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United States Environmental Protection Agency

Instructions for Completing EPA Form 3540-16

Pesticide Report for Pesticide-Producing and Device-Producing Establishments

Reporting Year 2013

It is unlawful to knowingly falsify all or part of any pesticide or device production information 

reported on EPA Form 3540-16. (FIFRA §12(a)(2)(M))

General Information

Read all instructions before completing this form. Type or print clearly in dark ink. This form 

may also be filled out on-line and printed. Use the “Add additional page” button at the bottom of 

the on-line screen-fillable form and add as many pages as necessary to report all products. Each 

“Additional” page has space for four (4) products. If you add too many pages, click the “Remove 

Extra Page” button to remove the last page added. See the Pesticide Establishment Registration and 

Reporting web page for the instructions and the form. 

http://www.epa.gov/compliance/monitoring/programs/fifra/establishments.html

1. Who must report?

 All domestic and foreign producing establishments, regardless of whether or not the establishment 

produced or distributed a pesticide, active ingredient or device must submit a report. (FIFRA §§ 7 

and 17)

 Establishments with zero production or distribution in 2013. If your establishment did not produce 

or distribute products subject to this report in 2013:

o Complete Items 1-35 and Items 36-39.

o Check “No” in Item 18.

 Establishments that closed, went out of business or ceased production. 

o Report all production and distribution during 2013.

o See Number 7 for information on terminating your establishment’s registration.

2. Definitions

o Producer—any person, as defined by FIFRA, “who produces any pesticide, active 

ingredient, or device (including packaging, repackaging, labeling and relabeling).”

(40 CFR §167.3) 

o Produce—“manufacture, prepare, propagate, compound or process any pesticide, 

including any pesticide product pursuant to FIFRA §5, any active ingredient or device, 

or to package, repackage, label, relabel or otherwise change the container of any 

pesticide or device.” (40 CFR §167.3)
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o Establishment—Includes:

o Any site where a pesticidal product, active ingredient or device is produced. 

o Sites that are independently owned or operated regardless of whether such site is 

domestic and producing a pesticidal product for export only or whether the site is 

foreign and producing a pesticidal product for import into the United States. 

(40 CFR §167.3) 

o Sites that produce a pesticidal product for use under an Experimental Use Permit, 

FIFRA Section 18 Emergency Exemption or Section 24(c) Special Local Needs 

registration, must report. (40 CFR §167.20)

o Sites that produce unregistered pesticidal products for export from the US.

o Custom Blender—any facility that provides the service of mixing registered pesticides 

to a customer’s specifications, specifically:

o a pesticide-pesticide blend

o a pesticide-fertilizer blend

o a pesticide-animal feed mixture

when

o the blend is not held in inventory 

o the pesticide used in producing the blend bears labeling that does not prohibit the use 

of the pesticide in the blend 

o the blend is delivered to the end-user with a copy of the labeling of the pesticide 

used in producing the blend and a statement specifying the composition of the 

mixture

If these conditions are not met, the establishment does not meet the definition of “custom 

blender” and must comply with FIFRA Section 7 requirements.

3. What must be reported?

 Each producer operating an establishment must submit the following information for each 

pesticide, active ingredient or device produced at your establishment: (Please note that production 

and distribution of unregistered pesticides must be reported. See 40 CFR § 152.30).

o Types and amounts produced in 2013.

o Types and amounts sold or distributed in 2013, regardless of when the product was 

produced.

o An estimate of the amount expected to be produced in 2014.

NOTE: A facility where only custom blending activities take place is not considered a 

pesticide-producing establishment and therefore does not need to be registered. Please see the 

Pesticide Establishment Registration and Reporting FAQ for more information. 

http://compliance.supportportal.com/link/portal/23002/23009/ArticleFolder/1654/PesticideProducers
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 DO NOT REPORT:

o Production, distribution or sale of products NOT produced or repackaged by your 

establishment (e.g., no changes are made to the product formulation, container or 

label).

o Products shipped from your supplier directly to your customer.

o Any products for which Items 48, 49 and 50 are zero.

o Pesticides that are applied by your staff.

o Custom-blended products.

4. When to report:

 Annual Reports are due: On or before March 1, 2014, even if there has been no production.

 Initial Reports: FIFRA §7 requires all registered establishments to submit an initial report to the 

U.S. EPA 30 days after receipt of notification of establishment registration. 

5. Completing the Report:

 Enter the company official’s or authorized agent’s Name and Title (Items 36 and 37).

 An original signature of a company official or authorized agent is required on the report in Item 38.

 Enter the date in Item 39.

 For all pages complete at the bottom: “This is Page _____ of _____.”

