United States Environmental Protection Agency

Washington, DC 20460



### Notice of Arrival of

Pesticides and Devices Send Completed Form to

Appropriate Regional Office Listed

on the Reverse of this Form. OMB Control No. 2070

- 0020

Approva l Expires mm/dd/yyyy

Note: Read Instructions on reverse before completing form.

Part I: To Be Completed by Importer of Record or Licensed Customs Broker

1. Name and Complete Address of Licensed Customs Broker 2. Name and Complete Address of I mporter of Record

Return Form to this Address Return Form to this Address

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

6. Brand name of Product

7. Active Ingredients and Pe rcentage of Each

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

12. Port of Entry 13. Name and Complete Address of Carrier

14. Entry Number 15. Anticipated Entry Date

17. Location of Goods for Examination after I mportation 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)

18. Remarks

Certification

I certi fy 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 imprisonmen t or both under applicable law

19. Prin ted Name of Importer of Record or

Licensed Customs Broker Telephone Number 20. Signature of Importer o f Record o r Licensed

Customs Broker Date SignedOMB Control No. 2070

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EPA Form 3540

- 1 (Rev. #

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

Action to be taken by U.S. Cust oms Service

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

be held intact pending inspection.

Other (Specify)

Remarks

Signature and Title of EPA Official Date

Part III: To Be Completed by U.S. Customs and Border Protection

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

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

should also be noted in “Remarks.”

Remarks

Signature of District Director of Customs DateOMB Control No. 2070

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EPA Form 3540

- 1 (Rev. #

- ## ) 

## Instru ctions

U.S. Customs and Border Protection (CBP) 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 (NOA) to the U.S. Enviro nmental Protection Agency (EPA) prior to the arrival of shipment in the United

States. Th e NOA will be used by: Importer of Record o r Licensed Customs Broker : The i mporter of record or

licensed customs broker must complete Part I of the NOA form

. A separat e NOA must be submitted for each

pesticide or device in each shipment prior to its arrival at the port of entry. To expedite the handling of pesticide or

device shipments, submit NOA ( s ) to the EPA office listed below having jurisdiction over the state/terr itory of the

p ort of e ntry. It is recommended that all applicable blocks in Part I be completed prior to submission to EPA and

that supporting documentation (e.g. a product label and either CBP Form 7501, 346 1, or 3461 ALT ) for validating

information prov ided be included with the submission of each NOA

. When providing an address, the complete

address should include the mailing location, email address, and telephone number of the contact person. EPA : EPA

will c omplete Part II , indicating the disposition of the shipment, sign and return the NOA (s) to the importer or

agent for presentation to C BP at the time of entry. CBP : CBP will c ompare the information shown on the NOA(s)

with the entry documents and the shipment , b ring ing any discrepancies to EPA’s attent ion before the shipment is

released, and noting discrepancies in the R emarks section

. If the i mportation is not handled by C BP in the manner

instructed in Part II , this should also be noted in the R emarks . A fter completin g Part III and signing the NOA(s),

CBP will return the NOA(s) to EPA as the Official File Copy.

1. Name and Complete Address of the Licensed Customs Broker. P erson (such as p rivate individual,

partnership, association or corporation ) who is licensed, regulated and empowered by CBP to as sist and transact on

behalf of others (importers and exporters) in meeting Federal requirements governing imports and exports (customs

business ).

2. Name and Complete Address of the Importer of Record. Owner, purchaser, or when designated by the owner,

pur chaser, or consignee, an authorized agent acting on importer’s behalf. The importer of record is the individual

or firm liable for payment of all duties and meeting all statutory and regulatory requirements incurred as a result of

importation.

3. Name and Address of Shipper. The name and address of person primarily responsible exporting the pesticide to

the United States.

4. EPA Registration No. T he pesticide product registration number assigned at the time of registration that

identifies the product. The product registration number must be an approved EPA Registration No. as it appears on

the pesticide product label

. If the product is a device, write the word “DEVICE” in this block. If the pesticides

product does not have an EPA

- approved registration nu mber or is not a device, to expedite review of the NOA, it is

recommended that “OTHER” be entered and an explan ation, including the intended use and a description of why

the product is being imported into the United States, be provided in the remarks.

