United States Environmental Protection Agency

Washington, DC 20460

Notice of Arrival of

Pesticides and Devices	Send Completed Form to Appropriate Regional Office Listed on the Reverse of this Form.

Form Approved

OMB No. 2070-0020
Note: Read Instructions on reverse before completing form.
Part I: To Be Completed by Importer or Agent
1. Name and Complete Address of Broker or Agent

2. Name and Complete Address of Importer or Consignee
Return Form to this Address	Return Form to this Address
3. Name and Address of Shipper

4. EPA Registration Number	5. EPA Producer Establishment No.

6. Brand name of Product
7. Major Active Ingredients and Percentage of Each

8. Unit Size

9. Quantity	10. Total Net Weight	11. Country of Origin
12. Port of Entry

13. Carrier
14. Entry Number

15. Entry Date	16.	I assert that information constituting Confidential Business Information is shown in the above blocks numbered: (Note: Blocks 4, 5, 6, 7 are not entitled to CBI treatment–see Instructions)
17. Location of Goods for Examination after Importation

18. Remarks

Certification

I certify that the statements I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
19. Printed Name of Importer or Agent

Telephone Number	20. Signature of Importer or Agent	Date Signed
Part II: To Be Completed by U.S. Environmental Protection Agency
Action to be taken by U.S. Customs Service
Release Shipment	Detain for Inspection	Release shipment to consignee under bond. Shipment must be held intact pending inspection.
Other (Specify)

Remarks

Signature and Title of EPA Official	Date

Part III: To Be Completed by U.S. Customs Service
The information shown in Part I was compared with the entry papers for this shipment and no discrepancies were noted. The shipment was handled as instructed by EPA in Part II. Any deviations should be brought to the attention of EPA before releasing shipment and should also be noted in "Remarks."
Remarks

Signature of District Director of Customs	Date

EPA Form 3540-1 (Rev. 2-00)

Instructions

. 19 CFR 12.112 requires an importer desiring to import pesticides or devices into the United States to submit EPA Form 3540-1, Notice of Arrival of Pesticides and Devices, to the U.S. Environmental Protection Agency prior to the arrival of shipment in the United States. This form will be used by:

Importer or Agent. The Importer or his agent must complete P art 1 of the form. It may be necessary to complete some of the items at the time of entry, e.g., entry data, carrier. To expedite the handling of pesticides shipments, submit this form to the EPA office listed below having jurisdiction over the state/territory in which the Port of Entry is located prior to the arrival of the shipment.

EPA. Part II of this form will be completed by EPA. EPA will retain the EPA Copy for its files and return the other copies to the importer or agent for presentation to Customs at the time of entry.

Customs . Customs will compare the information shown on this form with the entry documents and the shipment. Bring any discrepancies to the attention of EPA before the shipment is released and noted in the remarks section. If the importation is not handled by Customs in the manner instructed in Part II, this should also be noted in remarks. All data left blank by the importer (e.g., entry date) must be completed at this time. After completion of Part III and signing the form, Customs will return the Official File Copy to EPA and retain the Custom's Copy.

The following blocks are self explanatory - 1, 2, 8, 9, 10, 12, 14, 15, 18, 19, and 20.

3. Name and Address of Shipper. The name and address of person exporting the pesticide to the United States.

4. EPA Registration No. The product registration number assigned at the time of registration which identifies the product. If the product is a device, write the word 'device' in the block.

5. EPA Producer Establishment No. The producing establishment registration number which identified where the pesticidal product, active ingredient, or device was produced.

6. Brand Name of Product. Name under which the product is sold or distributed.

7. Major Active Ingredients and Percentage of Each. If block 4 contains registration number, leave blank. If no registration number, list active ingredients (or two major ingredients and percentage of each).

11. Country of Origin. The country in which the pesticide producer is located.

13. Carrier. E.g., ship's name, airline or trucking company.

16. Confidential Business Information (CBI) designation. Please note that the information provided in blocks 4, 5, 6, and 7 is not entitled to confidential treatment under section 7(d) of FIFRA and under labeling requirements for pesticides at 40 CFR 156.10. Information provided in those blocks will be made public with no further notice.

17. Location of Goods for Examination after Importation. Enter the EPA establishment number for importing registered establishment in the case of unregistered product imports between establishments operated by the same producer.

EPA Regional Offices	States Covered	EPA Regional Offices	States Covered

EPA Region I	CT MA ME	EPA Region VI	AR LA NM
1 Congress Street (SEA)	NH RI VT	1445 Ross Avenue	OK TX
Boston, MA 02114-2023	Suite #1200 (6PD-P)
Dallas, TX 75202-2733

EPA Region II	NJ NY	EPA Region VII	IA KS
MS-500, Bldg #5

2890 Woodbridge Ave.

Edison, NJ 08837-3679	PR VI	901 N. 5TH Street (PESTWWPD)

Kansas City, KS 66101	MO NE
EPA Region III	DE DC	EPA Region VIII	CO MT
1650 Arch Street (3WC32)

Philadelphia, PA 19103-
2029	MD PA

VA WV	999 18th Street

Suite #500 (8ENF/TEP)

Denver, CO 80202-2466

ND SD

UT WY
EPA Region IV	AL FL GA	EPA Region IX
AZ AS CA
61 Forsyth Street, SW (APT-PS)	KY MS NC	75 Hawthorne Street (CMD-4-3)	GU HI NV
Atlanta, GA 30303-8960	SC TN	San Francisco, CA 94105-
3901

PI WK
EPA Region V	IL IN	EPA Region X	AK ID
77 West Jackson Blvd.(DT-8J)

Chicago, IL 60604-3507	OH MI

MN WI	1200 Sixth Avenue

(ECO-084)

Seattle, WA 98101-9797
OR WA

EPA Form 3540-1 (Rev. 2-00)