form Approved. O.M.B. No. 20704Xl12. Approval~ 10-31 96. 

U.S. ENVIRONMENTAL PROTECTION AGENCY AGENCY USE ONt~ ~-

&EPA PREMANUFACTURE 

NOTICE 

FOR NEW CHEMICAL SUBSTANCES 

\\'h,·n 

""lllf'ktnl 

,, nd till' 

IPrJll l\1 

DOCUMENTCONTROLO~CER 

OFFICE OF POLLtiTION PREVENTION 

AND TOXIC SUBSTANCES, 7407 

U.S. E.P .A. 401 M STREET, SW 

WASHINGTON D.C. 20460 

Enter the total number o£ pages 

in the Premanufilcture Notice 

Date o! receipt 

Company Sanitized 

• Yoa mllllt provide alllafonn•llon req 11eated In thla fonn to Ike extent thai Ilia boWJt. to or nuoa.obly UC>erUin.oble by you. Make reao11able eatlmolea If you 

not ho~~ve ada.al data. 

•Before you cnmplete lids (o.,., you should re..d the "Inslrudlon• Manual forPremanufadure Nollflallon• (the lllllnadlona Manual I• available from the Toxic 

Substances Control Ad (TSCA) Informalon Service by ailing 2112·554-1404. or fulna202·5st-5603). 

• U a user lee hu been .emllted lor lhll nollce (40 CfR. 71111.45)1 lndlate In the boxes •bove the T5-user fee ldentiflallon number you have generated. 

Remember, your uoer fee ID n•mber muat al10 appear on your mrre•pondtns fee remittance, which Is sent to: EPA, HQ Accouallng Openllono Branch !PM-26 ), 

P.O. ~9!lM. Plttab~. PA 15251~99. Attn. TSCA User Fee. 

Part I- CEN£RAL INFORMATION 

You mut provide I he cur~enUy colftd Chemical Abotradl (CAl Name of the new ~aniQJ ••b•tancc, evca If yoa da.hn the Identity • coafldettllal. You may 

authorize aaolher -· to aubmlt chemical Ideality lnlormalloa for yo•, but 

your oubmlulon will :aot be complete and tile review will aot begin antll EPA 

~lve• thil llfomtatlo11. A letter !tlaupport of your •ubmiAioa 1hould 

.efe.ence your TS UHI' fee lden!lflcallon number. You mall 1ubmll '"" ortstnal 

md two copt .. of lhla aotlce lacludlng aU leal data. U you dahned any 

Information • cnnfldentlal, a alagle lllllllzed copy mull also be aubmltted. 

Part 11- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

U then: are several manufacture, procaelng, or uae operation• to be daaibed In 

Part II, oecllons A .aad B of this noUee, reproduce the MC!lona • aeeded. 

Part ID- UST OF AlTAOIMENTS 

All..ch add!Uonalsheeta U there Is not enoush space to answer a queallon fully. 

L>bel each contlnuaUon ohed with the cnrreapondlns Hdlon head Ins. In Part 

lll,llal these aHachmento, any 181 data or other d..t.a ilftd any oplloaal 

lnfomtallollladuded l11the 11ot!ce. 

OPTIONAL INFORMATION 

You m~ Include any laformolloa thai you want EPA lo ma1idC1' Ia evalaatia1 

the new 1ublllallce. 011 pqe 11 of lhl1 form, 1pac2 haa beea provided for you .., 

daoalbe pollatloa preventloa and recycllag Ia formation yo• may have regard Ins the aew substAnce. 

So-called "binding" box .. are Included throughout thia fonn for you to lndlc:ale 

your willlngn ... lobe bouad to Cledaln llatemenls you make In lllia Dotlce,lllch 

aa use, production volume, protective equipment ••• Thl1 optloa .. Intended to 

re4uce deLays that routlaely ac:company the development of conHitl ore! en or 

Slgn!flcant New Use Rules. Except Ia the cue of exemption appllcatloM (lllch • 

'~MEA, LYE, LOilEX) where c:edala lnlonnalloa provided Ia aucll nollflc:alloa Ia 

bindins on the aubmltter when the Aaency approvea the exe•ptloa appllallon, 

checldas a bind las box lathla nollClll.dliA.Jt&U by Itself pmhlblt the aubmltler 

fromloler deviating from tile Ia formation (except clle•icalldeatltyl reported Ia 

the fomt. 

