OMB Control Number: 2060-0482

 Expiration Date: 10/31/14

EPA Form # 5900-142, 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)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT EITHER (A) RECEIVED A CRITICAL STOCK ALLOWANCE, (B) BOUGHT A CRITICAL 

STOCK ALLOWANCE, OR (C) OWNS STOCKS OF METHYL 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 

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

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 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 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 # 5900-142, 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 bromide 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 reporting 

company sold to critical users. Stocks sold to non-critical user to not need to be reported.

2.3 Total Stocks of Pre-Phaseout Methyl Bromide**

kg

Owned by reporting company as of December 31 of this year (including all quantities 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 bromide 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 should be reported 

on form “Sales of Critical Use Methyl Bromide,” 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):