United States Environmental Protection Agency


### Notice of Arrival of Pesticides and Devices Send Completed Form to a ppropriate 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 N ame of Product

7. Major Active Ingredients and Percentage of Each

8. Unit Size 9. Quantity 10. Total Net Weight 11. C ountry 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 e marks

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 k nowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
19. P rinted 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 shi pment was handled as instructed by EPA in Part II. Any deviations should be brought to the attention of E PA before releasing the shipment.

Remarks

Signature of District Director of Customs D ate

EPA Form 3540

- 1 (Rev. 02 / 11 ) Official File CopyOMB Control No. 2070

- 0020 • Approval Expires 08/31/2012

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 t he 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 sh ipment. 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 Custo ms 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 Co py 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 th is block. 5. EPA Producer Establishment No. The producing establishment registration number that identified where the pesticid e 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 R egistration N umber, leave this block blank. If no EPA R

egistration N umber 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 P roducer Establishm ent 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 Examin ation after Importation. Enter the EPA E stablishment N umber 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) Dal las, 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. 5 th 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 12 th Floor (9T

- 25) Atlanta, GA 30303 AL , F L , 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 (OC E

- 084) Seattle, WA 98101 AK , ID , OR , WA