Form 5900-141 Methyl Bromide Producer Quarterly Report

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Overview

Instructions
Section 1
Section 2
Section 3

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Sheet 1: Instructions

	U.S. Environmental Protection Agency
	Stratospheric Ozone Protection Program
	Methyl Bromide Producer Quarterly Report (Sec 82.13)
	Version 1.0
	Last Updated: December 2017
	Instructions
	Complete this form by filling in the data fields that are highlighted in blue. Guidance on how to complete individual data fields are provided in comment bubbles. Use the arrows to navigate between the tabs. Once completed, use the 'prepare submission' button on the Summary tab to generate your CSV file.
	Report Submission: This Excel file, the generated CSV file, and all supporting attachments should be submitted to EPA through the Central Data Exchange (CDX). Refer to EPA's website for additional information on form submission:
	https://www.epa.gov/ods-phaseout/ods-recordkeeping-and-reporting
	All information submitted to EPA will be treated as confidential in accordance with 40 CFR Part 2, Subpart B, and will only be disclosed by the means set forth in the subpart.
	The public reporting and recordkeeping burden for this collection of information is estimated to average 1 hour 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 Avenue NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.
	EPA Form #5900-141
	OMB Control Number: 2060-0482
	Expiration Date: 8/31/2018

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Sheet 2: Section 1

	U.S. Environmental Protection Agency
	Methyl Bromide Producer Quarterly Report
	Date Prepared:
	Section 1: Report Identification Information
	Complete all fields below. No fields may be left blank.
	The company name must match the organization name under which this report is submitted to EPA through CDX. Company Name:			1
	Submission Type:			1
	Reporting Year:			1
	Reporting Quarter:			1
		Original Submission
		Re-Submittal

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Sheet 3: Section 2

U.S. Environmental Protection Agency

Methyl Bromide Producer Quarterly Report

Company Name:

Reporting Period:

Section 2: Production Data

In the table below, enter the quantity of methyl bromide that was produced during the reporting period. If no methyl bromide was produced, the table may be left blank. As a reminder, if methyl bromide was produced for QPS applications, global lab, emergency uses, second party transformation, or second party destruction, a copy of the transformation verification, destruction verification, QPS certification, and/or essential use certification from each company for whom material was produced must be provided to EPA along with the submission of this report.

Enter the quantity (kg) of methyl bromide produced for in-house transformation during the reporting period. In-House Transformation

Enter the quantity (kg) of methyl bromide produced for second party transformation during the reporting period. Second Party Transformation

Enter the quantity (kg) of methyl bromide produced for in-house destruction during the reporting period. In-House Destruction

Enter the quantity (kg) of methyl bromide produced for second party destruction during the reporting period. Second Party Destruction

Enter the quantity (kg) of methyl bromide produced for quarantine and preshipment (QPS) applications during the reporting period. QPS

Enter the quantity (kg) of methyl bromide produced for emergency uses during the reporting period. Emergency Use

Enter the quantity (kg) of methyl bromide produced for global lab during the reporting period. Global Lab

The gross quantity (kg) of methyl bromide produced during the reporting period is equal to in-house transformation + second party transformation + in-house destruction + second party destruction + QPS + emergency use + global lab. This field is autopopulated. Gross Production

kg

kg

kg

kg

kg

kg

kg

Autopopulated

1,500.00

0.00

0.00

0.00

100.50

0.00

0.00

1,800.50

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Sheet 4: Section 3

		U.S. Environmental Protection Agency
		Methyl Bromide Producer Quarterly Report
		Company Name:
		Reporting Period:
		Section 3: Shipment/Sales Data
		Identify the recipient company(s) of the methyl bromide produced for second party transformation, second party destruction, QPS, global lab, and/or emergency uses, and the amount shipped to or purchased by each recipient company during the quarter.
		Note: Due to a potential time lag between the date of production and the date of shipment, it is recognized that for a given quarter the information in Section 3 may not match the information reported in Section 2 for second party transformation, second party destruction, and QPS; however, it is expected that all material produced for second party transformation, second party destruction, and QPS will eventually be shipped to a second party and must be reported as such in the applicable quarterly report.
		As a reminder, a copy of the transformation verification, destruction verification, QPS certification, and/or essential use certification from each second party for whom material was produced must be provided to EPA along with the submission of this report.
		Enter the name of the company that received or purchased methyl bromide during the quarter for transformation, destruction, QPS, global lab, or emergency use. Recipient Company Name		Enter the quantity (kg) of methyl bromide shipped to or purchased by the recipient company during the reporting period. Quantity	Identify whether the material will be (1) transformed, (2) destroyed, (3) used for QPS, (4) distributed for global lab, or (5) used for emergency use. Purpose
		Text		kg	Selection
		Company A		10.00	Transformation
					x
					Transformation
					Destruction
					QPS
					Global Lab
					Emergency Use