OMB Control Number: 2060-0482

 Expiration Date: 6/30/15

EPA Form # 5900-139, Revised 6/12 

 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

CERTIFICATION OF PURCHASE OF CRITICAL 

USE METHYL BROMIDE (40 CFR 82.13)

SECTION 1 PURCHASER INDENTIFICATION

1.1 Date of Submission

1.2 Total Quantity of New Production Pre-Plant Critical Use Methyl Bromide Purchased (kg)

1.3 Total Quantity of New Production Post Harvest Critical Use Methyl Bromide Purchased (kg)

1.4 Company Information

Company Name 

Street Address 

City State Zip Code 

1.5 Company Contact Identification

Reporting Company Contact Person 

E-mail Address 

Phone Number Fax Number 

Approved critical use(s) are those uses of methyl bromide listed in Appendix L to Subpart A of 40 CFR Part 82. See 

www.epa.gov/ozone/mbr/cueuses.html. 

1.6 Signature of Reporting Company Representative

I certify, under penalty of law, that the quantities of methyl bromide specified in Section 1.2 and 1.3 of this form, are ordered/purchased 

and will be sold or used exclusively for an approved critical use (pre-plant or post-harvest) as identified, and not sold/ transferred to 

another person. I certify that I am an approved critical user and I will use this quantity of methyl bromide for an approved critical use. My 

action conforms to the requirements associated with the critical use exemption published in 40 CFR part 82. I am aware that any 

agricultural commodity within a treatment chamber, facility or field I fumigate with critical use methyl bromide cannot subsequently or 

concurrently be fumigated with non-critical use methyl bromide during the same control period, excepting a QPS treatment or treatment for 

a different use (e.g., a different crop or commodity). I will not use this quantity of methyl bromide for a treatment chamber, facility, or field 

that I previously fumigated with non-critical use methyl bromide during the same control period, excepting a QPS treatment or treatments 

for a different use (e.g., a different crop or commodity), unless a local township limit now prevents me from using methyl bromide 

alternatives or I have now become an approved critical user as a result of rulemaking.

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached 

documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the 

submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, 

including the possibility of fine and imprisonment.

Name 

Title 

Signature Date 

SEND COMPLETED FORMS TO: The Company From Whom the Critical Use Methyl Bromide is 

Being Purchased

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 respondent burden, including 

through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 

Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.