OMB Control Number: 2060

- 0482

Expiration Date: 10 / 31/1 4

EPA Form # 5900

- 144, Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IM PORTER QUARTERLY REPORT



### (40 CFR 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

Nine

- digit IRS Importer Number:



### 1.8 Sales to Critical Users

Information Did your company make sales directly to critical users?

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

attached? Yes

Yes No

No



### 1.9 Critical Stock Allowances

Information D id your company own pre

- phaseout stocks of methyl bromide, receive

critical s tock 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 Representa tive

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; 10 th Floor

Washington, DC 20005

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

m eans 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 notic e

to the company (40 CFR 2.203).

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 r espondent burden,

including through the use of automated col lection 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 c ompleted form to this

address.OMB Control Number: 2060

- 0482

Expiration Date: 10 / 31/1 4

EPA Form # 5900

- 144, Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IM PORTER QUARTERLY REPORT



### (40 CFR 82. 13 )



## SECTION 2 TRANSACTION R ECORD S

(Reproduce additional sheets as needed)

2.1 Company Name

2.2 Transaction Summaries

TRANSACTION #

Source Country Port of Exit from Source Countr y

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S.

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

Transaction Type (check one ): New Used Heels

Methyl Bromide will be imported for: Post

- Harvest CUE

Pre

- Plant CUE Destruction

Transformatio n QPS

Lab Use Emergency Use



### TRANSACTION #

Source Country Port of Exit from Source Country

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S.

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

Transaction Type (check one): New Used Heels

Methyl Bromide will be imported for: Post

- Harvest CUE

Pre

- Plant CU E Destruction

Transformatio n QPS

Lab Use Emergency Use



### TRANSACTION #

Source Country Port of Exit from Source Countr y

Quantity of Methyl Bromide Imported (kg) Port of Entry into the U.S.

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

Transaction Type (check one ): New Used Heels

Methyl Bromide will be imported for: Post

- Harvest CUE

Pre

- Plant CUE Destruction

Transformatio n QPS

Lab Use Emergency UseOMB Control Number: 2060

- 0482

Expiration Date: 10 /31/11

EPA Form # 5900

- 144, Revised 5/11



### U .S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IM PORTER QUARTERLY REPORT



### (40 CFR 82. 13 )



## SECTION 3 COMPANY IMPORT DATA

3.1 Company Name

3.2 Comp any Import Totals (Methyl Bromide Commodity Code 2903.30.1520 )

A B C D E F G H I J K

In

- House

Trans

formation

(kg) Second

Party Trans

formation

(kg) In

- House

Destruction

(kg) Second

Party

Destruction

(kg) Quarantine and

Pre

- shipment

(QPS) (kg) Crit ical Use Exemption (CUE)

(kg) 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)

F 1 F 2

Pre

- Plant Post

- HarvestOMB Control Number: 2060

- 0482

Expiration Date: 10 /31 /1 4 OMB Control Number: 2060

- 0482 Expiration Date: 8/31/11

EPA Form # 5900

- 144, Revised 5 /11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

IM PORTER QUARTERLY REPORT



### (40 CFR 82. 13 )



## SECTION 4 ALLOWANCE EXPENDITURE DATA

4.1 Company Name

4.2 Allowance Balance Summary

Expended Unexpended

A 1 

### Total pre

- pl ant critical use allowances (CUAs)

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

that were:

A 2 

### Total p ost

- h arvest critical use allow ances

(CUAs) 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 

### o wned by r eporting c ompany (a t end of the control period) (including all qua ntities held by other

suppliers )

4.4 Name(s) of Company(ies) for Which C ritical Use M ethyl B romide is Being H eld by Reporting Entity and

Associated Amounts (kg) Held for Each (ex cluding end

- users) (Complete 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):