United States Environmental Protection Agency

 Notice of Arrival of

Pesticides and Devices

Send Completed Form to appropriate 

EPA Regional Office Listed on the 

Reverse of this Form. 

OMB Control No. 2070-0020

Approval Expires 08/31/2012

Note: Read Instructions on reverse before completing form.

Part I: To Be Completed by Importer or Agent

1. Name and Complete Address of Broker or Agent 2. Name and Complete Address of Importer or Consignee

Return Form to this Address Return Form to this Address

3. Name and Address of Shipper 4. EPA Registration Number 5. EPA Producer Establishment No.

6. Brand Name of Product

7. Major Active Ingredients and Percentage of Each

8. Unit Size 9. Quantity 10. Total Net Weight 11. Country of Origin

12. Port of Entry 13. Carrier

14. Entry Number 15. Entry Date 16. I assert that information constituting Confidential Business Information is 

shown in the above blocks numbered: (Note: Blocks 4, 5, 6, 7 are not 

entitled to CBI treatment–see Instructions) 17. Location of Goods for Examination after Importation

18. R emarks

Certification

I certify that the statements I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any knowingly 

false or misleading statement may be punishable by fine or imprisonment or both under applicable law.

19. Printed Name of Importer or Agent Telephone Number 20. Signature of Importer or Agent Date Signed

Part II: To Be Completed by U.S. Environmental Protection Agency

Action to be taken by U.S. Customs Service

Release Shipment Detain for Inspection Release shipment to consignee under bond. Shipment must

be held intact pending inspection.

Other

Remarks

Signature and Title of EPA Official Date

Part III: To Be Completed by U.S. Customs Service

The information shown in Part I was compared with the entry papers for this shipment and no discrepancies were noted. The shipment was 

handled as instructed by EPA in Part II. Any deviations should be brought to the attention of EPA before releasing the shipment.

Remarks

Signature of District Director of Customs Date

EPA Form 3540-1 (Rev. 02/11) Official File Copy
OMB Control No. 2070-0020 • Approval Expires08/31/2012

EPA Form 3540-1 (Rev. 02-11)

Instructions

Customs Regulations. 19 CFR 12.112 requires an importer desiring to import pesticides or devices into the United States to submit 

EPA Form 3540-1, Notice of Arrival of Pesticides and Devices, to the U.S. Environmental Protection Agency prior to the arrival of 

shipment in the United States. This form will be used by: Importer or Agent. The Importer or his agent must complete Part 1 of the 

form. It may be necessary to complete some of the items at the time of entry, e.g., entry data, carrier. To expedite the handling of 

pesticides shipments, submit this form to the EPA office listed below having jurisdiction over the state/territory in which the Port of 

Entry is located prior to the arrival of the shipment. EPA. EPA will complete part II of this form. EPA will retain the EPA Copy for its 

files and return the other copies to the importer or agent for presentation to Customs at the time of entry. Customs. Customs will compare 

the information shown on this form with the entry documents and the shipment. Bring any discrepancies to the attention of EPA before 

the shipment is released and noted in the remarks section. If the importation is not handled by Customs in the manner instructed in Part 

II, this should also be noted in remarks. All data left blank by the importer (e.g., entry date) must be completed at this time. After 

completion of Part III and signing the form, Customs will return the Official File Copy to EPA and retain the Custom's Copy.

The following blocks are self explanatory - 1, 2, 8, 9, 10, 12, 14, 15, 18, 19, and 20.

3. Name and Address of Shipper. The name and address of person exporting the pesticide or device to the United States.

4. EPA Registration No. The product registration number assigned at the time of registration that identifies the product. If the product is a 

device, write the word “DEVICE” in this block.

5.EPA Producer Establishment No. The producing establishment registration number that identified where the pesticide product, 

active ingredient, or device was produced.

6. Brand Name of Product. Name under which the product is sold or distributed.

7. Major Active Ingredients and Percentage of Each. If block 4 contains an EPA Registration Number, leave this block blank. If no EPA 

Registration Number is listed in block 4, list active ingredients (or other major ingredients) by percentage of each.

11. Country of Origin. The country where the pesticide or device Producer Establishment is physically located.

13. Carrier. e.g., Provide the Name of ship, airline, trucking company, or other carrier.

16. Confidential Business Information (CBI) designation. Please note that the information provided in blocks 4, 5, 6, and 7 is not 

entitled to confidential treatment under section 7(d) of FIFRA and under labeling requirements for pesticides at 40 CFR 156.10. 

Information provided in those blocks will be made public with no further notice.

17. Location of Goods for Examination after Importation. Enter the EPA Establishment Number for importing registered establishment, or 

if not an EPA Establishment, provide information as to the exact location of the imported goods. 

EPA Regional Office States and Ports of Entry 

Locations in the U.S.

EPA Regional Office States and Ports of Entry 

Locations in the U.S.

EPA Region I

1 Congress Street

Suite 1100 (SEP)

Boston, MA 02114

CT, MA, ME, NH, RI, VT EPA Region VI

1445 Ross Avenue

Suite 1200 (6PD-P)

Dallas, TX 75202

AR, LA, NM, OK, TX

EPA Region II

Raritan Depot

Build. #5 (MS-500)

2890 Woodbridge Avenue

Edison, NJ 08837

NJ, NY, PR,VI EPA Region VII

901 N. 5th Street

(WWPDTOPE)

Kansas City, KS 66101

IA, KS, MO, NE

EPA Region III

1650 Arch Street

(3LC-62)

Philadelphia, PA 19103

DC, DE, MD, PA, VA, WV EPA Region VIII

1595 Wynkoop Street

(8P-P3T)

Denver, CO 80202

CO, MT, ND, SD, UT, WY

EPA Region IV

61 Forsyth Street, SW

12th Floor (9T-25)

Atlanta, GA 30303

AL, FL, GA, KY, MS, NC,

SC, TN

EPA Region IX

75 Hawthorne Street

(CMD-5)

San Francisco, CA 94105

AZ, CA, HI, NV, AS, CNMI,

GU

EPA Region V

77 West Jackson Blvd.

(LC-8J)

Chicago, IL 60604

IL, IN, MI, MN, OH, WI EPA Region X

1200 Sixth Avenue

Suite 900 (OCE-084)

Seattle, WA 98101

AK, ID, OR, WA