OMB Control Number: 2060-0482 

Expiration Date: 10/31/11 

EPA Form # 5900-144, Revised 6/08

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

METHYL BROMIDE IMPORTER QUARTERLY REPORT

(Sec 82.13)

SECTION 1 IMPORTING COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Number of 

Transactions Reported 

1.4 Number of Pages 

Submitted 

1.5 Quarter and Year to Which This Report Applies 1st 2nd 3rd 4th Year 

1.6 Importing Company

Company Name 

 

Street Address 

 

City State 

 

Zip Code 

1.7 Company Contact Identification

Reporting Company Contact Person 

 

Phone Number 

 

Fax Number 

 

E-mail Address 

1.8 Sales to Critical Users 

Information 

Did your company make sales directly to critical users? 

If yes, is the Sales of Critical Methyl Bromide to End Users Report 

attached? 

 Yes 

 Yes

 No 

 No

1.9 Critical Stock Allowances 

Information 

Did your company own pre-phaseout stocks of methyl bromide, 

receive critical stock allowances (CSAs) allocations, or purchase 

CSAs? 

If yes, is the Pre-2005 Methyl Bromide Stocks Report attached?

 Yes 

 Yes

 No 

 No

1.10 Signature of Reporting Company Representative

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: For U.S. Postal Service: 

Tracking System Program Manager 

Stratospheric Protection Division 

U.S. EPA (6205J) 

1200 Pennsylvania Avenue, NW 

Washington, DC 20460 

For Private Courier: 

Tracking System Program Manager 

Stratospheric Protection Division 

U.S. EPA (6205J) 

1310 L Street, NW; 10th Floor 

Washington, DC 20005

Information in reports submitted in compliance with the final rule may be claimed as confidential. A company may assert a claim of confidentiality for information submitted by 

clearly marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, 

Subpart B, and will only be disclosed by the means set forth in the subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public 

without further notice to the company (40 CFR 2.203). 

The public reporting and recordkeeping burden for this collection of information is estimated to average 18 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. 
OMB Control Number: 2060-0482 

Expiration Date: 10/31/11 

EPA Form # 5900-144, Revised 6/08

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE IMPORTER QUARTERLY REPORT

(Sec 82.13)

SECTION 2 TRANSACTION RECORDS 

 (Reproduce additional sheets as needed)

2.1 Company Name 

2.2 Transaction Summaries

TRANSACTION # 

Source Country 

Port of Exit from Source Country Importer Number 

Quantity of Commodity Imported (kg) 

 

Quantity of Methyl Bromide Imported (kg) 

 

Port of Entry into the U.S. Customs Entry Summary Number Date of Import (mm/dd/yy) 

 

Methyl Bromide will 

be imported for:

Post-Harvest 

CUE 

Pre-Plant CUE Destruction Transformation QPS Emergency Use Lab Use 

Transaction Type (check one): New Used Heels

TRANSACTION # 

Source Country 

Port of Exit from Source Country Importer Number 

Quantity of Commodity Imported (kg) 

 

Quantity of Methyl Bromide Imported (kg) 

 

Port of Entry into the U.S. 

 

Customs Entry Summary Number Date of Import (mm/dd/yy) 

 

Methyl Bromide will 

be imported for:

Post-Harvest 

CUE 

Pre-Plant CUE Destruction Transformation QPS Emergency Use Lab Use 

Transaction Type (check one): New Used Heels

TRANSACTION # 

Source Country 

Port of Exit from Source Country Importer Number 

Quantity of Commodity Imported (kg) 

 

Quantity of Methyl Bromide Imported (kg) 

 

Port of Entry into the U.S. Customs Entry Summary Number 

 

Date of Import (mm/dd/yy) 

 

Methyl Bromide will 

be imported for:

Post-Harvest 

CUE 

Pre-Plant CUE Destruction Transformation QPS Emergency Use Lab Use 

Transaction Type (check one): New Used Heels
OMB Control Number: 2060-0482 

 Expiration Date: 10/31/11 

 EPA Form # 5900-144, Revised 6/08

U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUSTANCE 

METHYL BROMIDE IMPORTER QUARTERLY REPORT

(Sec 82.13)

SECTION 3 COMPANY IMPORT DATA 3.1 Company Name3.2 Company Import Totals (Methyl Bromide Commodity Code 2903.30.1520)

A B C D E F G H I J K 

Critical Use Exemption (CUE) 

(kg)

F1 F2

In-House 

Transformation 

(kg) 

SecondParty Transformation 

(kg)

In-House 

Destruction 

(kg)

SecondParty 

Destruction 

(kg)

Quarantine and 

Pre-shipment 

(QPS) (kg)

Pre-Plant Post-Harvest

Emergency 

Use Exemption 

(kg)

Lab Use (kg) Gross Imports (kg)

(A+B+C+D+E+F1+ 

F2+G+H=I)

Total ‘Used’ 

Imports (kg)

Total 

‘Heels’ 

(kg) 
OMB Control Number: 2060-0482 

Expiration Date: 10/31/11 

EPA Form # 5900-144, Revised 6/08

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE IMPORTER QUARTERLY REPORT

(Sec 82.13)

SECTION 4 ALLOWANCE EXPENDITURE DATA

4.1 Company Name 

4.2 Allowance Balance Summary 

Expended Unexpended 

A1 Total pre-plant critical use allowances (CUAs) 

for year to date (as of the end of the quarter) 

that were:

 

A2 Total post-harvest critical use allowances 

(CUAs) for year to date (as of the end of the 

quarter) that were:

 

B Total critical stock allowances (CSAs) for year 

to date (as of the end of the quarter) that were: 

 

4.3 Importer’s CUE Methyl Bromide Ending Inventory, If Any (Complete this question for 4th quarter reporting only)

 kg owned by reporting company (at end of the control period) (including all quantities held by other suppliers, 

but not quantities sold to end-users)

4.4 Name(s) of Company(ies) for Which Critical Use Methyl Bromide is Being Held by Reporting Entity and Associated 

Amounts (kg) Held for Each (excluding end-users) (Complete this question for 4th quarter reporting only)

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg):