OMB Control Number: 2060-0170

Expiration Date: 12/31/08

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<tbody>
<tr class="odd">
<td colspan="8"><p><img src="media/image1.png"
style="width:0.56944in;height:0.26181in" /> U.S. Environmental
Protection Agency</p>
<p><strong><span class="smallcaps">stratospheric ozone protection
program</span></strong></p></td>
<td colspan="7"><p><span class="smallcaps">class i controlled
substance</span></p>
<p><strong><span class="smallcaps">essential use allowance holders &amp;
laboratory supplier quarterly report and essential use allowance holder
annual report (</span>Sec 82.13)</strong></p></td>
</tr>
<tr class="even">
<td colspan="15"><strong>SECTION 1 COMPANY IDENTIFICATION</strong></td>
</tr>
<tr class="odd">
<td><strong>1.1 Date of Submission</strong></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="9"><strong>1.2</strong> <strong>Original Submittal</strong>
<strong>Re-submittal</strong></td>
</tr>
<tr class="even">
<td><strong>1.3 Number of Transactions Reported</strong></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="7"><strong>1.4 Number of Pages Submitted</strong></td>
<td colspan="2"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>1.5 Quarter and Year to Which This Report
Applies (If 4<sup>th</sup> quarter is selected, Essential Use Holders
should also submit Section 5 of this form.)</strong></td>
<td colspan="4"> 1<sup>st</sup></td>
<td colspan="2"> 2<sup>nd</sup></td>
<td colspan="3"> 3<sup>rd</sup></td>
<td colspan="2"> 4<sup>th</sup></td>
<td>Year <strong><u>      </u></strong></td>
</tr>
<tr class="even">
<td colspan="15"><strong>1.6 Company Information</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><p>Company Name</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="15">Street Address<br />
<strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">City <strong>     </strong></td>
<td colspan="8">State <strong>     </strong></td>
<td colspan="5">Zip Code <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="15"><strong>1.7 Company Contact
Identification</strong></td>
</tr>
<tr class="odd">
<td colspan="4">Reporting Company Contact Person
<strong>     </strong></td>
<td colspan="7">Phone Number <strong>     </strong></td>
<td colspan="4">Fax Number <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="15">E-mail Address      </td>
</tr>
<tr class="odd">
<td colspan="15"><strong>1.8 Signature of Reporting Company
Representative</strong></td>
</tr>
<tr class="even">
<td colspan="15"><em>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.</em></td>
</tr>
<tr class="odd">
<td colspan="5"><p>Name <strong>     </strong></p>
<p>Title <strong>     </strong></p>
<p>Signature <strong>     </strong></p></td>
<td colspan="10">Date <strong>     </strong></td>
</tr>
</tbody>
</table>

+-------------------------+----------------------+---------------------+
| **SEND COMPLETED FORMS  | **For U.S. Postal    | **For Private       |
| TO:**                   | Service:**           | Courier:**          |
|                         |                      |                     |
|                         | Tracking System      | Tracking System     |
|                         | Program Manager      | Program Manager     |
|                         |                      |                     |
|                         | Stratospheric        | Stratospheric       |
|                         | Protection Division  | Protection Division |
|                         |                      |                     |
|                         | U.S. EPA (6205J)     | U.S. EPA (6205J)    |
|                         |                      |                     |
|                         | 1200 Pennsylvania    | 1310 L Street, NW;  |
|                         | Avenue, NW           | 10^th^ Floor        |
|                         |                      |                     |
|                         | Washington, DC 20460 | 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 7 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 ICR NUMBER 1432.25, Revised 3/07

