OMB Control Number: 2060-0482 

 Expiration Date: 10/31/11 

EPA Form 5900-146, Revised 6/08 

 U.S. Environmental Protection Agency 

 

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

NOTIFICATION OF METHYL BROMIDE TRANSFERS 

(Sec 82.12)

SECTION 1 TRANSFEROR 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 Company Information

Company Name 

Street Address 

City State Zip Code 

1.6 Company Contact Identification

Reporting Company Contact Person 

 

Phone Number Fax Number 

E-mail Address 

1.7 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 5900-146, Revised 6/08 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

NOTIFICATION OF METHYL BROMIDE TRANSFERS 

(Sec 82.12)

SECTION 2 TRANSACTION RECORD 

 (Reproduce additional sheets as needed)

TRANSACTION # 

 

2.1 Transferee Identification

Transferee Company Name 

 

Transferee Contact Person 

 

Street Address 

City State Zip Code 

Phone Number Fax Number 

Check only one: Pre-Plant CUA Post-Harvest CUA Article 5 Allowances Critical Stock Allowance (CSA)

2.2 Type of Allowances Transferred (check only one) Current Year Allowances Baseline Year Allowances

2.3 Number of Allowances Being Transferred (kg) 

2.4 Amount of Offset (kg) 

 For Pre-Plant and Post-Harvest CUAs, 0.001 x 

Section 2.3; 

 For Article 5 Allowances, 0.01 x Section 2.3; 

 For CSAs no offset is applied, proceed to Section 

2.5 

 

2.4 Number of Allowances Subtracted from Transferor’s 

Balance of Chemical Being Transferred (Section 2.3 + 

Section 2.4) (kg)

 

2.5 Number of Allowances Being Received (kg) 
 OMB Control Number: 2060-0482 

 Expiration Date: 10/31/11 

EPA Form 5900-146, Revised 6/08 

 U.S. Environmental Protection Agency 

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

NOTIFICATION OF METHYL BROMIDE TRANSFERS

(Sec 82.12)

SECTION 3 UNEXPENDED BALANCE SUMMARY

3.1 Balance of Unexpended Methyl Bromide Allowances Prior to Trades Reported

A B C D

Balance of Unexpended 

Pre-Plant Critical Use 

Allowances 

Balance of Unexpended 

Post-Harvest Critical Use 

Allowances

Balance of Unexpended 

Article 5 Allowances

Balance of Unexpended 

Critical Stock Allowances