CONFIDENTIALITY CLAIMS 

You "'"Y claim any lnfonnaUoa In lhla notice 11 amfldentlal. To -~~ a clal• 

on the fonn,. .,an.()() ttw. confidential box ne><l k>lhe lnfonnalloath..t yo• claim 

aa coafldentlal. To ... ert a claim Ia IJt allachmenl, drde or bncket the 

lnfonnallon you claim u.conftdenllal. U you d.alm totormaHoa lp the DDI!ce u 

conftdenlliJ. you must alto vroylde 1 ynl!b.c;d vcqlgp pf the aoU<:c Upcludiaa 

«"Qmcnts>. ~or .-JdJtlonAI lutnacllona on d.Um.ln& lnfo~lon M 

: cnnfldentlal, read th,e lnllruclloa• M.1nual. 

OCJ Mark lXI lf _ai.ylaformatlon In thia aollce 11 claimed u confidential. 

EPA FORM 7710..25 (Rev. 5-95) 

TEST DATA AND OlHEil DATA 

You ~required to aubmlt all t..t data In your poaaeulon or cnnlrol 

and to provide • deac:rlptloa of all otller data kaowa lo or re..onably 

.urtalaable by yoa, If thoe data are related to the healtk and 

nvlroJUDealal effeda of lloe •uufadure, P""'""lng, dl•lribllllon 

In m•mera, ue, or dlspoaal of the aew chemlc.al oubalanc.e. Standard 

Hleralure dtatloftl mil)' be aubmiHed for data Ia the opu odenllflc 

Hterature. Complete test data !mittel Ia En&lllhl. Dot aumm.vir:1 of dilL 

must bt sul!mllted If tl!q do Dot azvcar Ia !l!c DVCD I!Jcr.llg& You ohould 

deuly identify wloetker tat datal• on the aub•tance or on an analos. Alao, 

the chemical compoaltloa of the tested material ohould be charaderized. 

Followtas are enmplea of leal dota ud other dal.a. Data skould be 

aul>•ltled acmrdlng to the requlremenla of §720.50 of the Premanufacture 

NollflaiiOil Rate (40 CFK Put 7211). 

Teat Data (Check Below any Included In lhl.s notice) 

• Environmental fate data D Yes • Olherd.at.a D Yea 

• Healtk effeda d.ata D Yea lllsk -men .. 

• Eavlronmenl•l offeda data D Yea Stnadure/adlvlty relatlonahi 

• Phyakal/Chemlcal Propertl .. • ~ Yes Teal data not in Ike pooaeul " 

or coatrol of the 111bmitter 

•A phyalc.al and chetnlcal propertleo worksheet l•loc.ated on the JMI pase 

of thia form. 

n1'E OF NOTICE (Check Only Oae) 

PMN (Pr~anufadure Notice) S:-:; 

'-~-- INTERMEDIATE PMN (submlHed In aequence with flnal'Pdad 

~M ~ 

SNUN (Slgnlflant New Use NoiiCt) o:> 

TMEA (feat M.ukdlng Exemption Application) 

LVE (Low VoJ ... te Exemptloa) • 40 crR 723.50 (c)(l) 

D 

D 

D 

D 

0 

LOREX (Low llele.-ell.ql" Expoaure Exemption) e 723.50(<)(2~ •. (J'\ 

L VE Modification 0 LOREX Mod!ftcatloll 

ISTIDSACONSOLIDATEDPMN7 0 Yea 

I of chemlala 

(Prenotlce Communlation I required, enter I on page 3) 

page I··· Replaces previous editions of EPA Form 7710.25 
Public reporting burden for this collection of information is estimated to average 110 hours per response, including time for reviewing instruction , 

searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send 

comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, 

to Cllief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M. SL, S.W., Washington, D.C. 20460; and to the O£fice < 

Management and Budget, Paperwork Reduction Act (2070..0012), Washington, D.C. 20503. 