OMB Control Number: 2060-0170

Expiration Date: 12/31/08

+-----------+------+----+--------+---+---+-----+-----------------------+
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|           |      |    |        |   |   | ent |                       |
|           |      |    |        |   |   | ial |                       |
|           |      |    |        |   |   | use |                       |
|           |      |    |        |   |   | all |                       |
|           |      |    |        |   |   | owa |                       |
|           |      |    |        |   |   | nce |                       |
|           |      |    |        |   |   | hol |                       |
|           |      |    |        |   |   | der |                       |
|           |      |    |        |   |   | ann |                       |
|           |      |    |        |   |   | ual |                       |
|           |      |    |        |   |   | rep |                       |
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|           |      |    |        |   |   | (]  |                       |
|           |      |    |        |   |   | {.s |                       |
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|           |      |    |        |   |   | Sec |                       |
|           |      |    |        |   |   | 82  |                       |
|           |      |    |        |   |   | .13 |                       |
|           |      |    |        |   |   | )** |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **SECTION | **Q  |    |        |   |   |     |                       |
| 2**       | UART |    |        |   |   |     |                       |
|           | ERLY |    |        |   |   |     |                       |
|           | REPO |    |        |   |   |     |                       |
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|           | ance |    |        |   |   |     |                       |
|           | Hol  |    |        |   |   |     |                       |
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|           | Imp  |    |        |   |   |     |                       |
|           | orte |    |        |   |   |     |                       |
|           | rs** |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           | **(R |    |        |   |   |     |                       |
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|           | d)** |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **2.1     |      | *  |        |   |   |     |                       |
| Company   |      | *  |        |   |   |     |                       |
| Name**    |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      | ** |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **2.2     |      |    |        |   |   |     |                       |
| Tr        |      |    |        |   |   |     |                       |
| ansaction |      |    |        |   |   |     |                       |
| Su        |      |    |        |   |   |     |                       |
| mmaries** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
|           |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **TR      |      |    |        | * |   |     |                       |
| ANSACTION |      |    |        | * |   |     |                       |
| \#**      |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        | * |   |     |                       |
|           |      |    |        | * |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Source    |      |    |        |   |   |     |                       |
| Company   |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Street    |      |    |        |   |   |     |                       |
| Address   |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| City\     |      |    | State  |   |   |     | Zip Code (U.S.)\      |
| **     ** |      |    | (U.S.) |   |   |     | **     **             |
|           |      |    | or     |   |   |     |                       |
|           |      |    | Co     |   |   |     |                       |
|           |      |    | untry\ |   |   |     |                       |
|           |      |    | **     |   |   |     |                       |
|           |      |    |     ** |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Chemical  |      |    |        |   | Q |     |                       |
| Name of   |      |    |        |   | u |     |                       |
| Class I   |      |    |        |   | a |     |                       |
| Substance |      |    |        |   | n |     |                       |
| Received\ |      |    |        |   | t |     |                       |
| **     ** |      |    |        |   | i |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | y |     |                       |
|           |      |    |        |   | o |     |                       |
|           |      |    |        |   | f |     |                       |
|           |      |    |        |   | C |     |                       |
|           |      |    |        |   | l |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | I |     |                       |
|           |      |    |        |   | S |     |                       |
|           |      |    |        |   | u |     |                       |
|           |      |    |        |   | b |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | n |     |                       |
|           |      |    |        |   | c |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | R |     |                       |
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|           |      |    |        |   | c |     |                       |
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|           |      |    |        |   | i |     |                       |
|           |      |    |        |   | v |     |                       |
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|           |      |    |        |   | d |     |                       |
|           |      |    |        |   | ( |     |                       |
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|           |      |    |        |   | \ |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
|           |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **TR      |      |    |        | * |   |     |                       |
| ANSACTION |      |    |        | * |   |     |                       |
