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United States Environmental Protection Agency

Instructions for Completing EPA Form 3540-16

Pesticide Report for Pesticide-Producing and Device-Producing Establishments

Reporting Year 2010

It is unlawful to knowingly falsify all or part of any pesticide or device production information 

reported on EPA Form 3540-16. (FIFRA §12(a)(2)(M))

General Information

Read all instructions before completing this form. Type or print clearly in dark ink. This form 

may also be filled out and printed on-line. Page one has space to enter one product. Use the “Add 

additional page” button at the bottom of the on-line screen-fillable form and add as many pages as 

necessary to report all products. Each “Additional” page has space for four (4) products. Please make 

sure you number each page. If you add too many pages, click the “Remove Extra Page” button to 

remove the last page added. See the Pesticide Establishment Registration and Reporting web page for 

the instructions and the form. 

http://www.epa.gov/compliance/monitoring/programs/fifra/establishments.html

1. Who must report?

• All domestic and foreign producing establishments, regardless of whether or not the establishment 

produced or distributed a pesticide, active ingredient or device must submit a report. (FIFRA §§ 7 

and 17)

• Establishments with zero production or distribution in 2010. If your establishment did not produce 

or distribute products subject to this report in 2010:

o Complete Items 1-27 and Items 40-43.

o Check “No” in Item 14.

• Establishments that closed, went out of business or ceased production. 

o Report all production and distribution during 2010.

o See Number 7 for information on terminating your establishment’s registration.

2. Definitions

o Producer—any person, as defined by FIFRA, “who produces any pesticide, active 

ingredient, or device (including packaging, repackaging, labeling and relabeling).”

(40 CFR §167.3) 

o Produce—“manufacture, prepare, propagate, compound or process any pesticide, 

including any pesticide product pursuant to FIFRA §5, any active ingredient or device, or 
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to package, repackage, label, relabel or otherwise change the container of any pesticide or 

device.” (40 CFR §167.3)

o Establishment—Includes:

o Any site where a pesticidal product, active ingredient or device is produced. 

o Sites that are independently owned or operated regardless of whether such site is 

domestic and producing a pesticidal product for export only or whether the site is 

foreign and producing a pesticidal product for import into the United States. 

(40 CFR §167.3) 

o Sites that produce a pesticidal product for use under an Experimental Use Permit, 

FIFRA Section 18 Emergency Exemption or Section 24(c) Special Local Needs 

registration, must report. (40 CFR §167.20)

o Sites that produce unregistered pesticidal products for export from the US.

o Custom Blender—any establishment that provides the service of mixing registered 

pesticides to a customer’s specifications, specifically:

o a pesticide-pesticide blend

o a pesticide-fertilizer blend

o a pesticide-animal feed mixture

when

o the blend is not held in inventory 

o the pesticide used in producing the blend bears labeling that does not prohibit the use 

of the pesticide in the blend 

o the blend is delivered to the end-user with a copy of the labeling of the pesticide used 

in producing the blend and a statement specifying the composition of the mixture

If these conditions are not met, the establishment does not meet the definition of "custom 

blender" and must comply with FIFRA Section 7 requirements.

3. What must be reported?

• Each producer operating an establishment must submit the following information for each pesticide, 

active ingredient or device produced at your establishment: (Please note that production and 

distribution of unregistered pesticides must be reported. See 40 CFR § 152.30).

o Types and amounts produced in 2010.

o Types and amounts sold or distributed in 2010, regardless of when the product was 

produced.

o An estimate of the amount expected to be produced in 2011.

NOTE: A facility where only custom blending activities take place is not considered a 

pesticide-producing establishment and therefore does not need to be registered. Please see the 

Pesticide Establishment Registration and Reporting FAQ for more information. 

http://www.epa.gov/compliance/resources/monitoring/fifra/faqestablishment.html
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• DO NOT REPORT:

o Production, distribution or sale of products NOT produced or repackaged by your 

establishment (e.g., no changes are made to the product formulation, container or 

label).

o Products shipped from your supplier directly to your customer.

o Any products for which Items 36, 37 and 38 are zero.

o Pesticides that are applied by your staff.

o Returned inventory or carryover product from a previous year.

o Custom-blended products.

4. When to report:

• Annual Reports are due: On or before March 1, 2011, even if there has been no production.

• Initial Reports: FIFRA §7 requires all registered establishments to submit an initial report to the 

U.S. EPA 30 days after receipt of notification of establishment registration. Failure to file the initial 

report is an unlawful act and may result in termination of the establishment’s registration or your 

ability to import into the United States until you have fulfilled your reporting responsibility.

5. Completing the Report:

• Enter the company official’s or authorized agent’s Name and Title (Items 40 & 41).

