Document ID: EPA-HQ-OAR-2003-0039-0039
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2016-04-28T04:00Z

OMB
Control Number: 2060-0498

                                                                        
                                                                        
                                        Expiration Date: 2/28/2013

   U.S. Environmental Protection Agency

	

       stratospheric ozone protection program	class ii controlled
substance

transfers of production allowances, consumption allowances, or article 5
allowances 

(Sec 82.23)

SECTION 1    TRANSFEROR IDENTIFICATION

	1.1 Date of Submission	  FORMTEXT        	1.2 Number of
Transactions Reported	  FORMTEXT        

1.3 Number of Pages Submitted	  FORMTEXT        	1.4   
FORMCHECKBOX  Original Submittal    FORMCHECKBOX   Re-submittal

1.5 Company Information

	Company Name    FORMTEXT        

Street Address    FORMTEXT        

City    FORMTEXT        

	State    FORMTEXT        	Zip Code    FORMTEXT 
      

1.6 Company Contact Identification

Reporting Company Contact Person 

   FORMTEXT        

	Phone Number  

  FORMTEXT        	Fax Number  

      

Title    FORMTEXT        

Signature     FORMTEXT        	

Date    FORMTEXT        

SEND COMPLETED FORMS TO:	For U.S. Postal Service:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1200 Pennsylvania Avenue, NW

Washington, DC  20460	For Private Courier:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1310 L Street, NW, 10th Floor

Washington, DC  20005

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

The public reporting and recordkeeping burden for this collection of
information is estimated to average 4.5 hours per response.  Send
comments on the Agency's need for this information, the accuracy of the
provided burden estimates, and any suggested methods for minimizing
respondent burden, including through the use of automated collection
techniques to the Director, Collection Strategies Division, U.S.
Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW,
Washington, D.C. 20460.  Include the OMB control number in any
correspondence.  Do not send the completed form to this address.

EPA Form # 5900-205, Revised 2/10                                      
                                                                        
                                                                    	OMB
Control Number: 2060-0498                                               
                                                                        
                          

                                                                        
                                                                        
                                        Expiration Date: 2/28/2013

     U.S. Environmental Protection Agency

    stratospheric ozone protection program

	class ii controlled substance 

transfers of production allowances, consumption allowances, or article 5
allowances

(Sec 82.23)

SECTION 2    TRANSACTION RECORD 

      			

2.1 Transferee Identification	

Transferee Company Name

  FORMTEXT        	Transferee Contact Person

  FORMTEXT        

Street Address   FORMTEXT        

City  

  FORMTEXT        	State  

  FORMTEXT        	Zip Code  

  FORMTEXT        

Phone Number

  FORMTEXT        	Fax Number

  FORMTEXT        

 Type of Allowance Being Transferred

 (check only one)	  FORMCHECKBOX   Production	  FORMCHECKBOX  
Consumption	  FORMCHECKBOX   Article 5

2.2  Type of Allowances Transferred  

  (check only one)	  FORMCHECKBOX    Current Year Allowances            
     	    FORMCHECKBOX   Baseline Year Allowances

      2.3  HCFC Transferring From	  FORMTEXT        		 2.4 ODP
  FORMTEXT        

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

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ount of Offset (0.001 x Section 2.5) (kg)*	  FORMTEXT        

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

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

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

EPA Form # 5900-205, Revised 2/10  

                                                                       
                                                               	 OMB
Control Number: 2060-0498

                                                                        
                                                                        
                                       Expiration Date: 2/28/2013

  U.S. Environmental Protection Agency

  stratospheric ozone protection program

class ii controlled substance 

transfers of production allowances, consumption allowances, or article 5
allowances

 (Sec 82.23)

SECTION 3    ALLOWANCE BALANCE SUMMARY

3.1 Balance of Unexpended HCFC Allowances Prior to Transfers Reported

A	B	C	D

Chemical Name	Balance of Unexpended  Production Allowances	Balance of
Unexpended Consumption Allowances	Balance of Unexpended 

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Ԁ      	  FORMTEXT        	  FORMTEXT 
      

HCFC-142b	  FORMTEXT        	  FORMTEXT        	 
FORMTEXT        

HCFC-123	  FORMTEXT        	  FORMTEXT        	 
FORMTEXT        

HCFC-124	  FORMTEXT        	  FORMTEXT        	 
FORMTEXT        

HCFC-225ca	  FORMTEXT        	  FORMTEXT        	 
FORMTEXT        

HCFC-225cb	  FORMTEXT        	  FORMTEXT        	 
FORMTEXT        

EPA Form # 5900-205, Revised 2/10