                                                                        
                                     	 

     U.S. Environmental Protection Agency

          stratospheric ozone protection program	class i controlled
substance 

pre-2005 methyl bromide stocks report 

(Sec 82.13)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT EITHER A) RECEIVED A
CRITICAL STOCK ALLOWANCE, OR B) BOUGHT A CRITICAL USE ALLOWANCE, OR C)
OWNS STOCKS OF METHYL BROMIDE THAT WERE PRODUCED OR IMPORTED PRIOR TO
JANUARY 1, 2005.

SECTION 1    COMPANY IDENTIFICATION

	1.1 Date of Submission	  FORMTEXT        	1.2 Year to which
this Report Applies	Year   FORMTEXT        

1.3    FORMCHECKBOX  Original Submittal    FORMCHECKBOX   Re-submittal

1.4 Quarterly or Annual Submittal 	  FORMCHECKBOX   1st	  FORMCHECKBOX  
2nd	  FORMCHECKBOX   3rd	  FORMCHECKBOX   4th	  FORMCHECKBOX   Annual

1.5 Company Information

Company Name    FORMTEXT        

Street Address   FORMTEXT        

City    FORMTEXT           	State    FORMTEXT       
	Zip Code    FORMTEXT        

1.6 Company Contact Identification

Reporting Company Contact Person

  FORMTEXT        

	Phone Number    FORMTEXT        	Fax Number    FORMTEXT 
      

E-mail Address    FORMTEXT        

1.7 Company Type

(check all that apply) 	Distributor   FORMCHECKBOX   	Third Party
Applicator   FORMCHECKBOX   	Producer   FORMCHECKBOX  	Importer  
FORMCHECKBOX  

1.8 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    FORMTEXT        

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.        
                                                                        
                                                                        
                                                                        
                                                                        
     

  U.S. Environmental Protection Agency

stratospheric ozone protection program	class i controlled substance 

pre-2005 methyl bromide stocks report

h

h

h

h

h

h

h

h

h

h

,

愀Ĥ摧ᥜ/

Ȁn

~

‚

„

 

¢

¤

ª

¬

¾

À

Â

Æ

È

Ê

À

Â

-

6

:

<

P

R

T

^

`

b

d

‚

„

˜

š

œ

¦

jí

-

b

d

ª

kd]

摧ᥜ/Ԁ¦

¨

ª

¬

¸

º

Î

Ð

Ò

Ü

Þ

ä

æ

ô

ö

\

 hZ

 hZ

摧ⷮÑ

Æ

  hh

h

J

\

h

h

h

h

h

h

%

&

             kg    Owned by reporting company for year to date
(as end of the control period) (including all quantities owned by
reporting company that are held by other suppliers on the reporting
company’s behalf, but not quantities sold to end-users)

Company Holding Methyl Bromide on Behalf of Owner	Amount Held (kg)









	** These quantities of stocks refer only to amounts of methyl bromide
that were processed or imported before January 1, 2005.  Any quantities
of newly produced critical use methyl bromide left in the reporting
company’s possession as of December 31 of the year should be reported
on form “Sales of Critical Use Methyl Bromide,” section 2.4.



%

&

h

                                                                        
                                                                  OMB
Control Number: 2060-0482	

                                                                        
                                                                        
                                                 	 Expiration Date:
8/31/11

EPA Form # 5900-142, Revised 6/08         

