0152.14 Attachment E- Form 3540-1

OMB Control No. 2070-0020 United States Expires on XX/XX/XXXX ENVIRONMENTAL PROTECTION AGENCY Washington, DC 20460 Notice of Arrival of Pesticides and Devices Send Completed Form to Appropriate Regional Office Listed in the Instructions for this Form. Note: Read Instructions before completing form.
Part 1: To Be Completed by Importer of record or Licensed Customs Broker
1. Name, Complete Mailing Address, and Email Address of Licensed Customs Broker				2. Name, Complete Mailing Address, and Email Address of Importer of Record
Return Form to this Address				Return to this Address
3. Name, Complete Mailing Address, and Email Address of Shipper				4. EPA Registration Number	5. EPA Producer Establishment No.
				6. Brand Name of Pesticide Product or Pesticide Device
7. Active Ingredients and Percentage of Each
8. Unit Size (e.g., 500 lbs., 10 gal, etc.)	9. Quantity (e.g., 10 bags, 2 drums, etc.)		10. Total Net Weight (e.g., 5000 lbs., 100 gal, etc.)	11. Country of Origin
12. Port of Entry (Enter port code or the city and state)				13. Name, Complete Mailing Address and Email Address of Carrier
14. Entry Number		15. Anticipated Entry Date
17. Location of Goods for Examination after Importation				16. I assert that information constituting Confidential Business Information is shown in the above blocks numbered: (Note: Blocks 4, 5, 6 and 7 are not entitled to CBI treatment--see instructions.)
18. [Optional] For pesticides without an EPA Registration No., select all that apply: (The following information may expedite the processing of the Notice of Arrival.) 18a. A pesticide transferred between registered establishments operated by the same producer. Domestic Producer Establishment Number: 18b. A pesticide transferred between registered establishments not operated by the same producer. Domestic Producer Establish- ment Number (40 CFR §152.30(b)): EPA Registration Number of Product being Formulated, if applicable: 18c. A pesticide distributed under an Experimental Use Permit. Experimental Use Permit Number(40 CFR §152.30(c)(1)):

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EPA Registration Number:	Product Name:
Total Net Weight:	Entry Number:

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18d. A Pesticide distributed for research and development purposes without an Experimental Use Permit. (40 CFR §152.30(c)(2)
18e. A pesticide transferred solely for export. (40 CFR §152.30(d)/ PRN 99-1) It is recommended that you enter the foreign purchaser details in Box 19. Domestic Producer Establishment Number: 18f. A pesticide distributed under an emergency exemption. Emergency Exemption Number(40 CFR §152.30(e)): 18g. A pesticide transferred for the purposes of disposal. (40 CFR §152.30(f)) 18h. Other. Provide an explanation including the intended use and a description of why the product is being imported into the United States in Block 19 -- Remarks.
19. Remarks. Provide additional information here. It is recommended that a copy of the label affixed to the product be submitted with the NOA.
Certification I certify that the statements I made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
20. Printed Name of Importer of Record or Licensed Customs Broker	Telephone No.:
21. Signature of Importer of Record or Licensed Customs Broker:			Date:
Part II: To Be Completed by U.S. Environmental Protection Agency
Action to be taken by U.S. Customs and Border Protection: Release Shipment Detain for inspection Request CBP to collect samples (19 CFR §12.116) Release shipment to consignee under bond. Shipment must be held intact pending inspection Other. (Specify)
Remarks:
Signature and Title of EPA Official:		Date:
Part III: To Be Completed by U.S. Customs and Border Protection
The information shown in Part I was compared with the entry papers for this shipment and no discrepancies were noted. The shipment was handled as instructed by EPA in Part II. Any deviations should be brought to the attention of EPA before releasing the shipment and should be noted in "Remarks."
Remarks:
Signature of District Director of Customs:		Date:

Paperwork Reduction Act Notice: The estimated average time to read the instructions and complete this form is 26 minutes. Send comments regarding the burden estimates or any other aspect of this collection of information to: Director, Regulatory Support Division, Office of Mission Support (OMS), U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Avenue, NW, Washington, DC 20460. Include OMB number 2070-0020 in any correspondence.