• An original signature of a company official or authorized agent is required on the report in Item 42.

• Enter the date in Item 43.

• For all pages complete at the bottom: “This is Page _____ of _____.”

• Submit completed reports as directed on Page 9. Please make a copy of the report for your records.

• EPA will not accept any copies (xeroxed, faxed or electronic document formats) of the initial 

or annual reports (EPA Form 3540-16).

6. What if I fail to file this production report?

Failure to file an initial or annual production report is a violation of FIFRA, and may result in 

termination of the establishment’s registration, civil penalties up to $7,500 per violation and/or 

criminal penalties. It may also affect your ability to import until you are in compliance.

7. How to terminate your establishment’s registration:

• Send a letter on company letterhead with this report stating the establishment is out of 

business or has ceased production of pesticides, active ingredients or devices requesting that 

your establishment number be terminated. 

• If EPA terminates your domestic establishment registration, it is illegal to sell or distribute 

any pesticide, active ingredient or device in the United States or to export a product out of the 

United States. If EPA terminates your foreign establishment registration, it is illegal for you 

to import any pesticide, active ingredient or device into to the United States.
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8. Additional Information is available at Pesticide Establishment—Registration and Reporting 

Questions at: http://www.epa.gov/compliance/resources/monitoring/fifra/faqestablishment.html.

General Instructions

Establishment Information: (Items 1 through 14)

• Item 1—Establishment Name: Enter the producing establishment name.

• Item 2—Establishment Number: Enter the producing establishment number.

• Item 3 to 6—Establishment Site Address: Enter the SITE address, not a post office box or 

route number, where your establishment is located. For foreign establishments, zip code is 

equivalent to postal code, post code or postcode.

• Item 7 to 10—Establishment Mailing Address: Enter the mailing address for the 

establishment if different from the site address.

• Item 11—Telephone Number: Enter the phone number for the establishment. For foreign 

establishments, please provide the country code.

• Item 12—Email: Enter your email address.

• Item 13—If the establishment name or site address has changed from the previous year, enter a 

check (X) in the box.

• Item 14— Did you produce or distribute in 2010? Check the appropriate box.

Note: If you checked the “No” box, do not fill in items 28 through 39.

Company Information: (Items 15 through 27)

• Item 15—Company Name: Enter the company name.

• Item 16 to 19—Company Site Address: Enter the company’s headquarter address.

• Item 20 to 23—Company Mailing Address: Enter the mailing address for the company if 

different from the company site address.

• Item 24—Telephone Number: Enter the phone number for the company. For foreign 

companies, please provide the country code.

• Item 25—Email: Enter your email address.

• Item 26—If company name or site address has changed from the previous year, enter a check 

(X) in the box.

• Item 27 — If Authorized Agent name or mailing address has changed from the previous year, 

enter a check (X) in the box. Please attach your company’s request to change the authorized 

agent on company letterhead and send to the appropriate EPA office listed on Page 9.

NOTE: For items 5, 9, 18 and 22—Foreign country abbreviation codes are available at:

http://www.epa.gov/compliance/resources/publications/monitoring/fifra/fgnestablishments.html

Please contact U.S. EPA Headquarters 011-202-564-4203 if you do not see the appropriate 

country code listed.

http://www.epa.gov/compliance/resources/monitoring/fifra/faqestablishment.html
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Pesticide Production Information: (Items 28 through 39)

• Item 28—Product Code:

o Enter 1 — if product is registered with EPA.

o Enter 2 — if product registration is pending.

o Enter 3 — if product is an Experimental Use Permit.

o Enter 4 — if product is a device.

o Enter 5 — if product is a Special Local Need (SLN) registration.

“Special Local Need (SLN)” means an existing or imminent pest problem 

within a State for which the State lead agency, based upon satisfactory 

supporting information, has determined that an appropriate federally registered 

pesticide product is not sufficiently available. (See: EPA regulations at 40 CFR 

§162.151)

o Enter 6 — if product is an Unregistered Pesticide. Attach the formulation of the product to 

the end of the report showing the product’s active and inert ingredients; their common 

names; their CAS Registry numbers (if available); and the percentage, by weight, of each 

ingredient (must total 100%). Multiple formulations may appear on the same page; clearly 

identify each by product name. 

• Item 29—EPA Product Registration Number Information:

o Product Code 1— Enter EPA Registration No. (as it appears on product label) 

(See NOTE below on reporting production of multiple distributor 

registrations).

o Product Code 2 — Enter EPA File Symbol assigned to product.

o Product Code 3 — Enter the Experimental Use Permit number.

o Product Code 4 — For devices, leave Item 29 blank.

o Product Code 5 — For stand-alone SLN Registrations, enter the SLN registration number 

in Item 29 (e.g., SLN-CA-890022). A “stand-alone” SLN is one for 

which there are no uses other than the 24(c) uses.

o Product Code 6 — For Unregistered Pesticides, leave Item 29 blank.

