OMB Control Number: 2060-0482

Expiration Date: 6/30/15

EPA Form # 5900-144, Revised 7/14

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IMPORTER QUARTERLY REPORT

(40 CFR 82.13)

SECTION 1 IMPORTING COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Number of Transactions Reported 1.4 Number of Pages Submitted

1.5 Quarter and Year to Which This Report Applies 

1

st 2nd 3rd 4th Year 

1.6 Importing Company

Company Name 

Street Address 

City State Zip Code 

Nine-digit IRS Importer Number 

1.7 Company Contact Identification

Reporting Company Contact Person 

E-mail Address 

Phone Number Fax Number 

1.8 Sales to Critical Users Did your company make sales directly to critical users?

If yes, is the Sales of Critical Methyl Bromide to End Users Report attached?

 Yes

 Yes

 No

 No

1.9 Pre-Phaseout Stocks Did your company own pre-phaseout stocks of methyl bromide? 

If yes, is the Pre-2005 Methyl Bromide Stocks Report attached?

 Yes

 Yes

 No

 No

1.10 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 based 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, 

including 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

Office of Atmospheric Programs

Mail Code: 6205T

1200 Pennsylvania Avenue, NW

Washington, D.C. 20460

For Private Courier:

U.S. EPA

Stratospheric Protection Division

Office of Atmospheric Programs

Room 4355CC

1201 Constitution Avenue, NW

Washington, D.C. 20004

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 at 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 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 for 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 completed form to this address. 
OMB Control Number: 2060-0482

Expiration Date: 6/30/15

EPA Form # 5900-144, Revised 7/14

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IMPORTER QUARTERLY REPORT

(40 CFR 82.13)

SECTION 2 TRANSACTION RECORDS (Reproduce Additional Sheets as Needed)

2.1 Company Name

2.2 Transaction Summaries

TRANSACTION #

Source Country Port of Exit from Source Country 

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S. 

Date of Import (mm/dd/yy) Customs Entry Summary Number 

Transaction Type (check one): New Heels

Methyl Bromide will be imported for:

Post-Harvest CUE 

Pre-Plant CUE

Destruction

Transformation

QPS 

Lab Use

Emergency Use

TRANSACTION #

Source Country Port of Exit from Source Country 

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S. 

Date of Import (mm/dd/yy) Customs Entry Summary Number 

Transaction Type (check one): New Heels

Methyl Bromide will be imported for:

Post-Harvest CUE 

Pre-Plant CUE

Destruction

Transformation

QPS 

Lab Use

Emergency Use

TRANSACTION #

Source Country Port of Exit from Source Country 

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S. 

Date of Import (mm/dd/yy) Customs Entry Summary Number 

Transaction Type (check one): New Heels

Methyl Bromide will be imported for:

Post-Harvest CUE 

Pre-Plant CUE

Destruction

Transformation

QPS 

Lab Use

Emergency Use
OMB Control Number: 2060-0482

Expiration Date: 6/30/15

EPA Form # 5900-144, Revised 7/14

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IMPORTER QUARTERLY REPORT

(40 CFR 82.13)

SECTION 3 COMPANY IMPORT DATA

3.1 Company Name

3.2 Company Import Totals (Methyl Bromide Commodity Code 2903.30.1520)

A B C D E F G H I J

In-House 

Transformation 

(kg)

SecondParty Transformation 

(kg)

In-House 

Destruction

(kg)

SecondParty 

Destruction 

(kg)

Quarantine 

and Preshipment 

(QPS) (kg)

Critical Use (kg) Emergency 

Use (kg)

Lab Use 

(kg)

Gross Imports (kg)

(A+B+C+D+E+F1+ 

F2+G+H=I)

Total 

‘Heels’

F (kg) 1 F2

Pre-Plant PostHarvest

SECTION 4 ALLOWANCE EXPENDITURE DATA

4.1 Allowance Balance Summary 

Expended Unexpended

A1 Total pre-plant critical use allowances for year to date (as 

of the end of the quarter) that were:

A2 Total post-harvest critical use allowances for year to date 

(as of the end of the quarter) that were:

4.2 Importer’s CUE Methyl Bromide Ending Inventory, If Any (Complete this question for 4th quarter reporting only)

kg owned by reporting company (at end of the control period) (including all quantities held by other suppliers)

4.3 Name(s) of Company(ies) for which Critical Use Methyl Bromide is Being Held by Reporting Entity and 

Associated Amounts Held for Each (excluding end-users) (Complete this question for 4th quarter reporting only)

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg):