5900-142 Pre-2005 Methyl Bromide Stocks Report

OMB Control Number: 2060-0482

Expiration Date: 8/31/11

U.S. Environmental Protection Agency stratospheric ozone protection program

class i controlled substance pre-2005 methyl bromide stocks report (Sec 82.13)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT EITHER A) RECEIVED A CRITICAL STOCK ALLOWANCE, OR B) BOUGHT A CRITICAL USE 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 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 pre-2005 methyl bromide stocks report (Sec 82.13)
SECTION 2 TRANSACTION DATA
2.1 Company Name	     
2.2 Number of Critical Stock Allowances (CSAs) Allocated (kg) (if applicable):					     
2.3 Total CSAs for Year to Date (as of the end of the quarter) that were (if applicable):
Received in Trade		Traded Away		Expended*		Unexpended
     		     		     		     
*if the reporting company sold critical use methyl bromide to a critical user in a fumigation or as gas, the reporting company must “expend” or use a critical stock allowance 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.
2.4 Total Stocks of Pre-phaseout Methyl Bromide** (Complete this question for 4th quarter or annual reporting only)
      kg Owned by reporting company for year to date (as end of the control period) (including all quantities owned by reporting company that are held by other suppliers on the reporting company’s behalf, but not quantities sold to end-users)
Company Holding Methyl Bromide on Behalf of Owner				Amount Held (kg)
** These quantities of stocks refer only to amounts 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 the year should be reported on form “Sales of Critical Use Methyl Bromide,” section 2.4.

EPA Form # 5900-142, Revised 6/08