5. E PA Producer Establishment No. The EPA P roduc er E stablishment No. that appears on the pesticide or device

product label. The EPA Producer Establishment No. on the product label is the final establishment where the

product was produced prior to shipment to t he U.S

. Foreign establishments that produce pesticides or devices for

distribution in the U nited S tates . are required to have an EPA

- registered producer establishment number.

6. Brand Name of Product. Name of the product as it appears on the label at th e time of import

. 7. Active Ingredients and Percentage of Each

. List each active ingredient by percentage of each. If block 4

contains an EPA Reg

. N o.

, this block may be left blank. To expedite review of the NOA, it is recommended that

each active ingredi ent and percentage be listed to ensure accuracy of information.

8. Unit Size. Net weight or net contents as identified on the product label of the pesticide or device in the

immediate container, not including the wrapper or other packaging material s

. 9. Qu antity. Number of units.

10. Total Net Weight. Unit size multiplied by quantity

.OMB Control No. 2070

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EPA Form 3540

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### 11. Country of Origin. The c ountry of manufacture, production, or formulation of the pesticide or device of

foreign origin entering the United States

. 1 2. Port of Entry. The port of entry where the pesticide or device offered for import is processed for entry into the

United States. Por ts of entry are designated locations where CBP enforces the import and export laws and

regulations of the U nited States federal government. P orts of entry are under the jurisdiction of a CBP port

director.

1 3. Name and complete address of the carrier . The carrier is a person or carrier service ( ship, airline, or trucking )

who undertakes to transport goods or merchandise to and across the U.S. b order

. 1 4. Entry Number. T he 11

- character entry number using the format XXX

- NNNNNNN

- N, including the hyphens

. 15. Anticipated Entry Date. Anticipated date of entry into the United States or anticipated date when the pesticide

or device will arrive within t he port of entry limits.

1 6. 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 pe sticides 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. E nter the physical address of the location of goods

for examination after importation . In t he case of unregistered pesticides products imported between establishments

operated by the same or different producer (s)

, e nter the EPA establishment number for the importing registered

establishment

. 18. Remarks. This block may be used to provide additional information.

19. Printed Name of Importer of Record or Licensed Customs Broker. Print name and telephone number of the

Importer of Record or Licensed Customs Broker.

20. Signature of Importer of Record or Licensed Customs Broker. Signature of Importer of R ecord or Licensed

Customs Broker.

EPA Regional Offices States and Ports of Entry

Locations in the US EPA Regional Offices States and Ports of Entry

Locations in the US

EPA Region 1

1 Congress Street (SEA)

Boston, MA 02114

- 2023 CT

, MA

, ME

, NH

, RI

, VT EPA Region 6

445 Ross Avenue

Suite #1200 (6PD

- P)

Dallas, TX 75202

- 2733 AR

, LA

, NM

, OK

, TX

EPA Region 2

MS

- 500, Bldg #5

2890 Woodbridge Ave.

Edison, NJ 08837

- 3679 NJ, NY, PR, VI EPA Region 7

901 N. 5 th Street (PESTWWPD)

Kansas City, KS 66101 IA, KS , MO, NE

EPA Region 3

1650 Arch Street (3WC32)

Philadelphia, PA 19103

- 2029 DE, DC, MD, PA, VA, WV EPA Region 8

1595 Wynkoop Street

Denver, CO 80202

- 1129 CO, MT, ND, SD, UT, WY

EPA Region 4

61 Forsyth Street, SW

(APT

- PS)

Atlanta, GA 30303

- 8960 AL, FL, GA, KY, MS, NC,

SC, TN EPA Region 9

75 Hawwthorne Street (CED

- 5)

San Francisco, CA 94105

- 3901 AZ, AS, CA, GU, HI, NV,

PI, WK

EPA Region 5

77 West Jackson Blvd.

(DT

- 8J)

Chicago, IL 60604

- 3507 IL, IN, OH, MI, MN, WI EPA Region 10

1200 Sixth Avenue,

Suite 900 (ECO

- 084)

Seattle, WA 98101

- 3140 AK, ID, OR, WA