 Submit completed reports as directed on Page 9. Please make a copy of the report for your records.

 EPA will not accept any copies, faxes or emails of establishment initial or annual reports.

6. What if I fail to file the production report?

 Failure to file the initial or annual report is an unlawful act and may result in civil penalties up to 

$7,500 per violation or termination of the establishment’s registration.

7. How to inactivate an establishment’s registration:

 Send a letter on company letterhead with this report stating the establishment is out of 

business or has ceased production of pesticides, active ingredients or devices requesting that 

an establishment number be inactivated. 

 If EPA terminates your domestic establishment registration, it is illegal to sell or distribute 

any pesticide, active ingredient or device in the United States or to export a product out of 

the United States. If EPA terminates your foreign establishment registration, it is illegal for 

you to import any pesticide, active ingredient or device into the United States.

8. Additional Information is available at Pesticide Establishment—Registration and Reporting 

Questions at: 

http://compliance.supportportal.com/link/portal/23002/23009/ArticleFolder/1654/PesticideProducers
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General Instructions

Establishment Information: (Items 1 through 18)

 Item 1—Establishment Name: Enter the producing establishment name.

 Item 2—Establishment Number: Enter the producing establishment number.

 Item 3 to 8—Establishment Site Address: Enter the SITE address, not a post office box or 

route number, where your establishment is located. 

 Item 9 to 14—Establishment Mailing Address: Enter the mailing address for the 

establishment if different from the site address.

 Item 15—Telephone Number: Enter the phone number for the establishment. For foreign 

establishments, please provide the country code.

 Item 16—eMail: Enter your email address.

 Item 17—If the establishment name or site address has changed from the previous year, enter 

a check (X) in the box.

 Item 18— Did you produce or distribute in 2013? Check the appropriate box.

Note: If you checked the “No” box, do not fill in Items 40 through 51.

Company Information: (Items 19 through 35)

 Item 19—Company Name: Enter the company name.

 Item 20 to 25—Company Site Address: Enter the company’s headquarter address.

 Item 26 to 31—Company Mailing Address: Enter the mailing address for the company if 

different from the company site address.

 Item 32—Telephone Number: Enter the phone number for the company. For foreign 

companies, please provide the country code.

 Item 33— eMail: Enter your email address.

 Item 34—If company name or site address has changed from the previous year, enter a check 

(X) in the box.

 Item 35 — If Authorized Agent name or mailing address has changed from the previous year, 

enter a check (X) in the box. Please attach your company’s request to change the authorized 

agent on company letterhead and send to the appropriate EPA office listed on Page 9.

NOTE: For items 7, 13, 24 and 30—Foreign country abbreviation codes are available at:

http://www.epa.gov/compliance/resources/publications/monitoring/fifra/fgnestablishments.html

Please contact U.S. EPA Headquarters 011-202-564-4203 if you do not see the appropriate 

country code listed.

http://compliance.supportportal.com/link/portal/23002/23009/ArticleFolder/1654/PesticideProducers
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Pesticide Production Information: (Items 40 through 51)

 Item 40—Product Code:

o Enter 1 — if product is registered with EPA.

o Enter 2 — if product registration is pending.

o Enter 3 — if product is an Experimental Use Permit.

o Enter 4 — if product is a device.

o Enter 5 — if product is a Special Local Need (SLN) registration.

o Enter 6 — if product is an Unregistered Pesticide. Attach the formulation of the product 

to the end of the report showing the product’s active and inert ingredients; their common 

names; their CAS Registry numbers (if available); and the percentage, by weight, of each 

ingredient (must total 100%). Multiple formulations may appear on the same page; 

clearly identify each by product name. 

 Item 41—EPA Product Registration Number Information:

o Product Code 1— Enter EPA Registration No. (as it appears on product label) 

(See NOTE below on reporting production of multiple distributor 

registrations).

o Product Code 2 — Enter EPA File Symbol assigned to product.

o Product Code 3 — Enter the Experimental Use Permit number.

o Product Code 4 — For devices, leave Item 41 blank.

o Product Code 5 — For stand-alone SLN Registrations, enter the SLN registration number 

in Item 41 (e.g., SLN-CA-890022). A “stand-alone” SLN is one for 

which there are no uses other than the 24(c) uses.

o Product Code 6 — For Unregistered Pesticides, leave Item 41 blank.

