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<col style="width: 3%" />
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<col style="width: 18%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="4"><img src="media/image1.png"
style="width:0.81181in;height:0.29514in" />Number range CHAPTER</td>
<td colspan="4"><p>United States Environmental Protection Agency</p>
<p>Washington, DC 20460</p>
<p><strong>Notice of Arrival of</strong></p>
<p><strong>Pesticides and Devices</strong></p></td>
<td colspan="5" rowspan="2">Send Completed Form to Appropriate Regional
Office Listed on the Reverse of this Form.</td>
<td colspan="2" rowspan="2"><p>Form Approved</p>
<p>OMB No. 2070-0020</p></td>
</tr>
<tr class="even">
<td colspan="8"><strong>Note:</strong> Read Instructions on reverse
before completing form.</td>
</tr>
<tr class="odd">
<td colspan="8"></td>
<td colspan="5"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Part I: To Be Completed by Importer or
Agent</strong></td>
</tr>
<tr class="odd">
<td colspan="8">1. Name and Complete Address of Broker or Agent</td>
<td colspan="7">2. Name and Complete Address of Importer or
Consignee</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="5">Return Form to this Address</td>
<td></td>
<td></td>
<td></td>
<td colspan="4">Return Form to this Address</td>
</tr>
<tr class="odd">
<td colspan="8" rowspan="2">3. Name and Address of Shipper</td>
<td colspan="4">4. EPA Registration Number</td>
<td colspan="3">5. EPA Producer Establishment No.</td>
</tr>
<tr class="even">
<td colspan="7">6. Brand name of Product</td>
</tr>
<tr class="odd">
<td colspan="15">7. Major Active Ingredients and Percentage of Each</td>
</tr>
<tr class="even">
<td colspan="4">8. Unit Size</td>
<td colspan="3">9. Quantity</td>
<td>10. Total Net Weight</td>
<td colspan="7">11. Country of Origin</td>
</tr>
<tr class="odd">
<td colspan="8">12. Port of Entry</td>
<td colspan="7">13. Carrier</td>
</tr>
<tr class="even">
<td colspan="7">14. Entry Number</td>
<td>15. Entry Date</td>
<td colspan="7" rowspan="3">16. I assert that information constituting
Confidential Business Information is shown in the above blocks numbered:
(Note: Blocks 4, 5, 6, 7 are not entitled to CBI treatment–see
Instructions)</td>
</tr>
<tr class="odd">
<td colspan="8">17. Location of Goods for Examination after
Importation</td>
</tr>
<tr class="even">
<td colspan="8">18. Remarks</td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>Certification</strong></p>
<blockquote>
<p>I certify that the statements I have made on this form and all
attachments thereto are true, accurate, and complete. I acknowledge that
any knowingly false or misleading statement may be punishable by fine or
imprisonment or both under applicable law.</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="7">19. Printed Name of Importer or Agent</td>
<td>Telephone Number</td>
<td colspan="6">20. Signature of Importer or Agent</td>
<td>Date Signed</td>
</tr>
<tr class="odd">
<td colspan="15"><strong>Part II: To Be Completed by U.S. Environmental
Protection Agency</strong></td>
</tr>
<tr class="even">
<td colspan="8">Action to be taken by U.S. Customs Service</td>
<td colspan="7"></td>
</tr>
<tr class="odd">
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2">Release Shipment</td>
<td></td>
<td rowspan="2"></td>
<td rowspan="2">Detain for Inspection</td>
<td rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td colspan="4" rowspan="2">Release shipment to consignee under bond.
Shipment must be held intact pending inspection.</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2">Other <em>(Specify)</em></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="15">Remarks</td>
</tr>
<tr class="odd">
<td colspan="13">Signature and Title of EPA Official</td>
<td colspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="15"><strong>Part III: To Be Completed by U.S. Customs
Service</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><blockquote>
<p>The information shown in Part I was compared with the entry papers
for this shipment and no discrepancies were noted. The shipment was
handled as instructed by EPA in Part II. Any deviations should be
brought to the attention of EPA before releasing shipment and should
also be noted in “Remarks.”</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="15">Remarks</td>
</tr>
<tr class="odd">
<td colspan="13">Signature of District Director of Customs</td>
<td colspan="2">Date</td>
</tr>
</tbody>
</table>

