                                                                        
                                                                        
                                                	

	U.S. Environmental Protection Agency

                    stratospheric ozone protection program	class i
controlled substance

methyl bromide

certification of purchase of critical 

      

	1.2  Total Quantity of New Production Pre-Plant Critical Use Methyl
Bromide Purchased (kg)	  FORMTEXT        

1.3  Total Quantity of New Production Post Harvest Critical Use Methyl
Bromide Purchased (kg)	  FORMTEXT        

1.4 Company Information

Company Name    FORMTEXT                                    

Street Address    FORMTEXT          

City    FORMTEXT        	State    FORMTEXT          
  	Zip Code    FORMTEXT        

1.5 Company Contact Identification

Reporting Company Contact Person    FORMTEXT        

E-mail Address    FORMTEXT        

Phone Number    FORMTEXT        	Fax Number    FORMTEXT 
      

Approved critical use(s) are those uses of methyl bromide listed in
Appendix L to Subpart A of 40 CFR Part 82.  See
www.epa.gov/ozone/mbr/cueuses.html. 

1.6 Signature of Reporting Company Representative

I certify, under penalty of law, that the quantities of methyl bromide
specified in Section 1.2 and 1.3 of this form, are ordered/purchased and
will be sold or used exclusively for an approved critical use (pre-plant
or post-harvest) as identified, and not sold/ transferred to another
person. I certify that I am an approved critical user and I will use
this quantity of methyl bromide for an approved critical use. My action
conforms to the requirements associated with the critical use exemption
published in 40 CFR part 82. I am aware that any agricultural commodity
within a treatment chamber, facility or field I fumigate with critical
use methyl bromide cannot subsequently or concurrently be fumigated with
non-critical use methyl bromide during the same control period,
excepting a QPS treatment or treatment for a different use (e.g., a
different crop or commodity). I will not use this quantity of methyl
bromide for a treatment chamber, facility, or field that I previously
fumigated with non-critical use methyl bromide during the same control
period, excepting a QPS treatment or treatments for a different use
(e.g., a different crop or commodity), unless a local township limit now
prevents me from using methyl bromide alternatives or I have now become
an approved critical user as a result of rulemaking.

      

Title    FORMTEXT        

Signature     FORMTEXT        	Date      FORMTEXT 
      

SEND COMPLETED FORMS TO:	The Company From Whom the Critical Use Methyl
Bromide is Being Purchased



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ction 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.        

                                                                        
                                                                 	   
OMB Control Number: 2060-0482

	   Expiration Date: 6/30/15

EPA Form # 5900-139, Revised 6/12  

