5900-138 Sales of Critical Use Methyl Bromide to End Users Annual

OMB Control Number: 2060-0170
Expiration Date: 4/16/2023

CLASS I CONTROLLED SUBSTANCE
METHYL BROMIDE

U.S. Environmental Protection Agency
STRATOSPHERIC OZONE PROTECTION PROGRAM

SALES OF CRITICAL USE METHYL BROMIDE
TO END USERS ANNUAL REPORT (40 CFR 82.13)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT PROVIDED METHYL BROMIDE GAS OR FUMIGATIONS TO CRITICAL USERS.
FORM MUST BE COMPLETED BY A CENTRAL OFFICE ON BEHALF OF THEIR DIVISIONS; ONE FORM PER COMPANY.

SECTION 1 COMPANY IDENTIFICATION
1.1 Date of Submission
1.3

Original Submittal

1.2 Year to Which This Report Applies
Re-submittal

1.4 Company Information
Company Name
Street Address
City

State

Zip Code

1.5 Company Contact Identification
Reporting Company Contact Person
E-mail Address
Phone Number

1.6 Company Type
(check all that apply)

Fax Number
Distributor

Third Party Applicator

Producer

Importer

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

SEND COMPLETED FORMS TO:

Date
For U.S. Postal Service:

For Private Courier:

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

U.S. EPA
Stratospheric Protection Division
Office of Atmospheric Programs
Room 4355VV
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).
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0170). Responses to
this collection of information are mandatory (40 CFR 82.13). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The number and expiration date are displayed in the upper right corner of the form. The
public reporting and recordkeeping burden for this collection of information is estimated to be 1 hour per response. Send comments on the Agency’s need this
formation, 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, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 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.
EPA Form # 5900-138, Revised 8/18

OMB Control Number: 2060-0170
Expiration Date: 4/16/2023

CLASS I CONTROLLED SUBSTANCE
METHYL BROMIDE

U.S. Environmental Protection Agency
STRATOSPHERIC OZONE PROTECTION PROGRAM

SALES OF CRITICAL USE METHYL BROMIDE
TO END USERS ANNUAL REPORT (40 CFR 82.13)

SECTION 2 SALES DATA
2.1 Company Name
2.2 Critical Use Methyl Bromide (newly produced or imported)
sold (active ingredient only)*

Pre-Plant (kg)
Post-Harvest (kg)

Year-End Inventory Calculation
2.3.A Beginning Inventory of Critical Use Methyl Bromide from
Prior Control Periods, if any (NOT pre-phaseout stocks).
Note: This is the same amount as the previous control
period’s ending inventory.*

Pre-Plant (kg)
Post-Harvest (kg)

2.3.B Critical Use Methyl Bromide Bought this Year (only new
production/import, NOT pre-phaseout stocks)*

Pre-Plant (kg)

2.4 Critical Use Methyl Bromide Sold to an Entity Other than a
Critical User (e.g., Distributor, Third Party Applicator)*

Pre-Plant (kg)

2.5 Year-End Inventory – Critical Use Methyl Bromide Not Sold
In Reporting Year (2.3.A + 2.3.B – 2.2 – 2.4)*

Post-Harvest (kg)

Post-Harvest (kg)
Pre-Plant not sold by year end (kg)
Post-Harvest not sold by year end (kg)

2.6 Name(s) of Company(ies) for which Newly Produced Critical Use Methyl Bromide is Being Held and Associated
Amount (kg) Held for Each (excluding end-users)
Company Name:

Pre-Plant (kg):

Post-Harvest (kg):

Company Name:

Pre-Plant (kg):

Post-Harvest (kg):

Company Name:

Pre-Plant (kg):

Post-Harvest (kg):

NOTE: COMPLETE THE PRE-2005 METHYL BROMIDE STOCKS REPORT FOR QUANTITIES OF METHYL BROMIDE OWNED THAT WAS
PRODUCED/IMPORTED BEFORE JANUARY 1, 2005.

*If none, enter 0. Do not leave blank.

EPA Form # 5900-138, Revised 8/18