| \#**      |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        | * |   |     |                       |
|           |      |    |        | * |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Source    |      |    |        |   |   |     |                       |
| Company\  |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Street    |      |    |        |   |   |     |                       |
| Address   |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| City      |      |    | State  |   |   |     | Zip Code (U.S.)\      |
|           |      |    | (U.S.) |   |   |     | **     **             |
| **     ** |      |    | or     |   |   |     |                       |
|           |      |    | Co     |   |   |     |                       |
|           |      |    | untry\ |   |   |     |                       |
|           |      |    | **     |   |   |     |                       |
|           |      |    |     ** |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Chemical  |      |    |        |   | Q |     |                       |
| Name of   |      |    |        |   | u |     |                       |
| Class I   |      |    |        |   | a |     |                       |
| Substance |      |    |        |   | n |     |                       |
| Received\ |      |    |        |   | t |     |                       |
| **     ** |      |    |        |   | i |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | y |     |                       |
|           |      |    |        |   | o |     |                       |
|           |      |    |        |   | f |     |                       |
|           |      |    |        |   | C |     |                       |
|           |      |    |        |   | l |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | I |     |                       |
|           |      |    |        |   | S |     |                       |
|           |      |    |        |   | u |     |                       |
|           |      |    |        |   | b |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | n |     |                       |
|           |      |    |        |   | c |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | R |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | c |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | i |     |                       |
|           |      |    |        |   | v |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | d |     |                       |
|           |      |    |        |   | ( |     |                       |
|           |      |    |        |   | k |     |                       |
|           |      |    |        |   | g |     |                       |
|           |      |    |        |   | ) |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
|           |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| **TR      |      |    |        | * |   |     |                       |
| ANSACTION |      |    |        | * |   |     |                       |
| \#**      |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        | * |   |     |                       |
|           |      |    |        | * |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Source    |      |    |        |   |   |     |                       |
| Company   |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Street    |      |    |        |   |   |     |                       |
| Address\  |      |    |        |   |   |     |                       |
| **     ** |      |    |        |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| City\     |      |    | State  |   |   |     | Zip Code (U.S.)\      |
| **     ** |      |    | (U.S.) |   |   |     | **     **             |
|           |      |    | or     |   |   |     |                       |
|           |      |    | Co     |   |   |     |                       |
|           |      |    | untry\ |   |   |     |                       |
|           |      |    | **     |   |   |     |                       |
|           |      |    |     ** |   |   |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+
| Chemical  |      |    |        |   | Q |     |                       |
| Name of   |      |    |        |   | u |     |                       |
| Class I   |      |    |        |   | a |     |                       |
| Substance |      |    |        |   | n |     |                       |
| Received\ |      |    |        |   | t |     |                       |
| **     ** |      |    |        |   | i |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | y |     |                       |
|           |      |    |        |   | o |     |                       |
|           |      |    |        |   | f |     |                       |
|           |      |    |        |   | C |     |                       |
|           |      |    |        |   | l |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | I |     |                       |
|           |      |    |        |   | S |     |                       |
|           |      |    |        |   | u |     |                       |
|           |      |    |        |   | b |     |                       |
|           |      |    |        |   | s |     |                       |
|           |      |    |        |   | t |     |                       |
|           |      |    |        |   | a |     |                       |
|           |      |    |        |   | n |     |                       |
|           |      |    |        |   | c |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | R |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | c |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | i |     |                       |
|           |      |    |        |   | v |     |                       |
|           |      |    |        |   | e |     |                       |
|           |      |    |        |   | d |     |                       |
|           |      |    |        |   | ( |     |                       |
|           |      |    |        |   | k |     |                       |
|           |      |    |        |   | g |     |                       |
|           |      |    |        |   | ) |     |                       |
|           |      |    |        |   | \ |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   |   |     |                       |
|           |      |    |        |   | * |     |                       |
|           |      |    |        |   | * |     |                       |
+-----------+------+----+--------+---+---+-----+-----------------------+

