5900-146 Notification of Methyl Bromide Transfers

OMB Control Number: 2060-0482

Expiration Date: 10/31/14

U.S. Environmental Protection Agency stratospheric ozone protection program							class i controlled substance methyl bromide notification of transfers (40 CFR 82.13)
SECTION 1 TRANSFEROR IDENTIFICATION
1.1 Date of Submission	     	1.2 Original Submittal Re-submittal
1.3 Number of Transactions Reported		     				1.4 Number of Pages Submitted				     
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 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.

U.S. Environmental Protection Agency stratospheric ozone protection program

class i controlled substance methyl bromide notification of transfers (40 CFR 82.13)

SECTION 2 TRANSACTION RECORD (Reproduce additional sheets as needed)

TRANSACTION #

     

2.1 Transferee Identification

Transferee Company Name      

Transferee Contact Person      

Street Address      

City      

State      

Zip Code      

Phone Number      

Fax Number      

Check only one:

Pre-Plant CUA

Post-Harvest CUA

Article 5 Allowances

Critical Stock Allowance (CSA)

2.2 Type of Allowances Transferred (check only one)

Current Year Allowances

Baseline Year Allowances

2.3 Number of Allowances purchased by Transferee (kg)

     

2.4 Amount of Offset (kg) For Pre-Plant and Post-Harvest CUAs, 0.001 x Section 2.3; For Article 5 Allowances, 0.01 x Section 2.3; For CSAs no offset is applied, proceed to Section 2.5

     

2.5 Number of Allowances Subtracted from Transferor’s Balance of Chemical Being Transferred (Section 2.3 + Section 2.4) (kg)

     

U.S. Environmental Protection Agency stratospheric ozone protection program					class i controlled substance methyl bromide notification of transfers (40 CFR 82.13)
SECTION 3 UNEXPENDED BALANCE SUMMARY
3.1 Balance of Unexpended Methyl Bromide Allowances Prior to Trades Reported
A	B		C				D
Balance of Unexpended Pre-Plant Critical Use Allowances	Balance of Unexpended Post-Harvest Critical Use Allowances		Balance of Unexpended Article 5 Allowances				Balance of Unexpended Critical Stock Allowances
     	     		     				     

EPA Form 5900-146, Revised 5/11