OMB Control Number: 2060

- 0482

Expiration Date: 10/31/1 4

EPA Form # 5900

- 138 , Revised 5/11



### U.S. Environmental Protection Agency

STRATO SPHERIC OZONE PROTEC TION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

SALES OF CRITICAL US E METHYL BROMIDE

TO END USERS ANNUAL REPORT 

### (40 CFR 82. 13 )

NOTE 

### : FORM MUST BE COMPLET ED BY ANY COMPANY TH AT PROVIDED METHYL BROM IDE GAS OR FUMIGATIO NS TO CRI TICAL USERS



### .

FORM MUST BE COMPLET ED BY A CENTRAL OFFICE ON BE HALF OF THEIR DIVISI ONS 

### ; ONE FORM PER COMPANY



### .



## SECTION 1 COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Year to Which This Report Applies Year



### 1. 3 Original Submittal Re

- submittal

1. 4 Company Information

Company Name

Street Address

City State Zip Code



### 1. 5 Company Contact Identification

Reporting Company Contact Person Phone Number Fax Number

E

- mail Address



### 1. 6 Company Type

(chec k all that apply) Distributor Third Party Applicator Producer Importer



### 1. 7 Signature of Reporting Company Representative

I certify under penalty of law that I have personally exa mined 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, an d 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

Stratospheri c Protection Division

U.S. EPA (6205J)

1310 L Street, NW; 10 th Floor

Washington, DC 20005

A company may assert a claim of confidentiality for information submitted in this form by clearly marking that information as confidential. Such information

sha ll be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, Subpart B, and wi ll only be disclosed by the

means set forth in the subpart. If no claim of confidentiality accompanies the report when it is recei ved 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 1 .3 hours per response. Send comments on the

Agency's need fo r 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 comple ted form to this

address.OMB Control Number: 2060

- 0482

Expiration Date: 10/31/ 1 4

EPA Form # 5900

- 138 , Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

SALES OF CRITICAL US E METHYL BROMIDE

TO END USERS ANNUAL REPORT 

### (40 CFR 82. 13 )



## SECTION 2 SALES DATA *

2. 1 Company Name

2.2 Critical Use Methyl Bromide (newly produced or imported)

sold (active ingredient only) Pre

- Plant (kg)

Post

- Harvest (kg)



### 2.3 Critical Stock Allowance Methyl Bromide (pre

- phaseout

stocks) sold (active i ngredient only) Pre

- Plant (kg)

Post

- Harvest (kg)



### Year

- End Inventory Calculation

2.4.A Beginning Inventory of Critical Use Methyl Bromide

from Prior Control Periods, if any (NOT pre

- phaseout

stocks). Note: This i s the same amount as the

previous control period’s ending inventory. Pre

- Plant (kg)

Post

- Harvest (kg)



### 2.4.B Critical Use Methyl Bromide Bought this Year (only new

production/import, NOT pre

- phaseout stocks) Pre

- Pla nt (kg)

Post

- Harvest (kg)



### 2. 5 Critical Use Methyl Bromide Sold to an Entity Other than

a Critical User (e.g., Distributor, Third Party Applicator) Pre

- Plant (kg)

Post

- Harvest (kg)



### 2. 6 Year

- End Inventory

– Critical Use Methyl Bromide Not

Sold In Reporting Year (2.4.A + 2.4.B

– 2.2

– 2. 5 ) CUE Pre

- Plant not sold by year end (kg)

CUE Post

- Harvest not sold by year end (kg)

*If none, en ter 0. Do not leave any sections blank.



### 2

. 7 Name(s) of Company(ies) for which Newly Produced Critical Use Methyl Bromide is Being Held and Associated

Amount (kg) Held for Each (excluding end

- users)

Company Name: Pre

- Plant (kg): Post

- Harvest (kg):



### Company Name: Pre

- Plant (kg): Post

- Harvest (kg):



### Company Name: Pre

- Plant (kg): Post

- Harvest (kg):



### Company Name: Pre

- Plant (kg): Post

- Harvest (kg):



### Company Name: Pre

- Plant (kg): Post

- Harvest (kg):

NOTE 

### : COMPLETE T HE PRE



### - 2005 METHYL BROMIDE STOCK S REPORT FOR QUANTIT IES OF METHYL BROMID E OWNED THAT WAS

PRODUCED



### / IMPORTED BEFORE JANU ARY 

### 1, 2005, OR FOR ALLOCATIONS O R RECEIPT OF ANY CRI TICAL STOCK ALLOWANC ES



### .