  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          FORMTEXT 
      

1.6 Importing Company

Company Name    FORMTEXT                                    

Street Address    FORMTEXT          

City    FORMTEXT        	State    FORMTEXT          
  	Zip Code    FORMTEXT        

Nine-digit IRS Importer Number    FORMTEXT        

1.7 Company Contact Identification

Reporting Company Contact Person    FORMTEXT        

E-mail Address    FORMTEXT        

Phone Number    FORMTEXT        	Fax Number    FORMTEXT 
      

1.8  Sales to Critical Users 	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  Pre-Phaseout Stocks	Did your company own pre-phaseout stocks of
methyl bromide? 

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:

U.S. EPA

Stratospheric Protection Division

Office of Atmospheric Programs

Mail Code: 6205T

1200 Pennsylvania Avenue, NW

Washington, D.C. 20460	For Private Courier:

U.S. EPA

Stratospheric Protection Division

Office of Atmospheric Programs

Room 4355CC

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).

The public reporting and recordkeeping burden for this collection of
information is estimated to average 1.3 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

(40 CFR 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        

Quantity of Methyl Bromide Imported (kg)   FORMTEXT        
Port of Entry into the U.S.   FORMTEXT        

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

Transaction Type (check one): 	   FORMCHECKBOX   New	  FORMCHECKBOX   
Heels

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

   FORMCHECKBOX   Pre-Plant CUE	  FORMCHECKBOX   Destruction

  FORMCHECKBOX   Transformation	  FORMCHECKBOX   QPS  

  FORMCHECKBOX   Lab Use	  FORMCHECKBOX   Emergency Use





      				

Source Country    FORMTEXT        	Port of Exit from Source
Country   FORMTEXT        

Quantity of Methyl Bromide Imported (kg)   FORMTEXT        
Port of Entry into the U.S.   FORMTEXT        

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

Transaction Type (check one): 	   FORMCHECKBOX   New	  FORMCHECKBOX   
Heels

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

   FORMCHECKBOX   Pre-Plant CUE	  FORMCHECKBOX   Destruction

  FORMCHECKBOX   Transformation	  FORMCHECKBOX   QPS  

  FORMCHECKBOX   Lab Use	  FORMCHECKBOX   Emergency Use





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Quantity of Methyl Bromide Imported (kg)   FORMTEXT        
Port of Entry into the U.S.   FORMTEXT        

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

Transaction Type (check one): 	   FORMCHECKBOX   New	  FORMCHECKBOX   
Heels

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

   FORMCHECKBOX   Pre-Plant CUE	  FORMCHECKBOX   Destruction

  FORMCHECKBOX   Transformation	  FORMCHECKBOX   QPS  

  FORMCHECKBOX   Lab Use	  FORMCHECKBOX   Emergency Use





   	U.S. Environmental Protection Agency

                    stratospheric ozone protection program	class i
controlled substance

methyl bromide

importer quarterly report

(40 CFR 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

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

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







	F1	F2









	Pre-Plant	Post-Harvest





  FORMTEXT        	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      



SECTION 4    ALLOWANCE EXPENDITURE DATA

4.1  Allowance Balance Summary 



Expended	Unexpended

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

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

4.2  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)

4.3  Name(s) of Company(ies) for which Critical Use Methyl Bromide is
Being Held by Reporting Entity and Associated Amounts 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        



	OMB Control Number: 2060-0482

	Expiration Date: 6/30/15

EPA Form # 5900-144, Revised 7/14

	OMB Control Number: 2060-0482

	Expiration Date: 6/30/15		              Expiration Date: 6/30/15

EPA Form # 5900-144, Revised 7/14

