5900-140 Methyl Bromide Exporter Quarterly Report

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Overview

Instructions
Section 1
Section 2
Summary
Reference List

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Sheet 1: Instructions

	U.S. Environmental Protection Agency
	Stratospheric Ozone Protection Program
	Methyl Bromide Exporter 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.
	Copying and Pasting Data: If data are pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be
	accepted into EPA’s ODS Tracking System. Refer to the Reference List to identify the valid naming scheme for specific data fields. Additionally, select "Paste As Values" when pasting data into the form.
	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 2 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 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 #5900-140
	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 Exporter 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
	Enter your company's Employer Identification Number (EIN). Employer Identification Number (EIN):			1
		Original Submission
		Re-Submittal

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Sheet 3: Section 2

U.S. Environmental Protection Agency

Methyl Bromide Exporter Quarterly Report

Company Name:

Reporting Period:

Section 2: Export Transaction Data

In the table below, enter data for each export transaction containing methyl bromide that took place during the reporting period. If no methyl bromide was exported, the table may be left blank. For all transactions, all fields are required.

If copying and pasting data into the table, please refer to the Reference List and the accompanying instructions.

The transaction number is autopopulated. Transaction Number

Enter the date for when the shipment left the United States. Date of Export

Enter the name of the company that received or purchased methyl bromide during the reporting period. Recipient Company

Enter the street address of the recipient company. Recipient Company Street Address

Enter the city of the recipient company. Recipient Company City

Select the country to which the shipment was exported. If copying and pasting data into the table, please refer to the Reference List for the valid list of countries. Recipient Company Country

Enter the postal code of the recipient company. Recipient Company Postal Code

Enter the name of the contact for the recipient company. If this information is not available, enter "Not Available." Recipient Company Contact Name

Enter the phone number of the contact from the recipient company. If this information is not available, enter "Not Available." Recipient Company Phone Number

This field is autopopulated. Name of the Chemical Exported

Enter the total quantity (kg) of methyl bromide exported. Total Quantity Exported

Enter the 10-digit commodity code of the chemical exported as it appears on Customs documentation. Refer to the Reference List for a list of commonly used commodity codes. Commodity Code

Enter the name of the port where the shipment exited the United States. Port of Exit from the United States

Enter the Employer Identification Number (EIN) shown on the Shipper's Export Declaration Form. This number may or may not refer to the exporter as defined by EPA. If a shipping agent is acting on behalf of the exporter as defined by the regulation, the EIN of the agent shown on the U.S. Customs Form 7525 should be reported here. Your company's EIN as entered in Section 1 of this report will automatically populate for each transaction entered. Revise the number if the EIN for the shipment is different from your company's EIN. The number entered should have no dashes. Shipment EIN

Identify whether the material was exported for transformation, destruction, critical uses, quarantine and preshipment (QPS) applications, emergency uses, or global lab. If copying and pasting data into the table, please refer to the Reference List for the valid list of intended uses. Intended Use

Autopopulated

Date

Text

Text

Text

Selection

Text

Text

Text

Autopopulated

kg

Text

Text

Number

Selection

1

1/15/2018

Company A

1 Main Street

Melbourne

Australia

3000

John Smith

011 46 8 508 280 00

CH3Br

5,000.00

2903.39.1520

Miami, FL

12345678900

QPS

1

x

x

Afghanistan

Transformation

Albania

Destruction

Algeria

Critical Use

Andorra

QPS

Angola

Emergency Use

Antigua and Barbuda

Global Lab

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

British Virgin Islands

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

European Union

Fiji

Finland

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Niue

North Korea (Democratic People's Republic of Korea)

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia (Federal Republic of)

South Africa

South Korea (Republic of Korea)

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tahiti

Taiwan

Tajikistan

Thailand

The Former Yugoslav Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom of Great Britain and Northern Ireland

United Republic of Tanzania

#NAME?

