OMB Control Number: 2060

- 0482 Expiration Date : 6 /3 0 /1 5

EPA Form # 5900

- 14 2 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **PRE** 

### - **2005 STOCKS**  **AN NUA**  **L REPORT** 



### (40 CFR **82. 13**  **) NOTE**  

### : **FORM MUST BE COMPLET ED BY A**  **NY COMPA NY TH**  **AT OW**  **NS STOCKS OF ME THYL BROMIDE THA**  **T W E**  **RE PRODUCED OR IMPOR TED**  **PRIOR TO JA NUA**  **R Y**  

### 1, **2005.** 

## SECTION 1 COMPA **NY IDENTIFICA TION**  **1.1 Date of Submission 1.2 Year to Which This Report A**  **pplies 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 P erson E

- mail Address Phone Number Fax Number 

### 1.6 Company Type **(check 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 examined and am familiar with the information submitted in this and all attached documents, and that ba sed 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, inclu ding the possibility of fine and imprisonment. Name Title Signature Date 

## SEND COMPLETED FORMS TO: **For U.S. Postal Service:** U.S. EPA Stratospheric Protection Division Of fice of Atmos pheric Programs Mail Code: 6205T 1200 Pennsylvania Avenue, NW Wa shington, D.C. 20460 **For Private Courier:** U.S. EPA Stratospheric Protection Division Office of Atmospheric Programs Room 4355CC 1201 Constitution Avenue , NW Wa shington, D.C. 2000 4 A company may assert a claim of confidentiality for information submitted in this form by clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as confidential a t 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made p ublic without further notice to the company (40 CFR 2.203). Th e public reporting and recordkeeping burden for this collection of inform ation is estimated to average 1.3 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested method s for minimizing respondent burden, including throu gh the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., N W, W ashington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.OMB Control Number: 2060

- 0482 Expiration Date : 6 /3 0 /1 5

EPA Form # 5900

- 14 2 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION P ROGRA**  **M** 

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **PRE** 

### - **2005 STOCKS**  **AN NUA**  **L REPORT** 



### (40 CFR **82. 13**  **)** 

## SECTION **2 TRA**  **NSA CTION DA**  **TA**
**2. 1**  **Company Name 2** 

**. 2**  **Total Stocks of Pre -**  **P haseout Methyl Bromide**  *****

**kg** 

### O wned by r eporting c om pany as of December 3 1 of this year (including all qua ntities owned by reporting com pany that are held by other suppliers on the reporting company’s beh alf ) * These quantities of stocks refer only to amount of methyl bromide that were p roduced or imported before January 1, 2005. Any quantities of newly produced critical use methyl bromide left in the reporting company’s possession as of December 31 of t his year should be reported on form “Sales of Critical Use Methyl Bromide,” section 2.3

. 

### 2. **3 Name(s) of Company(ies) which are Holding Stocks of Pre**  **- Phaseout Methyl Bromide on Behalf of the Owner**  Company Name: Amount Held (kg): 

### Company Name: Amount Held (kg): 

### Company Name: Amount Held (kg):