EPA ICR NUMBER 1432.25, Revised 3/07

OMB Control Number: 2060-0170

Expiration Date: 12/31/08

+-----------+-------+---+----------+---+------+-----------------------+
| ![](m     |       |   |          |   | [c   |                       |
| edia/imag |       |   |          |   | lass |                       |
| e1.png){w |       |   |          |   | i    |                       |
| idth="0.5 |       |   |          |   | co   |                       |
| 694444444 |       |   |          |   | ntro |                       |
| 444444in" |       |   |          |   | lled |                       |
| heig      |       |   |          |   | su   |                       |
| ht="0.261 |       |   |          |   | bsta |                       |
| 805555555 |       |   |          |   | nce] |                       |
| 55557in"} |       |   |          |   | {.sm |                       |
| U.S.      |       |   |          |   | allc |                       |
| Envi      |       |   |          |   | aps} |                       |
| ronmental |       |   |          |   |      |                       |
| P         |       |   |          |   | **[e |                       |
| rotection |       |   |          |   | ssen |                       |
| Agency    |       |   |          |   | tial |                       |
|           |       |   |          |   | use  |                       |
| **[stra   |       |   |          |   | a    |                       |
| tospheric |       |   |          |   | llow |                       |
| ozone     |       |   |          |   | ance |                       |
| p         |       |   |          |   | hol  |                       |
| rotection |       |   |          |   | ders |                       |
| prog      |       |   |          |   | &    |                       |
| ram]{.sma |       |   |          |   | la   |                       |
| llcaps}** |       |   |          |   | bora |                       |
|           |       |   |          |   | tory |                       |
|           |       |   |          |   | supp |                       |
|           |       |   |          |   | lier |                       |
|           |       |   |          |   | q    |                       |
|           |       |   |          |   | uart |                       |
|           |       |   |          |   | erly |                       |
|           |       |   |          |   | re   |                       |
|           |       |   |          |   | port |                       |
|           |       |   |          |   | and  |                       |
|           |       |   |          |   | e    |                       |
|           |       |   |          |   | ssen |                       |
|           |       |   |          |   | tial |                       |
|           |       |   |          |   | use  |                       |
|           |       |   |          |   | a    |                       |
|           |       |   |          |   | llow |                       |
|           |       |   |          |   | ance |                       |
|           |       |   |          |   | ho   |                       |
|           |       |   |          |   | lder |                       |
|           |       |   |          |   | an   |                       |
|           |       |   |          |   | nual |                       |
|           |       |   |          |   | re   |                       |
|           |       |   |          |   | port |                       |
|           |       |   |          |   | (    |                       |
|           |       |   |          |   | ]{.s |                       |
|           |       |   |          |   | mall |                       |
|           |       |   |          |   | caps |                       |
|           |       |   |          |   | }Sec |                       |
|           |       |   |          |   | 82.1 |                       |
|           |       |   |          |   | 3)** |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| **SECTION | *     |   |          |   |      |                       |
| 3**       | *QUAR |   |          |   |      |                       |
|           | TERLY |   |          |   |      |                       |
|           | REP   |   |          |   |      |                       |
|           | ORT:\ |   |          |   |      |                       |
|           | For   |   |          |   |      |                       |
|           | Di    |   |          |   |      |                       |
|           | strib |   |          |   |      |                       |
|           | utors |   |          |   |      |                       |
|           | of    |   |          |   |      |                       |
|           | Labor |   |          |   |      |                       |
|           | atory |   |          |   |      |                       |
|           | Supp  |   |          |   |      |                       |
|           | lies: |   |          |   |      |                       |
|           | Am    |   |          |   |      |                       |
|           | ounts |   |          |   |      |                       |
|           | [S    |   |          |   |      |                       |
|           | uppli |   |          |   |      |                       |
|           | ed]{. |   |          |   |      |                       |
|           | under |   |          |   |      |                       |
|           | line} |   |          |   |      |                       |
|           | to    |   |          |   |      |                       |
|           | Each  |   |          |   |      |                       |
|           | Labor |   |          |   |      |                       |
|           | atory |   |          |   |      |                       |
|           | Cus   |   |          |   |      |                       |
|           | tomer |   |          |   |      |                       |
|           | Q     |   |          |   |      |                       |
|           | uarte |   |          |   |      |                       |
|           | rly** |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           | **    |   |          |   |      |                       |
