OMB Control Number: 2060-0498

 Expiration Date: TBD

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS II CONTROLLED SUBSTANCE 

PRODUCER QUARTERLY REPORT

(Sec 82.24)

SECTION 1 PRODUCING COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Quarter and Year to Which This 

Report Applies 1

st 2nd 3rd 4th Year 

1.4 Producing Company

Company Name 

Street Address 

City State Zip Code 

1.5 Company Contact Identification

Reporting Company Contact Person Phone Number Fax Number

E-mail Address 

1.6 Importer Information Is your company an importer of class II substances?

If yes, is the Importer Quarterly Report attached?

 Yes

 Yes

 No

 No

1.7 Exporter Information Is your company an exporter of class II substances?

If yes, is the Exporter Quarterly Report attached?

 Yes

 Yes

 No 

 No 

1.8 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 # 5900-202, Revised 9/12 
 OMB Control Number: 2060-0498

 Expiration Date: TBD

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS II CONTROLLED SUBSTANCE 

PRODUCER QUARTERLY REPORT 

(Sec 82.24)

SECTION 2 COMPANY PRODUCTION DATA

2.1 Company Name 

2.2 Company Production Totals

A B C D E F G H I

Chemical Name

Gross Production 

(kg)

In-House 

Transformation (kg)

Second-Party 

Transformation (kg)

In-House 

Destruction (kg)

Second-Party 

Destruction (kg)

HCFC-141b 

Exemption (kg)

Article 5 Production 

(kg)

Net Production (kg)

(B- C- D- E- F- G- H = I)

HCFC-22

HCFC-123

HCFC-124

HCFC-141b

HCFC-142b

HCFC-225ca

HCFC-225cb

If needed, please 

write in HCFC not 

listed above

EPA Form # 5900-202, Revised 9/12 
 OMB Control Number: 2060-0498

 Expiration Date: TBD

 U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS II CONTROLLED SUBSTANCE 

PRODUCER QUARTERLY REPORT 

(Sec 82.24)

SECTION 3 ALLOWANCE EXPENDITURE TOTALS

3.1 Company Name

3.2 Allowance Balance Summary

A B C D

Chemical 

Name

Total production allowances for year 

to date (as of the end of the quarter) 

that were:

Total consumption allowances for year 

to date (as of the end of the quarter) 

that were:

Total Article 5 allowances for year to 

date (as of the end of the quarter) that 

were:

Expended Unexpended Expended Unexpended Expended Unexpended

HCFC-22

HCFC-123

HCFC-124

HCFC-142b

HCFC-225ca

HCFC-225cb

If needed, 

please write in 

HCFC not listed 

above 

3.3 Name(s) of HCFC-141b Exemption Allowance Holder(s) from whom Orders were Received and Associated 

Quantity (kg) of HCFC-141b Requested and Produced

Company Name: HCFC-141b Requested and Produced (kg): 

Company Name: HCFC-141b Requested and Produced (kg): 

Company Name: HCFC-141b Requested and Produced (kg): 

Company Name: HCFC-141b Requested and Produced (kg): 

Company Name: HCFC-141b Requested and Produced (kg): 

EPA Form # 5900-202, Revised 9/12