OMB Control Number: 2060

- 0482

Expiration Date: 10/ 31/1 4

EPA Form # 5900

- 141 , Revised 5/11



### U.S. Environmental Protection Agency

STRATO SPHERIC OZONE PROTEC TION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

PRODUCER QUARTERLY REPORT



### (40 CFR 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 1 st 2 nd 3 rd 4 th Year



### 1. 4 Prod ucing Company

Company Name

Street Address

City State Zip Code



### 1. 5 Company Contact Identification

Reporting Com pany Contact Person Phone Number Fax Number

E

- mail Address



### 1. 6 I mporter Information Is your company an I mporter of methyl bromide ?

If yes, is the I mporter Quarterly Repor t 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

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 D id 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 exa mined 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, an d 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, N W

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 submitte d 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 disclo sed by the means set fort h 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 informati on 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 automated c ollection

techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania A ve., NW, Washington, D.C. 20460. Include the OMB

control number in any correspondence. Do not send the completed form t o this address.OMB Control Number: 2060

- 0482

Expiration Date: 10/31/1 4

EPA Form # 5900

- 141 , Revised 5/11



### U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

PRODUCER QUARTERLY REPORT



### (40 CFR 82. 13 )



## SECTION 2 COMPANY PRODUCTION DATA

2.1 Company

Name 2.2 Company Production To tals

A B C D E F G H I J

In

- House

Transformation

(kg) Second

- Party

Transformation

(kg) In

- House

Destruction

(kg) Second

- Party

Destruction

(kg) Quarantine

and

Preshipment

(QPS) (kg) Critical Use Exemption (CUE) (kg) Emergency Use

Exemption (kg) Article 5

Production (kg) Lab Use (kg) Gross Production of

Methyl Bromide (kg)

(A+B+C+D+E+F 1 +F 2 +

F 3 +G+H+I=J) F 1 F 2 F 3

Pre

- plant Post

Harvest For ExportOMB Control Number : 2 060

- 0482

Expiration Date: 10/ 31/ 14

EPA Form # 5900

- 141 , Revised 5/11 U.S. Environmental Protection Agency

STRATOSPHERIC OZONE PROTECTION PROGRAM 

### CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

PRODUCER QUAR TERLY REPORT



### (40 CFR 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:

B 1 

### T otal p re

- p lant critical use allowances for year

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

were:

B 2 

### Total p ost

- h arvest critical use allowances for

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

were:

3.3 Producer’s CUE Me thyl Bromide Ending Inventory, If Any (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 ntities held by other suppliers )

3.4 Name(s) of Company(ies) for Which C ritical Use M ethyl B romide is Being H eld by Reporting Entity and Associated

Amounts (kg) 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):

Company Name: Pre

- Plant (kg): Post

- Harvest (kg):

Company Name: Pre

- Plant (kg): Post

- Harvest (kg):

Company Name: Pre

- Plant (kg): Post

- Harvest (kg):