Epa Form 3540 1 PDF Details

Understanding the complexities and requirements for importing pesticides and devices into the United States can be a challenging endeavor, which is where the EPA Form 3540-1, Notice of Arrival of Pesticides and Devices, plays a crucial role. This form is a mandatory document that importers or their agents must submit to the Environmental Protection Agency (EPA) before a shipment reaches the U.S. It's part of a regulatory framework designed to ensure that any pesticides entering the country are properly documented, registered, and safe for use. The form is detailed, asking for information ranging from the importer's name and address to the brand name of the product, major active ingredients, total net weight, country of origin, and the EPA registration number, which is pivotal for the EPA to identify and assess the product. It also includes sections for both the importer and EPA to certify the accuracy of the information and instructions on how the shipment is to be handled upon arrival, including whether it should be released, detained, or inspected. Furthermore, the form serves as a communication tool among the EPA, U.S. Customs Service, and the importer, ensuring that pesticides are regulated effectively from the point of entry. By completing this form accurately, importers contribute to safeguarding public health and the environment from potential risks associated with pesticide use.

QuestionAnswer
Form NameEpa Form 3540 1
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesarrival notice example, arrival notice form, arrival notice sample, arrival notice template

Form Preview Example

United States Environmental Protection Agency

Form 3540-1

Notice of Arrival of

Pesticides and Devices

Note: Read Instructions on reverse before completing form.

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

Form Approved OMB No. 2070-0020

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

4. EPA Registration Number

 

5. EPA Producer Establishment No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shipper

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier

 

 

 

 

 

 

12. Port of Entry

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

17. Location of Goods for Examination after Importation

 

 

 

 

 

 

 

Instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 consigne under bond. Shipment must be held

intact pending inspection.

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

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)

Official File Copy

Instructions

Customs Regulations. 19 CFR 12.112 requires an importer desiring to import pesticides or devices into the United Statesto submit EPA Form 3540-1, Notice of Arrival of Pesticides and Devices, to the U.S. Environmental Protection Agencyprior 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 Part 1 of the form. It may be necessary to complete some ofthe items at the time of entry, e.g., entry data, carrier. To expedite the handling of pesticides shipments, submit this formto the EPA office listed below having jurisdiction over the state/territory in which the Port of Entry is located prior to thearrival 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 copiesto 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. Bringany discrepancies to the attention of EPA before the shipment is released and noted in the remarks section. If theimportation is not handled by Customs in the manner instructed in Part II, this should also be noted in remarks. All dataleft blank by the importer (e.g., entry date) must be completed at this time. After completion of Part III and signing theform, 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

445 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

PR VI

901 N. 5TH Street (PESTWWPD)

MO NE

2890 Woodbridge Ave.

 

Kansas City, KS 66101

 

Edison, NJ 08837-3679

 

 

 

EPA Region III

DE DC

EPA Region VIII

CO MT

1650 Arch Street (3WC32)

MD PA

999 18th Street

ND SD

Philadelphia, PA 19103-2029

VA WV

Suite #500 (8ENF/TEP)

UT WY

Denver, CO 80202-2466

 

 

 

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)

OH MI

1200 Sixth Avenue (ECO-084)

OR WA

Chicago, IL 60604-3507

MN WI

Seattle, WA 98101-9797

 

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

How to Edit Epa Form 3540 1 Online for Free

Handling PDF documents online is definitely quite easy with this PDF editor. You can fill in arrival notice form here in a matter of minutes. We at FormsPal are aimed at giving you the best possible experience with our tool by constantly introducing new features and enhancements. With all of these updates, using our tool becomes better than ever! To begin your journey, go through these basic steps:

Step 1: Open the PDF file in our tool by pressing the "Get Form Button" in the top part of this webpage.

Step 2: With this advanced PDF editing tool, it is possible to accomplish more than merely complete blank form fields. Try each of the features and make your forms appear perfect with custom textual content added in, or adjust the original content to excellence - all supported by the capability to incorporate any kind of pictures and sign it off.

In order to complete this document, make sure that you provide the information you need in every single area:

1. Whenever submitting the arrival notice form, be certain to complete all necessary blank fields in the associated area. This will help to expedite the process, allowing your information to be processed efficiently and properly.

Step number 1 for submitting cargo arrival notice sample

2. The subsequent part is usually to complete the next few blank fields: Remarks, I certify that the statements I, I acknowledge that any, Printed Name of Importer or Agent, Telephone Number, Signature of Importer or Agent, Date Signed, Certification, Part II, To Be Completed by US, Action to be taken by US Customs, Release Shipment, Detain for Inspection, Release shipment to consigne under, and Other.

Filling out section 2 in cargo arrival notice sample

When it comes to Certification and Telephone Number, ensure that you review things in this section. These two are viewed as the most important ones in this page.

Step 3: Be certain that the information is accurate and then just click "Done" to complete the project. Join us right now and immediately gain access to arrival notice form, set for download. Every last change made is handily preserved , helping you to edit the form at a later point as required. FormsPal is dedicated to the privacy of our users; we always make sure that all information put into our tool is kept secure.