CERTIFICATION 

I certify that to the best of my knowledge and belief: 

1. The company named in Part I, section A, subsection la of this notice form intends to manufacture or import for a 

commercial purpose, other than in small quantities solely for research and development, the substance identified in 

Part I, Section B. 

2. All information provided in this notice is complete and truthful as of the date of submission. 

3. I am submitting with this notice all test data in my possession or control and a description of all other data known to 

or reasonably ascertainable by me as required by §720.50 of the Prcmanufacture Notification Rule. 

Additional Certification Statements: 

If you are submitting a PMN, Intermediate PMN, Consolidated PMN, or SNUN, check the following user fee certification 

statement that applies: 

~ The Company named in Part I, Section A has remitted the fee of $2.500 specified in 40 CFR 700.45 (b), or 

0 The Company named in Part I, Section A has remitted the fee of $1000 for an Intermediate PMN (defined @ 40 CFR 700.4: ) in 

accordance with 40 CFR 700.45(b), or 

0 The Company named in Part I, Section A is a small business concern under 40 CFR 700.43 and has remitted 

a fee of $100 in accordance with 40 CFR 700.45 (b). 

If you are submitting a low volume exemption (L VE) application in a~ordance with 40 CFR 723.50 (c) (1) or a Low 

release and low exposure exemption (LoREX) application in accordance with 40 CFR 723.50 (c) (Z), checl< the folloWing 

certification statements: 

0 The manufacturer submitting this notice intends to manufacture or import the new chemical substance for 

commercial purposes, other than in small quantities solely lor research and development, under the terms 

of 40 CFR 723.50. 

0 

0 

D 

The manufacturer is familiar with the terms of this section and will comply with those terms; and 

The new chemical substance for which the notice is submitted meets all applicable exemption conditions. 

If this application is for an LYE in accordance with 40 CFR 723.50 (c)(l), the manufacturer intends to commence 

manufacture of the exempted substance for commercial purposes within 1 year of the date of the expiration of the 

30 day review period . .. 

The accuracy of the statements you make in this notice should reflect your best prediction of the anticipated facts regarding the chemical 

substance described herein. Any knowing and willful misinterpretation is subject to criminal penalty pursuant to 18 USC HXll. 

Signature and title of Authorized Official (Original Signature Required) Date 

h KUNIO TAKAHASHI ·'' /C. . ~AL t-tANAGER J U N. 3, .l..o o )_ ~ · ~ I'JAf~AC:i"J;". AMVOTf"'ll\ f"'f"''DD 

~ature of agen~ • (if applicable) Date 

FORM EPA 7710-25 (Rev. 5-95) Page2 

Confidenti 
Part I·· GENERAL INFORMATION 

Section A- SUBMriTER IDENTIFICATION 

la. Person 

Submitting 

Notice 

(in U.S.) 

b. Agent (lf 

applicable) 

Oty, State, ZIP Code 

Nev.; York 

Name of authorized official 

Company 

16' th 

I oo 3 

Mailing address (number and street) 

Oty, State, ZIP 

rC\.tio.-1 

Telephone 

c. If you are submitting this notice as pari of a joint submission, mark (X) this box. -----------------:J~ 

)oint 

Submitter 

{if applicable) 

authorized official 

Company 

Mailing address (number and street) 

2. Technical 

Contact 

(In U.S.) 

Oty, State, ZIP Code 

Name 

Go..r 

Company 

N 

Mailing 

546 

3. If)'ou have had a prenotice communication (PO concerning this notice 

and EPA assigned a PC Number to the notice, enter the number. 

>-

4. If you previowly submitted an exemption application for the chemical 

substance covered by this notice, enter the exemption number assigned 

by EPA. If you previously submitted a PMN for this substance enter the 

PMN number assigned by EPA (I.e. withdrawn or incomplete). 

