OMB Control Number: 2060-0482 

 Expiration Date: 10/31/11 

EPA Form # 5900-141, Revised 6/08 

 

 U.S. Environmental Protection Agency 

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

METHYL BROMIDE PRODUCER QUARTERLY REPORT 

(Sec 82.13)

SECTION 1 PRODUCING COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Original Submittal Re-submittal

1.3 Quarter and Year to Which This Report Applies 1st 2nd 3rd 4th Year 

1.4 Producing Company

Company Name 

Street Address 

City State Zip Code 

1.5 Company Contact Identification

Reporting Company Contact Person 

 

Phone Number Fax Number 

E-mail Address 

1.6 Importer Information Is your company an Importer of methyl bromide? 

If yes, is the Importer Quarterly Report attached?

 Yes 

 Yes 

 No 

 No

1.7 Exporter Information Is your company an Exporter of methyl bromide? 

If yes, is the Exporter Quarterly Report attached? 

 Yes 

 Yes

 No 

 No

1.8 Sales to Critical Users 

Information 

Did your company make sales directly to critical users? 

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) 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 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 # 5900-141, Revised 6/08

U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

METHYL BROMIDE PRODUCER QUARTERLY REPORT 

(Sec 82.13)

 SECTION 2 COMPANY PRODUCTION DATA 2.1 Company Name 2.2 Company Production Totals

A B C D E F G H I J K 

Critical Use Exemption (CUE) (kg)

F1 F2 F3

In-House 

Transformation 

(kg)

Second-Party 

Transformation 

(kg)

In-House 

Destruction 

(kg)

Second-Party 

Destruction 

(kg)

Quarantine 

and 

Preshipment 

(QPS) (kg)

Pre-plant PostHarvest For Export

Emergency 

Use 

Exemption 

(kg)

Article 5 

Production 

(kg) 

Lab Use (kg) Gross Production of 

Methyl Bromide (kg)

(A+B+C+D+E+F1+F2+

F3+G+H+I=J) 

Critical Stock 

Allowances 

(CSA) (kg) 
 OMB Control Number: 2060-0482 

 Expiration Date: 10/31/11 

EPA Form # 5900-141, Revised 6/08 

 

 U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE 

METHYL BROMIDE PRODUCER QUARTERLY REPORT 

(Sec 82.13)

SECTION 3 ALLOWANCE EXPENDITURE DATA

3.1 Company Name 

3.2 Allowance Balance Summary

 Expended Unexpended

A Total Article 5 allowances for year to date (as 

of the end of the quarter) that were:

 

B1 Total pre-plant critical use allowances for year 

to date (as of the end of the quarter) that 

were: 

 

B2 Total post-harvest critical use allowances for 

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

were: 

 

C Total critical stock allowances (CSAs) for year 

to date (as of end of the quarter) that were: 

 

3.3 Producer’s CUE Methyl Bromide Ending Inventory, If Any (Complete this question for 4th quarter reporting only)

 kg owned by reporting company (at end of the control period) (including all quantities held by other suppliers, but 

not quantities sold to end-users)

3.4 Name(s) of Company(ies) for Which Critical Use Methyl Bromide is Being Held by Reporting Entity and Associated 

Amounts (kg) Held for Each (excluding end-users) (Complete this question for 4th 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):