  SEQ CHAPTER \h \r 1 

   	U.S. Environmental Protection Agency

                    stratospheric ozone protection program	class i
controlled substance 

methyl bromide importer quarterly report

      	1.2    FORMCHECKBOX  Original Submittal    FORMCHECKBOX
  Re-submittal

1.3  Number of Transactions Reported	  FORMTEXT        	1.4
Number of Pages Submitted	  FORMTEXT        

1.5  Quarter and Year to Which This Report Applies 	  FORMCHECKBOX   1st
  FORMCHECKBOX   2nd	  FORMCHECKBOX   3rd	  FORMCHECKBOX   4th	Year  
FORMTEXT         

1.6 Importing Company

	Company Name    FORMTEXT        

                               

Street Address    FORMTEXT        

                            

                              

City    FORMTEXT        	State    FORMTEXT        

           	Zip Code     FORMTEXT        

1.7 Company Contact Identification

Reporting Company Contact Person

  FORMTEXT        

	Phone Number

  FORMTEXT        	Fax Number

  FORMTEXT        

E-mail Address   FORMTEXT        

1.8 Sales to Critical Users Information	Did your company make sales
directly to critical users?

If yes, is the Sales of Critical Methyl Bromide to End Users Report
attached?	  FORMCHECKBOX    Yes

  FORMCHECKBOX    Yes	  FORMCHECKBOX    No

  FORMCHECKBOX    No

1.9 Critical Stock Allowances Information	Did your company own
pre-phaseout stocks of methyl bromide, receive critical stock allowances
(CSAs) allocations, or purchase CSAs? 

If yes, is the Pre-2005 Methyl Bromide Stocks Report attached?	 
FORMCHECKBOX    Yes

  FORMCHECKBOX    Yes	  FORMCHECKBOX    No

      

Title    FORMTEXT        	



Signature    FORMTEXT        	Date    FORMTEXT 
      



SEND COMPLETED FORMS TO:	For U.S. Postal Service:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1200 Pennsylvania Avenue, NW

Washington, DC  20460	For Private Courier:

Tracking System Program Manager

Stratospheric Protection Division

U.S. EPA (6205J)

1310 L Street, NW;  10th Floor

Washington, DC  20005

Information in reports submitted in compliance with the final rule may
be claimed as confidential.  A company may assert a claim of
confidentiality for information submitted 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 18 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.       
  SEQ CHAPTER \h \r 1 	

     U.S. Environmental Protection Agency

               stratospheric ozone protection program	class i controlled
substance

methyl bromide importer quarterly report

(Sec 82.13)

SECTION 2    TRANSACTION RECORDS

                              (Reproduce additional sheets as needed)

2.1 Company Name	  FORMTEXT        			

2.2 Transaction Summaries	



TRANSACTION #	  FORMTEXT        			

Source Country    FORMTEXT        

Port of Exit from Source Country   FORMTEXT        	Importer
Number   FORMTEXT        

Quantity of Commodity Imported (kg)

  FORMTEXT        	Quantity of Methyl Bromide Imported (kg)

  FORMTEXT        

Port of Entry into the U.S.	Customs Entry Summary Number 	Date of Import
(mm/dd/yy)

  FORMTEXT        

Methyl Bromide will be imported for:	Post-Harvest CUE   FORMCHECKBOX  
Pre-Plant CUE

  FORMCHECKBOX  	Destruction

  FORMCHECKBOX  	Transformation

  FORMCHECKBOX  	QPS  

  FORMCHECKBOX  	Emergency Use

  FORMCHECKBOX  	Lab Use

  FORMCHECKBOX  

Transaction Type (check one): 	  FORMCHECKBOX   New	  FORMCHECKBOX  
Used	  FORMCHECKBOX    Heels



TRANSACTION #	  FORMTEXT        			

Source Country   FORMTEXT        

Port of Exit from Source Country   FORMTEXT        	Importer
Number   FORMTEXT        

Quantity of Commodity Imported (kg)

  FORMTEXT        	Quantity of Methyl Bromide Imported (kg)

  FORMTEXT        

Port of Entry into the U.S.