NOTE: Foreign Establishments – You must report production for products exported to or 

marketed in the United States. If your establishment produced a pesticide, active ingredient or 

device and sold some of the product in countries other than the United States, do not report this 

portion of your production and distribution. For example, if you produce 10,000 pounds of a 

product and sell 9,000 to other countries and 1,000 pounds to the United States; you should 

report 1,000 produced and 1,000 distributed.
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• Item 30—Product Name:

List the most common brand name. If marketed under alternate brand names, add the wording

“and alternate brand names” or “ABN” and report total production under all names for the 

formulation.

• Item 31—Product Classifications: Enter the code that best describes the product’s use.

o Classification for Devices

51 Device

o Classifications for Pesticides

04 Insect Repellant 07 Antimicrobial 09 Attractant

18 Sterilizer 20 Disinfectant 21 Sanitizer

27 Fungicide 28 Nematocide 29 Fumigant

34 Herbicide 36 Defoliant 37 Desiccant

38 Antifoulant 43 Insecticide 49 Plant Growth Regulator

54 Rodenticide 57 Animal Repellant 59 Algaecide

61 Molluscicide (e.g. slug bait) 69 Water Purifier

99 Multi-Use Active Ingredient (Chemicals that have both pesticidal and non-pesticidal 

uses). These chemicals do not have an EPA Reg. No. (This classification is rarely 

appropriate. Producers are required to register both the product and their 

establishment(s) and report production on an annual basis under FIFRA §7, if a 

producer has actual or constructive knowledge that a chemical or substance they 

produce is used or intended for use as an active ingredient in the manufacture of a 

pesticide. These producers are required to report only the amount of the chemical or 

substance manufactured and distributed or sold for pesticidal purposes.

• Item 32—Product Type:

o Enter 1 — Technical formulations or active ingredient for Manufacturing Use Only

products.

o Enter 2 — End-use product (this includes products where the formulation has been

blended, diluted, or changed).

o Enter 3 — Repackaged or relabeled (does not include any blending, dilution or change in

the formulation).

o Enter 4 — Device.

NOTE: Reporting Distributor Registrations—If you produce multiple pesticide products 

under the same basic EPA registration number (such as distributor products):

Report the total quantities for all distributor products under the basic EPA registration 

number, and following the product name add “and supplementals.” On a separate paper, list 

the basic registration number with each distributor company number and brand name and 

attach it to the report. 
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• Item 33—Market Sold or Distributed To:

o Enter 1 — if all the product was marketed in the United States.

o Enter 2 — if the product was marketed both in the United States and exported from the

United States.

o Enter 3 — if all the product was exported from the United States.

• Item 34—RUP Status:

o Enter 1 — Product label states RESTRICTED USE PESTICIDE at the top of the front

label panel.

o Enter 2 — All other products.

• Item 35—Unit of Measurement:

o G = Gallons (liquid chemical product)

o K = Kilograms (dry, solid, liquid or gaseous chemical product)

o L = Liters (liquid chemical product)

o P = Pounds (dry, solid, liquid or gaseous chemical product) 

o T = Tons (short ton = 2,000 lbs. or 907.2 kilograms) (dry, solid or gaseous

chemical product)

o U = Units (devices and pesticides that the label does not declare as gallons, pounds,

liters, kilograms or tons)

• Item 36—Amount Produced in 2010:

o Do not include amounts that are custom blended or applied to a crop, commodity or site by 

your staff.

o Round all quantities to the nearest whole number.

• Item 37—Amount Sold or Distributed in 2010 - United States:

o Enter only those products sold or distributed that were produced by your establishment, 

regardless of when the product was produced.

o Do not include amounts that are custom blended or applied to a crop, commodity or site by 

your staff.

o Foreign producers should enter only the amount of product or number of devices exported 

to the United States.

o Round all quantities to the nearest whole number.

• Item 38—Amount Sold or Distributed in 2010 to Foreign Markets (Exported):

o Enter the quantity exported from the United States in 2010, regardless of when the product 

was produced.

o Round all quantities to the nearest whole number.

o Foreign establishments enter “0” in Item 38.
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• Item 39—Amount (Estimated) to be Produced in 2011:

o Enter an estimate of the quantity to be produced in 2011.

o Round all quantities to the nearest whole number.

Signature Certification: (Items 40 through 43)

• Items 40 and 41—Name and Title of Company Official or Authorized Agent: Please enter 

the name and title of the person who is responsible for your establishment’s compliance with

the requirements of FIFRA §7. Note: If you are the authorized agent submitting this report, 

please enter your name and title. 

