5900-141 Methyl Bromide Producer Quarterly Report

OMB Control Number: 2060-0482

Expiration Date: 10/31/14

U.S. Environmental Protection Agency stratospheric ozone protection program					class i controlled substance methyl bromide producer quarterly report (40 CFR 82.13)
SECTION 1 PRODUCING COMPANY IDENTIFICATION
1.1 Date of Submission	     			1.2 Original Submittal Re-submittal
1.3 Quarter and Year to Which This Report Applies				1st		2nd	3rd		4th	Year      
1.4 Producing Company
Company Name      
Street Address      
City      					State      			Zip Code      
1.5 Company Contact Identification
Reporting Company Contact Person      			Phone Number      					Fax Number      
E-mail Address      
1.6 Importer Information		Is your company an Importer of methyl bromide? If yes, is the Importer Quarterly Report attached?								Yes Yes	No No
1.7 Exporter Information		Is your company an Exporter of methyl bromide? If yes, is the Exporter Quarterly Report attached?								Yes Yes	No No
1.8 Sales to Critical Users Information		Did your company make sales directly to critical users? If yes, is the Sales of Critical Methyl Bromide to End Users Report attached?								Yes Yes	No No
1.9 Critical Stock Allowances Information		Did your company own pre-phaseout stocks of methyl bromide, receive critical stock allowances (CSAs) allocations, or purchase CSAs? If yes, is the Pre-2005 Methyl Bromide Stocks Report attached?								Yes Yes	No No
1.10 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: 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

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 producer quarterly report (40 CFR 82.13)

SECTION 2 COMPANY PRODUCTION DATA

2.1 Company Name

     

2.2 Company Production Totals

A

B

C

D

E

F

G

H

I

J

In-House Transformation (kg)

Second-Party Transformation (kg)

In-House Destruction (kg)

Second-Party Destruction (kg)

Quarantine and Preshipment (QPS) (kg)

Critical Use Exemption (CUE) (kg)

Emergency Use Exemption (kg)

Article 5 Production (kg)

Lab Use (kg)

Gross Production of Methyl Bromide (kg) (A+B+C+D+E+F1+F2+ F3+G+H+I=J)

F1

F2

F3

Pre-plant

Post-Harvest

For Export

     

     

     

     

     

     

     

     

     

     

     

     

U.S. Environmental Protection Agency stratospheric ozone protection program						class i controlled substance methyl bromide producer quarterly report (40 CFR 82.13)
SECTION 3 ALLOWANCE EXPENDITURE DATA
3.1 Company Name		     
3.2 Allowance Balance Summary
					Expended		Unexpended
A	Total Article 5 allowances for year to date (as of the end of the quarter) that were:				     		     
B1	Total pre-plant critical use allowances for year to date (as of the end of the quarter) that were:				     		     
B2	Total post-harvest critical use allowances for year to date (as of the end of the quarter) that were:				     		     
3.3 Producer’s CUE Methyl Bromide Ending Inventory, If Any (Complete this question for 4th quarter reporting only)
     	kg owned by reporting company (at end of the control period) (including all quantities held by other suppliers)
3.4 Name(s) of Company(ies) for Which Critical Use Methyl Bromide is Being Held by Reporting Entity and Associated Amounts (kg) Held for Each (excluding end-users) (Complete this question for 4th quarter reporting only)
Company Name:      					Pre-Plant (kg):      		Post-Harvest (kg):      
Company Name:      					Pre-Plant (kg):      		Post-Harvest (kg):      
Company Name:      					Pre-Plant (kg):      		Post-Harvest (kg):      
Company Name:      					Pre-Plant (kg):      		Post-Harvest (kg):      
Company Name:      					Pre-Plant (kg):      		Post-Harvest (kg):      

EPA Form # 5900-141, Revised 5/11