OMB Control Number: 2060

- 0482

Expiration Date: 10 / 31/1 4

EPA Form 5900

- 146, Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

NOTIFICATION OF TRANSFER S



### (40 CFR 82. 13 )



## 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 S ubmitted

1.5 Company Information

Company Name

S treet 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

d ocuments, 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 fal se 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

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 with out further notice

to the company (40 CFR 2.203).

The public reporting and recordkeeping burden for this collection of inform atio n 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 co llection 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 comple ted form to this

address.OMB Control Number: 2060

- 0482

Expiration Date: 10 / 31/1 4

EPA Form 5900

- 146, Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

NOTIFICATION OF TRAN SFERS



### (40 CFR 82. 13 )



## 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 All owances Critical Stock Allowance (CSA)



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



### 2. 3 Number of Allowances purchased by Transferee (kg)

2. 4 Amount of Offset (kg)

 F or Pre

- Plant and Post

- Harvest CUAs, 0.001 x

Section 2. 3 ;

 F or Article 5 Allowances, 0.01 x Section 2. 3 ;

 F or CSAs no offset is applied, proceed to Section 2. 5

2. 5 Number of Allowances Subt racted from Transferor’s

Balance of Chemical Being Transferred (Section 2. 3 +

Section 2. 4 ) (kg)OMB Control Number: 2060

- 0482

Expiration Date: 10 / 31/1 4

EPA Form 5900

- 146, Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

NOTIFICATION OF TRAN SFERS



### (40 CFR 82. 13 )



## 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 Unex pended

Post

- Harvest Critical Use

Allowances Balance of Unexpended

Article 5 Allowances Balance of Unexpended

Critical Stock Allowances