|           | (Repr |   |          |   |      |                       |
|           | oduce |   |          |   |      |                       |
|           | addit |   |          |   |      |                       |
|           | ional |   |          |   |      |                       |
|           | s     |   |          |   |      |                       |
|           | heets |   |          |   |      |                       |
|           | as    |   |          |   |      |                       |
|           | need  |   |          |   |      |                       |
|           | ed)** |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| **3.1     |       | * |          |   |      |                       |
| Company   |       | * |          |   |      |                       |
| Name**    |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       | * |          |   |      |                       |
|           |       | * |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| **3.2     |       |   |          |   |      |                       |
| Quarterly |       |   |          |   |      |                       |
| Totals by |       |   |          |   |      |                       |
| Lab       |       |   |          |   |      |                       |
| C         |       |   |          |   |      |                       |
| ustomer** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
|           |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| **Amounts |       |   |          |   |      |                       |
| Supplied  |       |   |          |   |      |                       |
| Quarterly |       |   |          |   |      |                       |
| per Lab** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Lab       |       |   |          |   |      |                       |
| Company   |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
| **     ** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Street    |       |   |          |   |      |                       |
| Address\  |       |   |          |   |      |                       |
| **     ** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| City\     |       |   | State\   |   |      | Zip Code\             |
| **     ** |       |   | *        |   |      | **     **             |
|           |       |   | *     ** |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
|           |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| **Amounts |       |   |          |   |      |                       |
| Supplied  |       |   |          |   |      |                       |
| Quarterly |       |   |          |   |      |                       |
| per Lab** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Lab       |       |   |          |   |      |                       |
| Company   |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
| **     ** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Street    |       |   |          |   |      |                       |
| Address\  |       |   |          |   |      |                       |
| **     ** |       |   |          |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| City\     |       |   | State\   |   |      | Zip Code\             |
| **     ** |       |   | *        |   |      | **     **             |
|           |       |   | *     ** |   |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+
| Class I   |       |   |          | C |      |                       |
| Substance |       |   |          | l |      |                       |
| Supplied  |       |   |          | a |      |                       |
| to Lab    |       |   |          | s |      |                       |
| and       |       |   |          | s |      |                       |
| Quantity: |       |   |          | I |      |                       |
|           |       |   |          | S |      |                       |
| S         |       |   |          | u |      |                       |
| ubstance: |       |   |          | b |      |                       |
| **        |       |   |          | s |      |                       |
|  **       |       |   |          | t |      |                       |
| Quantity  |       |   |          | a |      |                       |
| (kg):     |       |   |          | n |      |                       |
| **        |       |   |          | c |      |                       |
|  **       |       |   |          | e |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | p |      |                       |
|           |       |   |          | l |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | o |      |                       |
|           |       |   |          | L |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | d |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | S |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | b |      |                       |
|           |       |   |          | s |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | c |      |                       |
|           |       |   |          | e |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | Q |      |                       |
|           |       |   |          | u |      |                       |
|           |       |   |          | a |      |                       |
|           |       |   |          | n |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | i |      |                       |
|           |       |   |          | t |      |                       |
|           |       |   |          | y |      |                       |
|           |       |   |          | ( |      |                       |
|           |       |   |          | k |      |                       |
|           |       |   |          | g |      |                       |
|           |       |   |          | ) |      |                       |
|           |       |   |          | : |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          |   |      |                       |
|           |       |   |          | * |      |                       |
|           |       |   |          | * |      |                       |
+-----------+-------+---+----------+---+------+-----------------------+