Uruguay

Uzbekistan

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Sheet 4: Summary

		U.S. Environmental Protection Agency
		Methyl Bromide Exporter Quarterly Report
		Company Name:
		Reporting Period:
		Export Totals
		The values in the table below are calculated based on data entered in Section 2. If the totals appear to be incorrect, please return to Section 2 to review your data.
		Chemical Name	Country	Transformation (kg)	Destruction (kg)	Critical Use (kg)	QPS (kg)	Emergency Use (kg)	Global Lab (kg)

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Sheet 5: Reference List

	U.S. Environmental Protection Agency
	Methyl Bromide Exporter Quarterly Report
	Reference List
	Copying and Pasting Data: If data is pasted into this reporting form from another spreadsheet, the formatting of specific cells must be consistent with the requirements of the form in order to be accepted into EPA’s ODS tracking system. When copying and pasting data into the form, please ensure consistency with the formatting of the lists provided below.
	Intended Use List: The table below lists the valid intended uses that may be used when entering data into Section 2 of this form.				Country List: The table below lists the valid country names that may be used when entering data into Section 2 of this form.
	Intended Uses				Source Country
	Transformation	Destruction	Critical Use		Afghanistan	Greece	Papua New Guinea
	QPS	Emergency Use	Global Lab		Albania	Grenada	Paraguay
					Algeria	Guatemala	Peru
	Commodity Code List: The table below lists commonly used methyl bromide commodity codes that may be used when entering data into Section 2 of this form. A complete list of commodity codes can be found in the Official Harmonized Tariff Schedule.				Andorra	Guinea	Philippines
					Angola	Guinea-Bissau	Poland
					Antigua and Barbuda	Guyana	Portugal
					Argentina	Haiti	Qatar
					Armenia	Holy See	Republic of Moldova
	Methyl Bromide Commodity Codes/Description				Australia	Honduras	Romania
	2903.39.1520	Methyl bromide			Austria	Hong Kong	Russian Federation
	3824.77.0000	Mixtures containing methyl bromide			Azerbaijan	Hungary	Rwanda
					Bahamas	Iceland	Saint Kitts and Nevis
					Bahrain	India	Saint Lucia
					Bangladesh	Indonesia	Saint Vincent and the Grenadines
					Barbados	Iran (Islamic Republic of)	Samoa
					Belarus	Iraq	San Marino
					Belgium	Ireland	Sao Tome and Principe
					Belize	Israel	Saudi Arabia
					Benin	Italy	Senegal
					Bermuda	Jamaica	Serbia
					Bhutan	Japan	Seychelles
					Bolivia (Plurinational State of)	Jordan	Sierra Leone
					Bosnia and Herzegovina	Kazakhstan	Singapore
					Botswana	Kenya	Slovakia
					Brazil	Kiribati	Slovenia
					Brunei Darussalam	Kuwait	Solomon Islands
					British Virgin Islands	Kyrgyzstan	Somalia (Federal Republic of)
					Bulgaria	Lao People's Democratic Republic	South Africa
					Burkina Faso	Latvia	South Korea (Republic of Korea)
					Burundi	Lebanon	South Sudan
					Cambodia	Lesotho	Spain
					Cameroon	Liberia	Sri Lanka
					Canada	Libya	Sudan
					Cape Verde	Liechtenstein	Suriname
					Central African Republic	Lithuania	Swaziland
					Chad	Luxembourg	Sweden
					Chile	Madagascar	Switzerland
					China	Malawi	Syrian Arab Republic
					Colombia	Malaysia	Tahiti
					Comoros	Maldives	Taiwan
					Congo	Mali	Tajikistan
					Cook Islands	Malta	Thailand
					Costa Rica	Marshall Islands	The Former Yugoslav Republic of Macedonia
					Côte d'Ivoire	Mauritania
					Croatia	Mauritius	Timor-Leste
					Cuba	Mexico	Togo
					Cyprus	Micronesia (Federated States of)	Tonga
					Czech Republic	Monaco	Trinidad and Tobago
					Democratic Republic of the Congo	Mongolia	Tunisia
					Denmark	Montenegro	Turkey
					Djibouti	Morocco	Turkmenistan
					Dominica	Mozambique	Tuvalu
					Dominican Republic	Myanmar	Uganda
					Ecuador	Namibia	Ukraine
					Egypt	Nauru	United Arab Emirates
					El Salvador	Nepal	United Kingdom of Great Britain and Northern Ireland
					Equatorial Guinea	Netherlands
					Eritrea	New Zealand	United Republic of Tanzania
					Estonia	Nicaragua	Uruguay
					Ethiopia	Niger	Uzbekistan
					European Union	Nigeria	Vanuatu
					Fiji	Niue	Venezuela (Bolivarian Republic of)
					Finland	North Korea (Democratic People's Republic of Korea)	Viet Nam
					France		Yemen
					Gabon	Norway	Zambia
					Gambia	Oman	Zimbabwe
					Georgia	Pakistan
					Germany	Palau
					Ghana	Panama