NOTE: Foreign Establishments – You must report production for products exported to or 

marketed in the United States or its territories. If your establishment produced a pesticide, active 

ingredient or device and sold some of the product in countries other than the United States, do 

not report this portion of your production and distribution. For example, if you produce 10,000 

pounds of a product and sell 9,000 pounds to other countries and 1,000 pounds to the United 

States; you should report 10,000 pounds produced and 1,000 distributed into the United States.
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 Item 42—Product Name:

List the most common brand name. If marketed under alternate brand names (ABN), add 

“ABN” and report total production under all names for the formulation.

 Item 43—Product Classifications: Enter the code that best describes the product’s use.

o Classification for Devices

51 Device

o Classifications for Pesticides

04 Insect Repellant 07 Antimicrobial 09 Attractant

18 Sterilizer 20 Disinfectant 21 Sanitizer

27 Fungicide 28 Nematocide 29 Fumigant

34 Herbicide 36 Defoliant 37 Desiccant

38 Antifoulant 43 Insecticide 49 Plant Growth Regulator

54 Rodenticide 57 Animal Repellant 59 Algaecide

61 Molluscicide (e.g. slug bait) 69 Water Purifier

99 Multi-Use Active Ingredient (Chemicals that have both pesticidal and non-pesticidal 

uses). These chemicals do not have an EPA Reg. No. (This classification is rarely 

appropriate. Producers are required to register both the product and their 

establishment(s) and report production on an annual basis under FIFRA §7, if a 

producer has actual or constructive knowledge that a chemical or substance they 

produce is used or intended for use as an active ingredient in the manufacture of a 

pesticide. These producers are required to report only the amount of the chemical or 

substance manufactured and distributed or sold for pesticidal purposes.

 Item 44—Product Type:

o Enter 1 — Technical formulations or active ingredient for Manufacturing Use Only

products.

o Enter 2 — End-use product (this includes products where the formulation has been

blended, diluted, or changed).

o Enter 3 — Repackaged or relabeled (does not include any blending, dilution or change

in the formulation).

o Enter 4 — Device.

NOTE: Reporting Distributor Registrations—If you produce multiple pesticide products 

under the same basic EPA registration number (such as distributor products):

Report the total quantities for all distributor products under the basic EPA registration number, 

and following the product name add “and supplementals.” On a separate paper, list the basic 

registration number with each distributor company number and brand name and attach it to the 

report. 
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 Item 45—Market Sold or Distributed To:

o Enter 1 — if all the product was marketed in the United States.

o Enter 2 — if the product was marketed both in the United States and exported from the

United States.

o Enter 3 — if all the product was exported from the United States.

 Item 46—RUP Status:

o Enter 1 — Product label states RESTRICTED USE PESTICIDE at the top of the front

label panel.

o Enter 2 — All other products.

 Item 47—Unit of Measurement:

o @ = Each (registered pesticides that are sold in a unit such as petri dishes)

o G = Gallons (liquid chemical product)

o K = Kilograms (dry, solid, liquid or gaseous chemical product)

o L = Liters (liquid chemical product)

o P = Pounds (dry, solid, liquid or gaseous chemical product) 

o T = Tons (short ton = 2,000 lbs. or 907.2 kilograms) (dry, solid or gaseous

chemical product)

o U = Units (devices)

 Item 48—Amount Produced in 2013:

o Do not include amounts that are custom blended, placed directly into application 

equipment, or applied to a crop, commodity or site by your staff.

o Round all quantities to the nearest whole number.

 Item 49—Amount Sold or Distributed in 2013 - United States:

o Enter only those products sold or distributed that were produced by your establishment, 

regardless of when the product was produced.

o Do not include amounts that are custom blended, placed directly into application 

equipment, or applied to a crop, commodity or site by your staff.

o Foreign producers should enter only the amount of product or number of devices exported 

to the United States.

o Round all quantities to the nearest whole number.

 Item 50—Amount Sold or Distributed in 2013 to Foreign Markets (Exported):

o Enter the quantity exported from the United States in 2013, regardless of when the product 

was produced.

o Round all quantities to the nearest whole number.

o Foreign establishments enter “0” in Item 50.
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 Item 51—Amount (Estimated) to be Produced in 2014:

o Enter an estimate of the quantity to be produced in 2014.

o Round all quantities to the nearest whole number.

Signature Certification: (Items 36 through 39)

 Items 36 and 37—Name and Title of Company Official or Authorized Agent: Please 

enter the name and title of the person who is responsible for your establishment’s compliance 

with the requirements of FIFRA §7. Note: If you are the authorized agent submitting this 

report, please enter your name and title. 

 Items 38 and 39—Signature of Company Official or Authorized Agent: The company 

official and/or authorized agent listed in Item 36 must sign and date the report in order for it to 

be complete.