EPA ICR NUMBER 1432.25, Revised 3/07

OMB Control Number: 2060-0170

Expiration Date: 12/31/08

+-----------+---+-----+---------------+--------+---------------------+
| ![](m     |   |     |               | [class |                     |
| edia/imag |   |     |               | i      |                     |
| e1.png){w |   |     |               | cont   |                     |
| idth="0.5 |   |     |               | rolled |                     |
| 694444444 |   |     |               | subs   |                     |
| 444444in" |   |     |               | tance] |                     |
| heig      |   |     |               | {.smal |                     |
| ht="0.261 |   |     |               | lcaps} |                     |
| 805555555 |   |     |               |        |                     |
| 55557in"} |   |     |               | **[ess |                     |
| U.S.      |   |     |               | ential |                     |
| Envi      |   |     |               | use    |                     |
| ronmental |   |     |               | all    |                     |
| P         |   |     |               | owance |                     |
| rotection |   |     |               | h      |                     |
| Agency    |   |     |               | olders |                     |
|           |   |     |               | &      |                     |
| **[stra   |   |     |               | labo   |                     |
| tospheric |   |     |               | ratory |                     |
| ozone     |   |     |               | su     |                     |
| p         |   |     |               | pplier |                     |
| rotection |   |     |               | qua    |                     |
| prog      |   |     |               | rterly |                     |
| ram]{.sma |   |     |               | report |                     |
| llcaps}** |   |     |               | and    |                     |
|           |   |     |               | ess    |                     |
|           |   |     |               | ential |                     |
|           |   |     |               | use    |                     |
|           |   |     |               | all    |                     |
|           |   |     |               | owance |                     |
|           |   |     |               | holder |                     |
|           |   |     |               | annual |                     |
|           |   |     |               | report |                     |
|           |   |     |               | (]{.s  |                     |
|           |   |     |               | mallca |                     |
|           |   |     |               | ps}Sec |                     |
|           |   |     |               | 82     |                     |
|           |   |     |               | .13)** |                     |
+-----------+---+-----+---------------+--------+---------------------+
| **SECTION | * |     |               |        |                     |
| 4**       | * |     |               |        |                     |
|           | Q |     |               |        |                     |
|           | U |     |               |        |                     |
|           | A |     |               |        |                     |
|           | R |     |               |        |                     |
|           | T |     |               |        |                     |
|           | E |     |               |        |                     |
|           | R |     |               |        |                     |
|           | L |     |               |        |                     |
|           | Y |     |               |        |                     |
|           | T |     |               |        |                     |
|           | O |     |               |        |                     |
|           | T |     |               |        |                     |
|           | A |     |               |        |                     |
|           | L |     |               |        |                     |
|           | S |     |               |        |                     |
|           | B |     |               |        |                     |
|           | Y |     |               |        |                     |
|           | C |     |               |        |                     |
|           | H |     |               |        |                     |
|           | E |     |               |        |                     |
|           | M |     |               |        |                     |
|           | I |     |               |        |                     |
|           | C |     |               |        |                     |
|           | A |     |               |        |                     |
|           | L |     |               |        |                     |
|           | * |     |               |        |                     |
|           | * |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| **4.1     |   | **  |               |        |                     |
| Company   |   |     |               |        |                     |
| Name**    |   |  ** |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| **4.2     |   |     |               |        |                     |
| Company   |   |     |               |        |                     |
| Totals**  |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| **A**     |   |     | **B**         |        | **C**               |
+-----------+---+-----+---------------+--------+---------------------+
| Chemical  |   |     | Total         |        | Total Quantity of   |
| Name      |   |     | Quantity of   |        | Class I ODS         |
|           |   |     | Essential Use |        | Supplied to Labs    |
|           |   |     | ODS Received  |        | (kg)                |
|           |   |     | from          |        |                     |
|           |   |     | Produc        |        |                     |
|           |   |     | ers/Importers |        |                     |
|           |   |     | (kg)          |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-11    |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-12    |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-13    |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-111   |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-112   |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-113   |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-114   |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| CFC-115   |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+
| Other     |   |     | **     **     |        | **     **           |
| CFCs      |   |     |               |        |                     |
| (please   |   |     |               |        |                     |
| specify)\ |   |     |               |        |                     |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| HBFCs     |   |     | **     **     |        | **     **           |
| (please   |   |     |               |        |                     |
| specify)\ |   |     |               |        |                     |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| Halons    |   |     | **     **     |        | **     **           |
| (please   |   |     |               |        |                     |
| specify)\ |   |     |               |        |                     |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| >         |   |     | **     **     |        | **     **           |
| **     ** |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| Carbon    |   |     | **     **     |        | **     **           |
| Tetr      |   |     |               |        |                     |
| achloride |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| Methyl    |   |     | **     **     |        | **     **           |
| C         |   |     |               |        |                     |
| hloroform |   |     |               |        |                     |
+-----------+---+-----+---------------+--------+---------------------+
| CBM       |   |     | **     **     |        | **     **           |
+-----------+---+-----+---------------+--------+---------------------+

