OMB Control Number: 2060 - 0482 Expiration Date : 6 / 30/ 1 5

EPA Form 5900 - 146, Revised 7 /1 4



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **NOTIFICA**

**TION OF TR**  **ANSFER S**  

### (40 CFR **82. 13**  **)** 

## SECTION 1 **TRA NSFEROR**  **IDENTIFICA TION**  **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 Company**  **Information** Company Name Street Address City State Zip Code 

### 1.6 **Company Contact Identification** Reporting Company Contact Person E - mail Address Phone Number Fax Number 

### 1.7 **Signature of Reporting Company Representative** I certify under penalty of law that I have personally examined and am familiar with the information submitt ed 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:** U.S. EPA Stratospheric Protection Division Office of Atmos pheric Programs Mail Code: 6205T 1200 Pennsylvania Ave nue, NW Wa shington, D.C. 20460 **For Private Courier:** U.S. EPA Stratospheric Protection Division Office of Atmospheric Programs Room 4355CC 1201 Constitution Avenue , NW Wa shington, D.C. 20004 A company may assert a claim of confidentiality for information submitted in this form 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 p ublic without further notice to the company (40 CFR 2.203). The public reporting and recordkeeping burden for this collection of inform ation 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 r espondent burden, including throu gh the use of au tomated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., N W, W ashington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the comple t ed form to this address.OMB Control Number: 2060 - 0482 Expiration Date : 6 / 30/ 1 5

EPA Form 5900 - 146, Revised 7 /1 4



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **NOTIFICA**

**TION OF TRA N**  **SFERS** 

### (40 CFR **82. 13**  **)** 

## SECTION 2 TRA **NSA CTION RECORDS**  **(Reproduce A**  **dditional S**  **heets as N**  **eeded) TRA**  **NSA CTION #**  **2. 1**  **Trans feree Identification**  Transferee Company Name Transferee Contact Person Street Address City Country Postal Code Phone Number Fax Number Check only one: Pre - Plant Critical Use Post - Harvest Critical Use 

### 2.2 Type of A **llowances Transferred (check only one)** Current Year Allowances Baseline Year Allowances 

### 2. **3 Number of A**  **llowances P urchased by Transferee (kg)**  **2.4 Am**  **ount of Offset (kg) (**  **0. 001 x Section 2.**  **3 )**  **2. 5**  **Number of A llowances Subtracted from Transferor’s Balance of**  **Chemical Being Transferred (kg)**  **(Section 2. 3**  **+ Section 2. 4**  **)**


## SECTION 3 UNEXPENDED BA **LA NCE SUMMA**  **RY 3.1 Balance of Unexpen**  **ded Methyl Bromide A llowances Prior to Trades Reported**  **A** Balance of Unexpended Pre - Plant Critical Use Allowances **B** Balance of Unexpended Post - Harvest Critical Use Allowances