5900-144 Methyl Bromide Importer Quarterly Report

OMB Control Number: 2060-0482

Expiration Date: 6/30/15

U.S. Environmental Protection Agency stratospheric ozone protection program

class i controlled substance methyl bromide importer quarterly report (40 CFR 82.13)

SECTION 1 IMPORTING COMPANY 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 Quarter and Year to Which This Report Applies

1st

2nd

3rd

4th

Year           

1.6 Importing Company

Company Name      

Street Address      

City      

State      

Zip Code      

Nine-digit IRS Importer Number      

1.7 Company Contact Identification

Reporting Company Contact Person      

E-mail Address      

Phone Number      

Fax Number      

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-Phaseout Stocks

Did 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 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: U.S. EPA Stratospheric Protection Division Office of Atmospheric Programs Mail Code: 6205T 1200 Pennsylvania Avenue, NW Washington, D.C. 20460

For Private Courier: U.S. EPA Stratospheric Protection Division Office of Atmospheric Programs Room 4355CC 1201 Constitution Avenue, NW Washington, D.C. 20004

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 importer quarterly report (40 CFR 82.13)
SECTION 2 TRANSACTION RECORDS (Reproduce Additional Sheets as Needed)
2.1 Company Name	     
2.2 Transaction Summaries
TRANSACTION #							     
Source Country      					Port of Exit from Source Country      
Quantity of Methyl Bromide Imported (kg)      					Port of Entry into the U.S.      
Date of Import (mm/dd/yy)      					Customs Entry Summary Number      
Transaction Type (check one):		New		Heels
Methyl Bromide will be imported for:			Post-Harvest CUE Pre-Plant CUE			Destruction Transformation				QPS Lab Use	Emergency Use

TRANSACTION #						     
Source Country      				Port of Exit from Source Country      
Quantity of Methyl Bromide Imported (kg)      				Port of Entry into the U.S.      
Date of Import (mm/dd/yy)      				Customs Entry Summary Number      
Transaction Type (check one):	New		Heels
Methyl Bromide will be imported for:		Post-Harvest CUE Pre-Plant CUE			Destruction Transformation			QPS Lab Use	Emergency Use

TRANSACTION #						     
Source Country      				Port of Exit from Source Country      
Quantity of Methyl Bromide Imported (kg)      				Port of Entry into the U.S.      
Date of Import (mm/dd/yy)      				Customs Entry Summary Number      
Transaction Type (check one):	New		Heels
Methyl Bromide will be imported for:		Post-Harvest CUE Pre-Plant CUE			Destruction Transformation			QPS Lab Use	Emergency Use

U.S. Environmental Protection Agency stratospheric ozone protection program

class i controlled substance methyl bromide importer quarterly report (40 CFR 82.13)

SECTION 3 COMPANY IMPORT DATA

3.1 Company Name

     

3.2 Company Import Totals (Methyl Bromide Commodity Code 2903.30.1520)

A

B

C

D

E

F

G

H

I

J

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 Imports (kg) (A+B+C+D+E+F1+ F2+G+H=I)

Total ‘Heels’ (kg)

F1

F2

Pre-Plant

Post-Harvest

     

     

     

     

     

     

     

     

     

     

     

SECTION 4 ALLOWANCE EXPENDITURE DATA
4.1 Allowance Balance Summary
				Expended		Unexpended
A1		Total pre-plant critical use allowances for year to date (as of the end of the quarter) that were:		     		     
A2		Total post-harvest critical use allowances for year to date (as of the end of the quarter) that were:		     		     
4.2 Importer’s CUE Methyl Bromide Ending Inventory, If Any (Complete this question for 4th quarter reporting only)
     	kg owned by reporting company (at end of the control period) (including all quantities held by other suppliers)
4.3 Name(s) of Company(ies) for which Critical Use Methyl Bromide is Being Held by Reporting Entity and Associated Amounts Held for Each (excluding end-users) (Complete this question for 4th quarter reporting only)
Company Name:      			Pre-Plant (kg):      		Post-Harvest (kg):      
Company Name:      			Pre-Plant (kg):      		Post-Harvest (kg):      

EPA Form # 5900-144, Revised 7/14