 2.10 and 2.11 should be rounded to the closest whole number.

EPA Form # 5900-205, Revised 2/10

OMB Control Number: 2060-0498

Expiration Date: 2/28/2013

U.S. Environmental Protection Agency stratospheric ozone protection program				class ii controlled substance transfers of production allowances, consumption allowances, or article 5 allowances (Sec 82.23)
SECTION 3 ALLOWANCE BALANCE SUMMARY
3.1 Balance of Unexpended HCFC Allowances Prior to Transfers Reported
A	B	C					D
Chemical Name	Balance of Unexpended Production Allowances	Balance of Unexpended Consumption Allowances					Balance of Unexpended Article 5 Allowances
HCFC-22	     	     					     
HCFC-142b	     	     					     
HCFC-123	     	     					     
HCFC-124	     	     					     
HCFC-225ca	     	     					     
HCFC-225cb	     	     					     

EPA Form # 5900-205, Revised 2/10