OMB Control Number: 2060-0170

Expiration Date: 4/30/12

EPA Form # 5900-151, Revised 11/11

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

PRODUCER QUARTERLY REPORT

(Sec 82.13)

SECTION 1 PRODUCING COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Producing Company

Company Name 

Street Address

City State Zip Code 

1.4 Company Contact Identification

Reporting Company Contact Person Phone Number Fax Number

E-mail Address 

1.5 Quarter and Year to Which This 

Report Applies 1

st 2nd 3rd 4th Year 

1.6 Importer Information Is your company an Importer of Class I substances?

If yes, is the Importer Quarterly Report attached?

 Yes

 Yes

 No 

 No

1.7 Exporter Information Is your company an Exporter of Class I 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 

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 2.4 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. 

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
OMB Control Number: 2060-0170

Expiration Date: 4/30/12

EPA Form # 5900-151, Revised 11/11

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

PRODUCER QUARTERLY REPORT 

(Sec 82.13)

SECTION 2 COMPANY PRODUCTION DATA

2.1 Company Name 

2.2 Company Production Totals

A B C D E F G

Chemical Name

Essential-Uses

In-House 

Transformation (kg)

Second-Party 

Transformation (kg)

In-House Destruction

(kg)

Second-Party 

Destruction (kg)

Gross Production of 

Class I Substance

(B + C + D + E + F = G) 

(kg)

B1

Global Laboratory 

Exemption (kg)

B2

Other Essential-Uses 

(i.e., MDI) (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 Tetrachloride

Methyl Chloroform

CBM