• Items 42 and 43—Signature of Company Official or Authorized Agent: The company 

official and/or authorized agent listed in Item 40 must sign and date the report in order for it to 

be complete.

Confidentiality. Under FIFRA §7(d) [7 USC §136e], information reported in Items 36, 37, 38 and 39 

of EPA Form 3540-16 will be treated as business confidential, subject to the provisions of FIFRA §10 

[7 USC §136h]. You are not required to assert a claim of confidentiality for this information.

If you wish to assert a claim of confidentiality for other information you have provided on this form, 

you must identify by the box number(s) information for which you are asserting a claim of 

confidentiality. Information so designated will be disclosed by the EPA only to the extent allowed by, 

and by means of, the procedures set forth in 40 CFR Part 2. If you do not claim the information as 

confidential upon submission of the report, it may be made available to the public without further 

notice to you.

Public Reporting Burden. The time required to complete this report is estimated to average one hour 

and 26 minutes, per response, including reviewing instructions, searching data sources, gathering and 

maintaining data needed, and completing review and collection of information. Send comments 

regarding this burden estimate or other aspects related to this information collection, including 

suggestions for reducing this burden, to: Director, Collection Strategies Division, U.S. Environmental 

Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, DC 20460. Include the OMB 

control number in any correspondence. Do not send the completed 3540-16 form to the above 

address.
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Where to Submit Reports

DOMESTIC PRODUCERS: Submit reports to the following EPA Regional Office where your company 

headquarters is located.

FOREIGN PRODUCERS: Submit reports to the following EPA Washington, DC address:

U.S. Postal Service Mail Address

Michelle Stevenson 

U.S. Environmental Protection Agency 

Agriculture Division (2225A) 

1200 Pennsylvania Avenue, NW 

Washington, DC 20460-0001 USA 

Telephone: 202-564-4203

Courier Delivery Address 

Michelle Stevenson 

U.S. Environmental Protection Agency 

Agriculture Division 

Ariel Rios Building -- South 

1200 Pennsylvania Avenue, NW, Room 6102 

Washington, DC 20004 USA

NOTE: The Agency does not notify you when your report is received. To ensure the Agency 

receives the report, you may wish to send it by certified or registered mail, return receipt 

requested.

EPA Regional Offices

States/Terr. 

Covered EPA Regional Offices

States/Terr. 

Covered

U.S. EPA Region 1 

Kan Tham

Toxics and Pesticides Unit (OES 05-4) 

5 Post Office Square, Suite 100

Boston, MA 02109-3912

Telephone: 617-918-1872

CT, MA

ME, NH

RI, VT

U.S. EPA Region 6

Chuck Ruple 

Pesticides Section (6PD-P)

1445 Ross Avenue

Dallas, TX 75202-2733

Telephone: 214-665-6534

AR, LA

NM, OK

TX

U.S. EPA Region 2

Michael Kramer

Pesticides Team (MS-500) 

2890 Woodbridge Avenue

Edison, NJ 08837-3679

Telephone: 732-321-6610

NJ, NY

PR, VI

U.S. EPA Region 7

Delbert Kelley

Pesticides Section (WWPD/TOPE/PEST)

901 N. 5th Street 

Kansas City, KS 66101-2798

Telephone: 913-551-7371

IA, KS

MO, NE

U.S. EPA Region 3

Kyla Townsend-McIntyre

Pesticides and Asbestos Programs Branch (3LC62)

1650 Arch Street

Philadelphia, PA 19103-2029

Telephone: 215-814-2045

DC, DE 

MD, PA

VA, WV

U.S. EPA Region 8

Kathleen Craig

Enforcement Division (8ENF-PJ)

1595 Wynkoop

Denver, CO 80202

Telephone: 303-312-6049

CO, MT

ND, SD

UT, WY

U.S. EPA Region 4

Mary Summers

Chemical Products & Asbestos Section

61 Forsyth Street, SW 12th Floor

Atlanta, GA 30303

Telephone: 404-562-8997

AL, FL

GA, KY

MS, NC

SC, TN

U.S. EPA Region 9

Glenda Dugan

Pesticides Office (CED-5)

75 Hawthorne Street

San Francisco, CA 94105-3901

Telephone: 415-947-4204 

AZ, CA

GU, HI

MP, NV

U.S. EPA Region 5

Gail Muffitt

PTCS (LC-8J)

77 W. Jackson Blvd.

Chicago, IL 60604-3507

Telephone: 312-886-6008

IL, IN

MI, MN

OH, WI

U.S. EPA Region 10

Erin Halbert

Pesticides and Toxics Unit (OCE-084)

1200 Sixth Avenue, Suite 900

Seattle, WA 98101-1128

Telephone: 206-553-4627

AK, ID

OR, WA