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OMB Control Number: xxxx-xxxx |
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Expiration Date: xx/xx/xxxx |
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U.S. Environmental Protection Agency |
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Stratospheric Ozone Protection Program |
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Class I Process Agent One-Time Report (Sec 82.13) |
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Version 1.0 |
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Last Updated: September 2024 |
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Instructions |
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Complete and submit a Class I ODS Process Agent One-Time Report if your company uses regulated Class I ODS as process agents. Please provide information for only one facility per reporting form. |
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Complete this form by filling in the data fields that are highlighted in blue. Guidance on how to complete individual data fields are provided in comment bubbles. Use the arrows to navigate between the tabs. Once completed, use the 'prepare submission' button in Section 3 to generate your CSV file. |
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Copying and Pasting Data: If data are pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be |
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accepted into EPA’s ODS Tracking System. Refer to the Reference List to identify the valid naming scheme for specific data fields. Additionally, select "Paste As Values" when pasting data into the form. |
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Report Submission: This Excel file, the generated CSV file, and all supporting attachments should be submitted to EPA through the Central Data Exchange (CDX). Refer to EPA's website for additional information on form submission: |
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https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting |
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This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. XXXX-XXXX). Responses to this collection of information are mandatory (40 CFR 82.13). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The number and expiration date are displayed in the upper right corner of the form. The public reporting and recordkeeping burden for this collection of information is estimated to be X hours per response. Send comments on the Agency’s need this formation, 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, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 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. |
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EPA Form #5900-656 |
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U.S. Environmental Protection Agency |
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Class I Process Agent One-Time Report |
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Faclity Name: |
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Reporting Period: |
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Section 2: Class I Substance Use Information |
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Complete all fields below for each process agent use of a Class I controlled substance. No fields may be left blank. |
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If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions. |
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Name |
Purpose |
Final Product Manufactured |
Amount Used |
Total Air Emissions (kg) |
Fugitive Air Emissions (kg) |
Stack Point Air Emissions (kg) |
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ODS Substance (1) |
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ODS Substance (2) |
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ODS Substance (3) |
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Name |
Amount Used |
Final Product Manufactured (1) |
Amount of Final Product (1) Produced |
Final Product Manufactured (2) |
Amount of Final Product (2) Produced |
Name of Byproduct (1) |
Amount of Byproduct (1) Produced |
Name of Byproduct (2) |
Amount of Byproduct (2) Produced |
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ODS Substance (1) |
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ODS Substance (2) |
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ODS Substance (3) |
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U.S. Environmental Protection Agency |
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Class I Process Agent One-Time Report |
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Facility Name: |
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Reporting Period: |
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Section 3: Substance Use Mitigation |
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Complete all fields below for each process agent use of a Class I controlled substance. |
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Description of technologies used or actions taken to minimized use or emissions of Class I controlled substances, including estimated emissions reductions: |
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Description of Class I substance lifecycle (including percentages used as process agent and (1) retained within the process agent application, (2) consumed in the process agent application, (3) recovered after the process agent application, (4) emitted, and (5) entrained in the final product): |
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x |
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