  FORMTEXT        	Customs Entry Summary Number	Date of Import
(mm/dd/yy)

  FORMTEXT        

Methyl Bromide will be imported for:	Post-Harvest CUE   FORMCHECKBOX  
Pre-Plant CUE

  FORMCHECKBOX  	Destruction

  FORMCHECKBOX  	Transformation

  FORMCHECKBOX  	QPS  

  FORMCHECKBOX  	Emergency Use

  FORMCHECKBOX  	Lab Use

  FORMCHECKBOX  

Transaction Type (check one):	  FORMCHECKBOX   New	  FORMCHECKBOX   Used
  FORMCHECKBOX    Heels



TRANSACTION #	  FORMTEXT        			

Source Country   FORMTEXT        

Port of Exit from Source Country   FORMTEXT        	Importer
Number   FORMTEXT        

Quantity of Commodity Imported (kg)

  FORMTEXT        	Quantity of Methyl Bromide Imported (kg)

  FORMTEXT        

Port of Entry into the U.S.	Customs Entry Summary Number   FORMTEXT 
      	Date of Import (mm/dd/yy)

  FORMTEXT        

Methyl Bromide will be imported for:	Post-Harvest   CUE   FORMCHECKBOX  
Pre-Plant CUE

  FORMCHECKBOX  	Destruction

  FORMCHECKBOX  	Transformation

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Transaction Type (check one):	  FORMCHECKBOX   New	  FORMCHECKBOX   Used
  FORMCHECKBOX    Heels

  SEQ CHAPTER \h \r 1                                                  
                                                                        
                                 

   U.S. Environmental Protection Agency

           stratospheric ozone protection program



class i controlled sustance 

methyl bromide importer quarterly report

(Sec 82.13)

SECTION 3    COMPANY IMPORT DATA

3.1 Company Name	  FORMTEXT        

3.2 Company Import Totals   (Methyl Bromide Commodity Code 2903.30.1520)

A	B	C	D	E	F	G	H	I	J	K

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 Exemption (CUE) (kg)	Emergency Use Exemption (kg)	Lab Use
(kg)	Gross Imports (kg)

(A+B+C+D+E+F1+ F2+G+H=I)	Total ‘Used’ Imports (kg)	Total 
‘Heels’ (kg)







	F1	F2











Pre-Plant	Post-Harvest





	  FORMTEXT        

	  FORMTEXT        

	  FORMTEXT        

	  FORMTEXT        

	  FORMTEXT        

	  FORMTEXT        	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      

	  FORMTEXT        

	  FORMTEXT        



  SEQ CHAPTER \h \r 1 	

   U.S. Environmental Protection Agency

           stratospheric ozone protection program	class i controlled
substance

methyl bromide importer quarterly report

(Sec 82.13)

SECTION 4    ALLOWANCE EXPENDITURE DATA

4.1 Company Name	  FORMTEXT        

4.2 Allowance Balance Summary 



Expended	Unexpended

A1	Total pre-plant critical use allowances (CUAs)  for year to date (as
of the end of the quarter) that were:	  FORMTEXT        

	  FORMTEXT        



A2	Total post-harvest critical use allowances (CUAs) for year to date
(as of the end of the quarter) that were:	  FORMTEXT        

	  FORMTEXT        



B	Total critical stock allowances (CSAs) for year to date (as of the end
of the quarter) that were:	  FORMTEXT        

	  FORMTEXT        



4.3 Importer’s CUE Methyl Bromide Ending Inventory, If Any (Complete
this question for 4th quarter reporting only)

  FORMTEXT        	kg  owned by reporting company (at end of
the control period) (including all quantities held by other suppliers,
but not quantities sold to end-users)

4.4 Name(s) of Company(ies) for Which Critical Use Methyl Bromide is
Being Held by Reporting Entity and Associated Amounts (kg) Held for Each
(excluding end-users) (Complete this question for 4th quarter reporting
only)

Company Name:    FORMTEXT        	Pre-Plant (kg):   FORMTEXT 
      	Post-Harvest (kg):   FORMTEXT        

Company Name:    FORMTEXT        	Pre-Plant (kg):   FORMTEXT 
      	Post-Harvest (kg):   FORMTEXT        

Company Name:    FORMTEXT        	Pre-Plant (kg):   FORMTEXT 
      	Post-Harvest (kg):   FORMTEXT        

Company Name:    FORMTEXT        	Pre-Plant (kg):   FORMTEXT 
      	Post-Harvest (kg):   FORMTEXT        

Company Name:    FORMTEXT        	Pre-Plant (kg):   FORMTEXT 
      	Post-Harvest (kg):   FORMTEXT        



	OMB Control Number: 2060-0482

	Expiration Date: 8/31/11

EPA Form # 5900-144, Revised 6/08

	         OMB Control Number: 2060-0482

			              Expiration Date: 8/31/11

	EPA Form # 5900-144, Revised 6/08

	OMB Control Number: 2060-0482

	Expiration Date: 8/31/11	         OMB Control Number: 2060-0482		      
       Expiration Date: 8/31/11

EPA Form # 5900-144, Revised 6/08