Confidentiality. Under FIFRA §7(d) [7 USC §136e], information reported in Items 48, 49, 50 and 

51 of EPA Form 3540-16 will be treated as business confidential, subject to the provisions of FIFRA 

§10 [7 USC §136h]. You are not required to assert a claim of confidentiality for this information.

If you wish to assert a claim of confidentiality for other information you have provided on this form, 

you must identify by the box number(s) information for which you are asserting a claim of 

confidentiality. Information so designated will be disclosed by the EPA only to the extent allowed 

by, and by means of, the procedures set forth in 40 CFR Part 2. If you do not claim the information 

as confidential upon submission of the report, it may be made available to the public without further 

notice to you.

Public Reporting Burden. The time required to complete this report is estimated to average one 

hour and 26 minutes, per response, including reviewing instructions, searching data sources, 

gathering and maintaining data needed, and completing review and collection of information. Send 

comments regarding this burden estimate or other aspects related to this information collection, 

including suggestions for reducing this burden, to: Director, Collection Strategies Division, U.S. 

Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, DC 20460. 

Include the OMB control number in any correspondence. Do not send the completed 3540-16 form 

to the above address.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Where to Submit Applications 

DOMESTIC PRODUCERS:	 Submit applications to the following EPA Regional Office where your 

company headquarters is located. 

EPA Regional Offices 

States/Terr. 

Covered EPA Regional Offices 

States/Terr. 

Covered 

U.S. EPA Region 1 

Kan Tham 

Toxics and Pesticides Unit (OES 05-4) 

5 Post Office Square, Suite 100 

Boston, MA 02109-3912 

Telephone: 617-918-1872 

CT, MA 

ME, NH 

RI, VT 

U.S. EPA Region 6 

Chuck Ruple 

Pesticides Section (6PD-P) 

1445 Ross Avenue 

Dallas, TX 75202-2733 

Telephone: 214-665-6534 

AR, LA 

NM, OK 

TX 

U.S. EPA Region 2 

Michael Kramer 

Pesticides Team (MS-500) 

2890 Woodbridge Avenue 

Edison, NJ 08837-3679 

Telephone: 732-321-6610 

NJ, NY 

PR, VI 

U.S. EPA Region 7 

Delbert Kelley 

Pesticides Section 

(WWPD/TOPE/PEST) 

11201 Renner Boulevard 

Lenexa, KS 66219 

Telephone: 913-551-7371 

IA, KS 

MO, NE 

U.S. EPA Region 3 

Kyla Townsend-McIntyre 

Pesticides and Asbestos Programs Branch (3LC62) 

1650 Arch Street 

Philadelphia, PA 19103-2029 

Telephone: 215-814-2045 

DC, DE 

MD, PA 

VA, WV 

U.S. EPA Region 8 

Dan Webster 

FIFRA Division (8ENF-UFO) 

1595 Wynkoop 

Denver, CO 80202 

Telephone: 303-312-7076 

CO, MT 

ND, SD 

UT, WY 

U.S. EPA Region 4 

Mary Summers 

Chemical Products & Asbestos Section 

61 Forsyth Street, SW 12th Floor 

Atlanta, GA 30303 

Telephone: 404-562-8997 

AL, FL 

GA, KY 

MS, NC 

SC, TN 

U.S. EPA Region 9 

Scott McWhorter 

FIFRA Section (ENF 3-3) 

75 Hawthorne Street 

San Francisco, CA 94105-3901 

Telephone: 415-972-3584 

AZ, CA 

GU, HI 

MP, NV 

U.S. EPA Region 5 

Pesticide Reports Contact 

Pesticides & Toxics Compliance Section (LC-8J) 

77 West Jackson Boulevard 

Chicago, IL 60604 

Telephone: 312-886-7061 

IL, IN 

MI, MN 

OH, WI 

U.S. EPA Region 10 

Erin Williams 

Pesticides and Toxics Unit (OCE-084) 

1200 Sixth Avenue, Suite 900 

Seattle, WA 98101-1128 

Telephone: 206-553-0505 

AK, ID 

OR, WA 

FOREIGN PRODUCERS: Submit applications to the following EPA Washington, DC address: 

U.S. Postal Service Mail Address Courier Delivery Address 

Michelle Stevenson Michelle Stevenson 

U.S. Environmental Protection Agency U.S. Environmental Protection Agency 

Pesticides, Waste & Toxics Branch (2227A) William J. Clinton Building—South 

1200 Pennsylvania Avenue, NW Ariel Rios Building -- South 

Washington, DC 20460-0001 USA 1200 Pennsylvania Avenue, NW, Room 6102 

Telephone: 202-564-4203 Washington, DC 20004 USA 

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