**EPA Form 3540-1 (Rev. 2-00)**

**Instructions**

**Customs Regulations**. 19 CFR 12.112 requires an importer desiring to
import pesticides or devices into the United States to submit EPA Form
3540-1, Notice of Arrival of Pesticides and Devices, to the U.S.
Environmental Protection Agency prior to the arrival of shipment in the
United States. This form will be used by:\
**Importer or Agent**. The Importer or his agent must complete Part 1 of
the form. It may be necessary to complete some of the items at the time
of entry, e.g., entry data, carrier. To expedite the handling of
pesticides shipments, submit this form to the EPA office listed below
having jurisdiction over the state/territory in which the Port of Entry
is located prior to the arrival of the shipment.\
**EPA**. Part II of this form will be completed by EPA. EPA will retain
the EPA Copy for its files and return the other copies\
to the importer or agent for presentation to Customs at the time of
entry.\
**Customs** . Customs will compare the information shown on this form
with the entry documents and the shipment. Bring any discrepancies to
the attention of EPA before the shipment is released and noted in the
remarks section. If the importation is not handled by Customs in the
manner instructed in Part II, this should also be noted in remarks. All
data left blank by the importer (e.g., entry date) must be completed at
this time. After completion of Part III and signing the form, Customs
will return the Official File Copy to EPA and retain the Custom's Copy.

**The following blocks are self explanatory - 1, 2, 8, 9, 10, 12, 14,
15, 18, 19, and 20.**

1.  **3. Name and Address of Shipper.** The name and address of person
    exporting the pesticide to the United States.

    **4. EPA Registration No.** The product registration number assigned
    at the time of registration which identifies the product. If the
    product is a device, write the word 'device' in the block.

    **5. EPA Producer Establishment No.** The producing establishment
    registration number which identified where the pesticidal product,
    active ingredient, or device was produced.

    **6. Brand Name of Product.** Name under which the product is sold
    or distributed.

    **7. Major Active Ingredients and Percentage of Each**. If block 4
    contains registration number, leave blank. If no registration
    number, list active ingredients (or two major ingredients and
    percentage of each).

    **11. Country of Origin.** The country in which the pesticide
    producer is located.

    **13. Carrier.** E.g., ship's name, airline or trucking company.

    **16. Confidential Business Information (CBI) designation.** Please
    note that the information provided in blocks 4, 5, 6, and 7 is not
    entitled to confidential treatment under section 7(d) of FIFRA and
    under labeling requirements for pesticides at 40 CFR 156.10.
    Information provided in those blocks will be made public with no
    further notice.

    **17. Location of Goods for Examination after Importation.** Enter
    the EPA establishment number for importing registered establishment
    in the case of unregistered product imports between establishments
    operated by the same producer.

> **EPA Regional Offices States Covered EPA Regional Offices States
> Covered**

  --------------------- ----------- ------------------------ -------------
  EPA Region I          CT MA ME    EPA Region VI            AR LA NM

  1 Congress Street     NH RI VT    1445 Ross Avenue         OK TX
  (SEA)                                                      

  Boston, MA 02114-2023             Suite #1200 (6PD-P)      

                                    Dallas, TX 75202-2733    

  EPA Region II         NJ NY       EPA Region VII           IA KS

  MS-500, Bldg #5       PR VI       901 N. 5TH Street        MO NE
                                    (PESTWWPD)               

  2890 Woodbridge Ave.              Kansas City, KS 66101    

  Edison, NJ 08837-3679                                      

  EPA Region III        DE DC       EPA Region VIII          CO MT

  1650 Arch Street      MD PA       999 18th Street          ND SD
  (3WC32)                                                    

  Philadelphia, PA      VA WV       Suite #500 (8ENF/TEP)    UT WY
  19103-2029                                                 

                                    Denver, CO 80202-2466    

  EPA Region IV         AL FL GA    EPA Region IX            AZ AS CA

  61 Forsyth Street, SW KY MS NC    75 Hawthorne Street      GU HI NV
  (APT-PS)                          (CMD-4-3)                

  Atlanta, GA           SC TN       San Francisco, CA        PI WK
  30303-8960                        94105-3901               

  EPA Region V          IL IN       EPA Region X             AK ID

  77 West Jackson       OH MI       1200 Sixth Avenue        OR WA
  Blvd.(DT-8J)                      (ECO-084)                

  Chicago, IL           MN WI       Seattle, WA 98101-9797   
  60604-3507                                                 
  --------------------- ----------- ------------------------ -------------

**EPA Form 3540-1 (Rev. 2-00)**