OMB Control Number: 2060

- 0482

Expiration Date: 10/31 /1 4

EPA Form # 5900

- 14 2 , Revised 5/11



### U.S. Environmental Protection Agency

STRATO SPHERIC OZONE PROTEC TION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

PRE



### - 2005 STOCKS ANNUAL REPORT



### (40 CFR 82. 13 )

NOTE 

### : FORM MUST BE COMPLET ED BY ANY COMPANY TH AT EITHER 

### ( A 

### ) RECEIVED A CRITICAL STOCK ALLOWANCE



### , ( B 

### ) BOUGHT A CRITICAL

STOCK ALLOWANC E



### , OR 

### ( C 

### ) OWNS STOCKS OF METHY L BROMIDE THAT WERE PRODUCED OR IMPORTED PRIOR TO JANUARY 1, 2005



### .



## SECTION 1 COMPANY IDENTIFICATION

1.1 Date of Submission 1 .2 Year to Which This Report Applies Year



### 1. 3 Original Submittal Re

- submittal

1. 4 Company Information

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 Company Type

(check all that apply) Distributor Third Party Applicator Producer Importer



### 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



## SEN D 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 Protecti on 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 trea ted 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 1 .3 hours per response. Send comments on the

Agency's need for this inf ormation, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, includin g through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protec tion 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: 10/31/11

EPA Form # 5900

- 14 2 , Revised 5/11

U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

PRE



### - 2005 STOCKS ANNUAL REPORT



### (40 CFR 82. 13 )



## SECTION 2 TRANSACTION DATA

2. 1 Company Name

2.2 Total Critical Stock Allowances (CSAs) (if applicable):

Received in Trade Traded Away Expended* Unexpended

*if the reporting company sold stocks of methyl bromi de to a critical user in a fumigation or as a gas, the reporting company must “expend” or

use a CSA for each kilogram sold. The total number of CSAs expended should equal the total amount of stocks (in kg) the repo rting

company sold to critical users. St ocks sold to non

- critical user to not need to be reported.



### 2

. 3 Total Stocks of Pre

- P haseout Methyl Bromide **

kg 

### O wned by r eporting c ompany as of December 3 1 of this year (including all qua ntities owned by reporting

company that are held by other suppliers on the reporting company’s behalf )

** These quantities of stocks refer only to amount of methyl bromi de that were processed or imported before January 1, 2005. Any quantities

of newly produced critical use methyl bromide left in the reporting company’s possession as of December 31 of this year shoul d be reported

on form “Sales of Critical Use Methyl Brom ide,” section 2.4.



### 2

. 4 Name(s) of Company(ies) which are Holding Stocks of Pre

- Phaseout Methyl Bromide on Behalf of the Owner

Company Name: Amount Held (kg):



### Company Name: Amount Held (kg):



### Company Name: Amount Held (kg):