**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 **1 st**  

### 2 **nd** 

### 3 **rd** 

### 4 **th** 

### 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 us ers?** 

**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) allocation s, or purchase** 

**CSAs?**

**If yes, is the Pre-2005 Methyl Bromide Stocks Repor t attached?**  **Yes**

**Yes No** 

**No**



### 1.10 Signature of Reporting Company Representative

I certify under penalty of law that I have personal ly examined and am familiar with the information su bmitted in this and all attached

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

submitted information is true, accurate, and comple te. I am aware that there are significant penaltie s 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; 10 th**  **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 i nformation submitted by** 

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

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

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

**The public reporting and recordkeeping burden for t his collection of information is estimated to avera**  **ge 18 hours per response. Send comments on the Age ncy's need for this** 

**information, the accuracy of the provided burden es timates, and any suggested methods for minimizing r**  **espondent burden, including through the use of auto mated collection** 

**techniques to the Director, Collection Strategies D ivision, U.S. Environmental Protection Agency (2822**  **T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20 460. Include the** 

**OMB control number in any correspondence. Do not s end 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 PROGR AM 

### 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**METHYLBROMIDE IMPORTER QUARTERLY REPORT(Sec82.13)SECTION 3 COMPANY IMPORT DATA3.1 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)** F1F2**In-House Trans** **formation (kg)** **Second Party Trans** **formation (kg)** **In-House Destruction** **(kg) Second** **Party 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+F** **1 +** **F 2** **+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**

A 1 

### Total pre-plant critical use allowances (CUAs)

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

**that were:**

A 2 

### 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 4 th 

### quarter reporting only)

**kg** 

### owned by reporting company (at end of the control p **eriod) (including all quantities held by other supp liers,** 

**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 an d Associated

Amounts (kg) Held for Each (excluding end-users) (C omplete this question for 4 th 

### 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):**