OMB Control Num ber: 2060
- 0482 Expiration Date: 6/30/15

EPA Form # 5900
- 144, Revised 7/14



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

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **IMPORTER QUA RTERLY R**  **EPORT** 

### (40 CFR 82.13) 

## SECTION 1 **IMPORTING COMPA NY IDENTIFICA**  **TION 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 t**  **o Which This Report A pplies** 

1 st 

### 2 nd 

### 3 rd 

### 4 th 

### Year **1.6 Importing Company** Company Name Street Address Ci ty 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 -**  **P haseout Stocks**  D id 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 documen ts, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that t he submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false inf ormation, 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 Atmos pheric Programs Mail Code: 6205T 1200 Pennsylvania Ave nue, 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. 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 m eans 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 notic e 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 r espondent burden, including through the use of au tomated 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 comple t ed 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 **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **IMPORTER QUA RTERLY R**  **EPORT** 

### (40 CFR 82.13) 

## SECTION 2 **TRA NSA**  **CTION RECORDS (Reproduce**  **A dditional**  **S heets as**  **N eeded)**  **2.1 Company Name 2.2 Transaction Summaries** 
**TRA NSA**  **CTION #** Source Country Port of Exit from S ource 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 Typ e (check one): New Heels Methyl Bromide will be imported for: Post
- Harvest CUE Pre
- Plant CUE Destruction Transformatio n QPS Lab Use Emergency Use



### TRA **NSA CTION #**  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 Transformatio n QPS Lab Use Emergency Use



### TRA **NSA CTION #**  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 Transformatio n QPS Lab Use Emergency UseOMB Control Number: 2060
- 0482 Expiration Date: 6/30/15

EPA Form # 5900
- 144, Revised 7/14



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

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **IMPORTER QUA RTERLY R**  **EPORT** 

### (40 CFR 82.13) 

## SECTION 3 COMPA **NY IMPORT D AT**  **A 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 Trans
formation (kg) Second
Party Trans
formation (kg) In
- House

Destruction (kg) Second
Party Destruction (kg) Quarantine

and Pre
shipment (QPS) (kg) Critical Use (kg) Emergency Use (kg) Lab Use

(kg) Gross Imports (kg)

(A+B+C+D+E+F 1 + F 2 +G+H=I ) Total

‘Heels’ (kg) **F 1**  **F 2**  Pre
- Plant Post
Harvest



## SECTION 4 A **LLOWA NCE EXPENDITURE DA**  **TA 4.1**  **Al lowance Balance Summary**  Ex pended Unexpended 

### A **1** 

### Total pre
- plant critical use allowances for y ear to date (as of the end of the quarter) that were: **A 2**  

### 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 A**  **ny (Complete this question for 4**  **th** 

### quarter reporting only)

kg 

### o wned by r eporting c ompany (a t end of the control period) (incl uding all qua ntities held by other suppliers ) **4. 3**  **Name(s) of Company(ies) for w hich Critical Use Methyl Bromide is Bei**  **ng Held by Reporting Entity and A**  **ssociated A mounts Held for**  **Each (excluding end -**  **users) (Complete this question for 4 th**  

### quarter reportin **g only)** Company Name: Pre
- Plant (kg): Post
- Harvest (kg): Company Name: Pre
- Plant (kg): Post
- Harvest (kg):