OMB
Control
Number:
2060­
0498
Pending
Expiration
Date:
6/
30/
06
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
Quarter
and
Year
to
Which
This
Report
Applies
1st
2nd
3rd
4th
Year
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
Importer
Information
Is
your
company
an
importer
of
class
II
substances?
If
yes,
is
the
Importer
Quarterly
Report
attached?
Yes
Yes
No
No
1.6
Exporter
Information
Is
your
company
an
exporter
of
class
II
substances?
If
yes,
is
the
Exporter
Quarterly
Report
attached?
Yes
Yes
No
No
1.7
Signature
of
Reporting
Company
Representative
I
certify
under
penalty
of
law
that
I
have
personally
examined
and
am
familiar
with
the
information
submitted
in
this
and
all
attached
documents,
and
that
based
on
my
inquiry
of
those
individuals
immediately
responsible
for
obtaining
the
information,
I
believe
that
the
submitted
information
is
true,
accurate,
and
complete.
I
am
aware
that
there
are
significant
penalties
for
submitting
false
information,
including
the
possibility
of
fine
and
imprisonment.

Name
Title
Signature
Date
SEND
COMPLETED
FORMS
TO:
For
U.
S.
Postal
Service:

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

Tracking
System
Program
Manager
Stratospheric
Protection
Division
U.
S.
EPA
(
6205J)
1310
L
Street,
NW,
8th
Floor
Washington,
DC
20005
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.

Pending
EPA
ICR
NUMBER
2014.03,
Revised
4/
06
OMB
Control
Number:
2060­
0498
Pending
Expiration
Date:
6/
30/
06
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
J
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)
Export
Production
(
kg)
Article
5
Production
(
kg)
Net
Production
of
HCFC
(
kg)

(
B
­
C
­
D
­
E
 
F
=
J)

HCFC­
22
HCFC­
123
HCFC­
124
HCFC­
133
HCFC­
141b
HCFC­
142b
HCFC­
225ca
HCFC­
225cb
If
needed,

please
write
in
HCFC
not
listed
above
Pending
EPA
ICR
NUMBER
2014.03,
Revised
4/
06
OMB
Control
Number:
2060­
0498
Pending
Expiration
Date:
6/
30/
06
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
E
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
export
production
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:
Chemical
Name
Expended
Unexpended
Expended
Unexpended
Expended
Unexpended
Expended
Unexpended
HCFC­
22
HCFC­
123
HCFC­
124
HCFC­
133
HCFC­
141b
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):

Pending
EPA
ICR
NUMBER
2014.03,
Revised
4/
06
