5900-138 Sales of Critical Use Methyl Bromide to End Users Report

OMB Control Number: 2060-0482

Expiration Date: 8/31/11

U.S. Environmental Protection Agency stratospheric ozone protection program

class i controlled substance sales of critical use methyl bromide to end users report (Sec 82.13)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT PROVIDED METHYL BROMIDE GAS OR FUMIGATIONS TO CRITICAL USERS. FORM MUST BE COMPLETED BY CENTRAL OFFICE ON BEHALF OF THEIR DIVISIONS; ONE FORM PER COMPANY.

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 Quarterly or Annual Submittal

1st

2nd

3rd

4th

Annual

1.5 Company Information

Company Name      

Street Address      

City      

State      

Zip Code      

1.6 Company Contact Identification

Reporting Company Contact Person      

Phone Number      

Fax Number      

E-mail Address      

1.7 Company Type (check all that apply)

Distributor

Third Party Applicator

Producer

Importer

1.8 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

Information in reports submitted in compliance with the final rule may be claimed as confidential. A company may assert a claim of confidentiality for information submitted 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 18 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.

U.S. Environmental Protection Agency stratospheric ozone protection program			class i controlled substance sales of critical use methyl bromide to end users report (Sec 82.13)
SECTION 2 SALES DATA
2.1 Company Name		     
2.2 Critical Use Methyl Bromide (newly produced or imported methyl bromide) sold in the following sectors (active ingredient only)
Pre-Plant (kg)       Post-Harvest (kg)       (If none, enter 0. Do not leave blank)
2.3 Critical Stock Allowance Methyl Bromide (pre-phaseout stocks) sold to the following critical users (active ingredient only)
Pre-Plant (kg)       Post-Harvest (kg)       (If none, enter 0. Do not leave blank)
Year-End Inventory Calculation (Complete for 4th quarter reporting only)
2.4A Beginning Inventory of Critical Use Methyl Bromide from Prior Control Periods, if any (NOT pre-phaseout Stocks). Note: This is the same amount as the previous control period’s ending inventory.
Pre-Plant (kg)       Post-Harvest (kg)       (If none, enter 0. Do not leave blank)
2.4B Critical Use Methyl Bromide Bought this Control Period (only new production/import, NOT pre-phaseout Stocks)
Pre-Plant (kg)       Post-Harvest (kg)       (If none, enter 0. Do not leave blank)
2.5 Critical Use Methyl Bromide Sold to an Entity Other than a Critical User (e.g., Distributor, Third Party Applicator)
Pre-Plant (kg)       Post-Harvest (kg)       (If none, enter 0. Do not leave blank)
2.6 Year-End Inventory – Critical Use Methyl Bromide Not Sold In Reporting Year (2.4A + 2.4B – 2.2 – 2.5)
CUE Pre-Plant not sold by year end (kg)       CUE Post-Harvest not sold by year end (kg)      
2.7 Name(s) of Company(ies) for Which Newly Produced Critical Use Methyl Bromide is Being Held and Associated Amounts (kg) Held for Each (excluding end-users)
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):      
NOTE:	COMPLETE THE PRE-2005 METHYL BROMIDE STOCKS REPORT FOR QUANTITIES OF METHYL BROMIDE OWNED THAT WAS PRODUCED/IMPORTED BEFORE JANUARY 1, 2005, OR FOR ALLOCATIONS OR RECEIPT OF ANY CRITICAL STOCK ALLOWANCES.

EPA Form # 5900-138, Revised 11/08