    	U.S. Environmental Protection Agency
                    stratospheric ozone protection program

                         class i controlled substance
                                methyl bromide
                                       
                          notification of transfers 
                                (40 CFR 82.13)
SECTION 1    TRANSFEROR IDENTIFICATION
1.1  Date of Submission
                                          
1.2      Original Submittal        Re-submittal
1.3  Number of Transactions Reported
                                          
1.4  Number of Pages Submitted
                                          
1.5 Company Information
Company Name                                        
Street Address              
City            
State                 
Zip Code            
1.6 Company Contact Identification
Reporting Company Contact Person            
E-mail Address            
Phone Number            
Fax Number            
1.7 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            
Title            
Signature            
Date            
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 1.0 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
                                       
                          notification of transfers 
                                (40 CFR 82.13)

SECTION 2    TRANSACTION RECORDS                              (Reproduce Additional Sheets as Needed)
                                                                  TRANSACTION #
                                          
                                                                             		
2.1 Transferee Identification	
Transferee Company Name            
Transferee Contact Person            
Street Address            
City            
Country            
Postal Code            
Phone Number            
Fax Number            
Check only one:
 Pre-Plant Critical Use
 Post-Harvest Critical Use
2.2  Type of Allowances Transferred (check only one)
 Current Year Allowances
 Baseline Year Allowances
2.3  Number of Allowances Purchased by Transferee (kg) 
          
  Amount of Offset (kg) (0.001 x Section 2.3)
          
2.5  Number of Allowances Subtracted from Transferor's Balance of Chemical Being Transferred (kg) (Section 2.3 + Section 2.4) 
          


SECTION 3    UNEXPENDED BALANCE SUMMARY
3.1  Balance of Unexpended Methyl Bromide Allowances Prior to Trades Reported
                                       A
Balance of Unexpended Pre-Plant Critical Use Allowances
          
                                       B
Balance of Unexpended Post-Harvest Critical Use Allowances
          