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Instructions

19. Customs and Border Protection (CBP) Regulations. 19 CFR 12.112(a) requires an importer or the importer’s agent desiring to import pesticides or devices into the United States to submit, prior to arrival of the shipment in the United States, a Notice of Arrival of Pesticides and Devices on U.S. Environmental Protection Agency (EPA) Form 3540-1. In the alternative, the importer or the importer’s agent may file an electronic alternative to the Notice of Arrival, with the filing of the entry documentation, via any CBP-authorized electronic interchange system. The NOA will be used by:

1. Importer of Record or Licensed Customs Broker: The importer of record or licensed customs broker must complete Part I of the NOA form. A separate NOA must be submitted for each pesticide or device in each shipment prior to its arrival at the port of entry. To expedite the handling of pesticide or device shipments, submit NOA(s) to the EPA office listed below having jurisdiction over the state/territory of the port of entry. It is recommended that all applicable blocks in Part I be completed prior to submission to EPA, and that a copy of the label affixed to the product be submitted with each NOA. Additional supporting documentation (e.g. CBP Form 7501, 3461, or 3461 ALT) for validating information provided may also be included with the submission. When providing an address, the complete address should include the mailing location, e-mail address, and telephone number of the contact person. EPA may require and request additional documentation in order to review and make final compliance determinations regarding import shipments. (FIFRA §§ 8(b) and 17(c))

2. EPA: EPA will complete Part II, indicating the disposition of the shipment, sign and return the NOA(s) to the importer or agent for presentation to CBP at the time of entry.

3. CBP: CBP will compare the information shown on the NOA(s) with the entry documents and the shipment, bringing any discrepancies to EPA's attention before the shipment is released, and noting discrepancies in the Remarks section. If the importation is not handled by CBP in the manner instructed in Part II, this should also be noted in the Remarks.

1. Name, Complete Mailing Address, and Email Address of the Licensed Customs Broker. Custom broker means a person who is licensed under this part to transact customs business on behalf of others. (19 CFR § 111.1)

2. Name, Complete Mailing Address, and Email Address of the Importer of Record. Importer means the person primarily liable for the payment of any duties on the merchandise, or an authorized agent acting on his behalf. The importer may be the consignee, or the importer of record, or the actual owner of merchandise, or the transferee of the merchandise.

3. Name, Complete Mailing Address, and Email Address of Shipper. The name and address of person primarily responsible for exporting the pesticide or pesticide device to the United States.

4. EPA Registration No. The pesticide product registration number assigned at the time of registration that identifies the product. The product registration number must be an approved EPA Registration No. as it appears on the pesticide product label. If the pesticide does not have an EPA registration number, it is recommended that “OTHER” be written in block 4 and block 18 be completed. If the product is a device, write the word “DEVICE” in block 4.

5. EPA Producer Establishment No. The EPA Producer Establishment No. that appears on the pesticide or device label, as defined at 40 CFR 156.10, is the final producer establishment where the pesticide or device was produced, as “produce” is defined at 40 CFR 167.3, just prior to shipment to the United States. This includes any activity defined as production at 40 CFR 167.3 (to package, repackage, label, relabel or otherwise change the container of any pesticide or device) which occurs at the final producer establishment before the pesticide or device is shipped to the United States. Foreign establishments that produce pesticides or devices for distribution in the United States are required to have an EPA-registered producer establishment number pursuant to 40 CFR 167.20(a)(2).

6. Brand Name of Pesticide Product or Pesticide Device. Name of the pesticide product as it appears on the label at the time of import.

7. Active Ingredients and Percentage of Each. List each active ingredient by percentage. If the product is a pesticide device, this block may be left blank.

8. Unit Size. Net weight or net contents as identified on the product label of the pesticide or device in the immediate container, not including the wrapper or other packaging materials.

9. Quantity. Number of units comprising the shipment as defined at 19 CFR § 101.1.

10. Total Net Weight. Unit size multiplied by quantity.

11. Country of Origin. The country of manufacture, production, or formulation of the pesticide or device of foreign origin entering the United States.

