**OMB Control Number: 2060-0482 Expi**  **ration 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 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 information submitted by clearly marking that infor**  **mation 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 mea**  **ns set forth in the subpart. If no claim of confid entiality**  **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 t his collection of information is estimated to avera**  **ge 18 hours per response. Send comments on the Agency's need for this information, the accuracy of**  **the provided burden estimates, and any suggested m ethods 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. Inc**  **lude the OMB control number in any correspondence. Do not send the completed form to this address.** **OMB Control Number: 2060-0482 Expi**  **ration 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 additiona l 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 Transfero r’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 Expi**  **ration 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 Allowance s 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**