EPA ICR NUMBER 1432.25, Revised 3/07

OMB Control Number: 2060-0170

<table>
<colgroup>
<col style="width: 11%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 9%" />
<col style="width: 1%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="8"><p><img src="media/image1.png"
style="width:0.56944in;height:0.26181in" /> U.S. Environmental
Protection Agency</p>
<p><strong><span class="smallcaps">stratospheric ozone protection
program</span></strong></p></td>
<td colspan="4"><p><span class="smallcaps">class i controlled
substance</span></p>
<p><strong><span class="smallcaps">essential use allowance holders &amp;
laboratory supplier quarterly report and essential use allowance holder
annual report (</span>Sec 82.13)</strong></p></td>
</tr>
<tr class="even">
<td colspan="2"><strong>SECTION 5</strong></td>
<td colspan="10"><p><strong>ANNUAL REPORT:</strong></p>
<p><strong>For 4<sup>th</sup> Quarter Essential Use Holder Reporting
Only</strong></p>
<p><strong>(To be completed by the person allocated essential-use
allowances)</strong></p></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>5.1 Distributor Name</strong></td>
<td colspan="10"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="12"><strong>5.2 Company Totals</strong></td>
</tr>
<tr class="odd">
<td><strong>A</strong></td>
<td colspan="2"><strong>B</strong></td>
<td colspan="2"><strong>C</strong></td>
<td><strong>D</strong></td>
<td><strong>E</strong></td>
<td colspan="2"><strong>F</strong></td>
<td><strong>G</strong></td>
<td><strong>H</strong></td>
<td><strong>I</strong></td>
</tr>
<tr class="even">
<td rowspan="2">Chemical Name</td>
<td colspan="2" rowspan="2">Amount Acquired by Production (kg)</td>
<td colspan="2">Amount Acquired for Essential Uses by Import and
Country(s) of Manufacture</td>
<td rowspan="2">Amounts On Hand at the <u>End of the Year</u> (includes
pre-1996 amounts) (kg)</td>
<td rowspan="2">Pre-phaseout Stockpiled Amounts Held<br />
(kg)</td>
<td colspan="2" rowspan="2">Amounts Used for the Essential Uses
(kg)</td>
<td rowspan="2">Amount Contained in Exported Products (kg)</td>
<td rowspan="2">Amounts Destroyed or Recycled (kg)</td>
<td rowspan="2">Total Number of Marketable MDI Units Manufactured</td>
</tr>
<tr class="odd">
<td>Amount (kg)</td>
<td>Country</td>
</tr>
<tr class="even">
<td>CFC-11</td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td rowspan="3"><strong>     </strong></td>
</tr>
<tr class="odd">
<td>CFC-12</td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td>CFC-114</td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td rowspan="10"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

Expiration Date: 12/31/08

EPA ICR NUMBER 1432.25, Revised 3/07