12. 

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    Port of Entry. The port of entry where the pesticide or device offered for import is processed for entry into the United States. Ports of entry are designated locations where CBP enforces the import and export laws and regulations of the United States federal government. Ports of entry are under the jurisdiction of a CBP port director. Enter either the port code or the city and state.

13. Name, Complete Mailing Address, and Complete Email Address of the Carrier. The carrier is a person or carrier service (rail, ship, airline, trucking) who undertakes to transport goods or merchandise to and across the U.S. border.

14. Entry Number. The 11-character entry number using the format XXX-NNNNNNNN, including the hyphen as defined at 19 CFR 142.3a(b).

15. Anticipated Entry Date. Anticipated date of entry into the United States or anticipated date when the pesticide or device will arrive within the port of entry limits.

16. Confidential Business Information (CBI) designation. Please note that the information provided in blocks 4,5, 6, and 7 is not entitled to confidential treatment under section 7(d) of FIFRA and under labeling requirements for pesticides at 40 CFR 156.10. Information provided in those blocks will be made public with no further notice.

17. Location of Goods for Examination after Importation. Enter the physical address of the location of goods after release to the consignee. This is the physical location where the goods will be available for EPA inspection. In the case of unregistered pesticides products imported between establishments operated by the same or different producer(s), enter the EPA establishment number for the importing registered establishment. [Note: Section 17(c) of FIFRA and 19 CFR 12.115 give EPA the authority to instruct CBP to conditionally release a shipment of pesticides or pesticide devices into the importer of record’s custody, under a bond, pending resolution of certain issues with the shipment. Typically, the shipment is held by the importer of record until EPA conducts an inspection under FIFRA § 8(b) and makes a determination of compliance.]

18. Importation of Pesticides without an EPA Registration No. It is recommended that block 18 be completed when importing an unregistered pesticide. Check all that apply and provide additional information as indicated.

19. Remarks. This block may be used to provide additional information. It is recommended that a copy of the label affixed to the product be submitted with the NOA.

20. Printed Name of Importer of Record or Licensed Customs Broker. Print name and telephone number of the Importer of Record or Licensed Customs Broker.

21. Signature of Importer of Record or Licensed Customs Broker. Signature of Importer of Record or Licensed Customs Broker.

Table 1- EPA Form 3540-1 should be addressed to "Pesticide Imports Coordinator"

EPA Regional Offices	States and Ports of Entry Locations in the U.S.	EPA Regional Offices	States and Ports of Entry Locations in the U.S.
EPA Region 1 5 Post Office Square Suite #100 (OES 05-4) Boston, MA 02109-3912	CT, MA, ME, NH, RI, VT	EPA Region 6 1201 Elm Street Mail code: LCRPT Dallas, TX 75270	AR, LA, NM, OK, TX
EPA Region 2 2890 Woodbridge Avenue MS-500, Bldg #205 Edison, NJ 08837-3679	NJ, NY, PR, VI	EPA Region 7 11201 Renner Boulevard (ECAD/CB) Lenexa, KS 66219-9601	IA, KS, MO, NE
EPA Region 3 1650 Arch Street PAPB/LCD (ED23) Philadelphia, PA 19103-2029	DE, DC, MD, PA, VA, WV	EPA Region 8 1595 Wynkoop Street Denver, CO 80202-1129	CO, MT, ND, SD, UT, WY
EPA Region 4 ECAD 61 Forsyth Street, SW Atlanta, GA 30303-8960	AL, FL, GA, KY, MS, NC, SC, TN	EPA Region 9 75 Hawthorne Street (CED-5) San Francisco, CA 94105-3901	AS, AZ, CA, GU, HI, MP, NV, Trust Territories
EPA Region 5 77 West Jackson Boulevard. (LC-8J) Chicago, IL 60604-3507	IL, IN, OH, MI, MN, WI	EPA Region 10 1200 Sixth Avenue Suite 155 (20-C04) Seattle, WA 98101-3140	AK, ID, OR, WA

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EPA Form 3540-01 (Rev. 3/14) Previous versions are obsolete.