OMB Control Num ber: 2060
- 0482 Expiration Date: 6/30/15

EPA Form # 5900
- 141 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **PRODUCER QUA RTERLY**  **REPORT** 

### (40 CFR **82. 13**  **)** 

## SECTION 1 PRODUCING COMPA **NY IDENTIFICA TION**  **1.1 Date of Submission**  **1.2 Original Submittal**  **Re -**  **submittal 1.**  **3 Quarter and Year t**  **o Which This Report A pplies** 

1 st 

### 2 nd 

### 3 rd 

### 4 th 

### Year **1.4 Producing**  **Company** Company Name Street Address City State Zip Code 

### 1.5 **Company Contact Id entification**  Reporting Company Contact Person E
- mail Address Phone Number Fax Number 

### 1. **6 I**  **mporter Information** Is your company an I mporter of methyl bromide ? If yes, is the I mporter Quarterly Report attached? Yes Yes N o

No 

### 1. **7 Exporter Information**  Is your company an E xporter of methyl bromide? If yes, is the Exporter Quarterly Report attached? Yes Yes No

No 

### 1. **8 Sales to Critical Users**  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 Pre**  **- P**  **haseout Stocks** D id your company own pre - phaseout stocks of methyl bromide? 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 atta ched 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 submitti ng false information, including the possibility of fine and imprisonment. Name Title Signature Date 

## SEND COMPLETED FORMS TO: **For U.S. Postal Service:** U.S. EPA Stratospheric Protection Division Office of Atmos pheric Programs Mail Code: 6205T 1200 Pennsylvania Ave nue, NW Wa shington, D.C. 20460 **For Private Courier:** U.S. EPA Stratospheric Protection Division Office of Atmospheric Programs Room 4355CC 1201 Constitution Avenue , NW Wa shington, D.C. 20004 A company may assert a claim of confidentiality for information submitted in this form by clearl y 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 disclo sed 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 com pany (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, inclu ding through the use of au tomated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsy lvania A ve., NW , W ashington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the complet ed form to this address.OM B Control Number : 2060
- 0482 Expiration Date : 6/30/15

EPA Form # 5900
- 141 , Revised 7/14



### U.S. Environmental Protection Agency **STRA TOSPHERIC OZONE**  **PROTECTION PROGRA M**  

### CLASS I CONTROLLED SUBSTANCE METHYL BROMIDE **IMPORTER QUA RTERLY R**  **EPORT** 

### (40 CFR 82.13)


## SECTION **2 COMPA**  **NY PRODUCTION**  **DA TA**  **2 .1 Company Name**  **2 .2**  **Company Production Totals A**  **B C**  **D E**  **F G**  **H I**  In
- House Trans
formation (kg) Second
Party Trans
formation (kg) In
- House

Destruction (kg) Second
Party Destruction (kg) Quarantine

and Pre
shipment (QPS) (kg) Critical Use (kg) Emergency Use (kg) Lab Use

(kg) Gross Production of

Methyl Bromide (kg) (A+B+C+D+E+F 1 +F 2 + F 3 +G+H=I) **F 1**  **F 2**  **F 3**  Pre
- Plant Post
Harvest For

Export



## SECTION **3 AL**  **LOWA NCE EXPENDITURE DA**  **TA 3.1**  **Al lowance Balance Summary**  Expended Unexpended 

### A **1** 

### Total pre
- plant critical use allowances for year to date (as of the end of the quarter) that were: **A 2**  

### Total post
- harvest critical use allowances for year to date (as of the end of the quarter) that were: **3.2 Producer**  **’s CUE Methyl Bromide Ending Inventory, If A ny**  **(Complete this question for 4 th**  

### quarter reporting only)

kg 

### o wned by r eporting c ompany (a t end of the control period) (including all qua ntit ies held by other suppliers ) **3**
**. 3**  **Name(s) of Company(ies) for w hich Critical Use Methyl Bromide is Bei**  **ng Held by Reporting Entity and A**  **ssociated A mounts Held for**  **Each (excluding end -**  **users) (Complete this question for 4 th**  

### quarter reporting only) Company Name: Pre
- Plant (kg): Post
- Harvest (kg): Company Name: Pre
- Plant (kg): Post
- Harvest (kg):