                                                                        
                                                                        
                                                	

	U.S. Environmental Protection Agency

                    stratospheric ozone protection program	class i
controlled substance

methyl bromide

producer quarterly report

      	1.2       FORMCHECKBOX   Original Submittal        
FORMCHECKBOX   Re-submittal

1.3  Quarter and Year to Which This Report Applies 

  FORMCHECKBOX   1st	  FORMCHECKBOX   2nd	  FORMCHECKBOX   3rd	 
FORMCHECKBOX   4th	Year   FORMTEXT          FORMTEXT 
      

1.4 Producing Company

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 
      

1.6  Importer Information	Is your company an Importer of methyl bromide?

If yes, is the Importer Quarterly Report attached?	  FORMCHECKBOX    Yes

  FORMCHECKBOX    Yes	  FORMCHECKBOX    No

  FORMCHECKBOX    No

1.7  Exporter Information	Is your company an Exporter of methyl bromide?

If yes, is the Exporter Quarterly Report attached?	  FORMCHECKBOX    Yes

  FORMCHECKBOX    Yes	  FORMCHECKBOX    No

  FORMCHECKBOX    No

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.        


           

	U.S. Environmental Protection Agency

                    stratospheric ozone protection program	class i
controlled substance

methyl bromide

importer quarterly report

(40 CFR 82.13)



SECTION 2    COMPANY PRODUCTION DATA

2.1  Company Name	  FORMTEXT        

2.2  Company Production Totals

A	B	C	D	E	F	G	H	I

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 Production of
Methyl Bromide (kg)

(A+B+C+D+E+F1+F2+ F3+G+H=I)





	F1	F2	F3









Pre-Plant	Post-Harvest	For Export



	  FORMTEXT        	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      	  FORMTEXT        	  FORMTEXT 
      

	

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

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



 

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                  	OMB Control Number: 2060-0482

                                                                        
                                                                        
                                  	 Expiration Date: 6/30/15

EPA Form # 5900-141, Revised 7/14  

                                                                        
                                                                 	   
OMB Control Number: 2060-0482

	   Expiration Date: 6/30/15