--~>~ 

If you have submitted a notice of Bona fide Intent to manufacture or 

import for the chemical substance covered by this notice, enter the 

notice number asslgn.,q,by EPA. )loo 

. 'I'ype of Notice.- Mark (X) 

FORM EPA 7710-25 (Rev. 5-95) 

1. D 

D 

M~ulacture 

Only 

Binding Option 

Mark(x) 

Page3 

Position 

Telephone 

Position 

IVlCA r ke-t.\ 

')..I .l.. I 

I 7l.)~ /340 

Mark()() )loo I]] if none 

Mark (X) 

if none > 00 

.l.(ark (X) > [ill ·if none 

2. ~Import Only D 3. 0 Both BindingOption 

Mark(x) 

.. 
Part I --GENERAL INFORMATION- Continued 

Section B _ CHEM1CAL IDENTITY INFORMATION: You muat provide a currently CorTect Chemical Abstracts (CA) name of 

based on the ninth Collective Index (90) of CA nomenclature rules 

Complete either item 1 (Clasal or 2 substances) or 2 (Polymers) as appropriate. Complete all other items. 

U another person will submit chemical identity information for you (for either item 1 or 2), mark (X) the box at the right. 0 

the and address of that in a continuation sheet. > 

1. Classl or 2 chemicalsubatancea (for definitions of class 1 and class 2 substan<l!S, see the Instructions Manual) 

a. Class of substance- Mark 00 1 D Oass 1 or 2 D Oass 2 

b. Otemical name (Currently correct Otemical Abstracts (CA) Name that Is consistent with TSCA Inventory listings for similar substan<l!S. 

For Oass 1 substances a CA Index Name must be provided. For Oasa 2 substances either a CA Index Name orCA Preferred Name 

be provided, whichever Is appropriate based on CA 90 nomenclature rules and conventions.). 

c. Please identify which method you Ulied to develop or obtain the spedfied chemicalindentity information reported in this notice: 

(check one). 

0 Method 1 (CAS Inventory Expert Service - a copy of the Identification 0Method 2 (Other Source) 

report obtained from the CAS Inventory Expert Service must be 

submitted as an attachment to this notice) 

d. Molecular formula and CAS Registry Number (if a number already exists for the substance) 

CAS II 

e. For a classl substance, provide a complete and correct chemical structure diagram. For a clau 2 substance- (1) Ust the immediate 

precursor substances with their respective CAS Registry Numbers. a> Describe the nature of the reaction or process. (3) Indicate the 

range of composition and the typicill composition (where appropriate). (4) Provide a correct representative or partial chemical 

structure diagram, as complete as can be :known, If one can be reasonably ascertained . 

.. 

,· 

Mark (X) this bOx If you attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) Page4 
Part I.- GENERAL INFORMATION-- Continued 

~ Section B- CHEMICAL IDENTITY INFORMATION - Continued 

2. Polymers (For a definition of polymer, see the lnstruc:tions Manual.) ~::. r;~ a. Indicate the number-average weight of the lowest molecular weight composition of the polymer you intend to manufacture. 

Indicate maximum weight percent of low molecular weight species (not Including residual monomers, reactants, or solvents) below X 500 and below 1,000 absolute molecular weight of that composition. 

Describe the method• of measurement or the basis for your eatimatea: GPC D Other0 : <Specify> 

I) lowest number a~ molecular weight: 

II) maximum weight "' below 500 molecular weight 

110 maximum weight 'll. below 1000 molecular weight 

D Mark (X) this box if you attach a continuation sheet. 

b. You must make separate confidentiality claims for monomer or other reactant identity, composition information, and residual information. 

Mark (X) the "Confidential" box next to any item you claim as confidential. 

(1) - Provide the specific chemical name and CAS Registry Number (if a number exists) of each monomer or other reactant used in the 

manufacture of the polymer. 

(2) - Mark (X) this column if entry in column (1) is mnfidential. 

(3) - Indicate the typical weight perrent of each monomer or other reactant in the polymer. 

(4) - Mark (X) the identity column if you want a monomer or other reactant u.ed at two weight percent or le•• to be listed as part of the 

polymer deacription on the TSCA Chemical Substance Inventory. 

(5) - Mark (X) this column if entries In columN (3) and (4) are confidential. 

(6) - Indicate the maximum weight peroent of eac:h monomer or other reactant that may be present as a residual in the polymer as 

manufactured for commercial purposes. 

(7) - Mark (X) this column if entry in column (6) is confidentiaL 

Monomer or other reactant and CAS Registry Number Confi- Typi~. Identity Confi- Maximum 

(I) 

dmtial 

(2) j3) 

Mark 00 dential residual ~= ~ (~ (5) (6) (j 

X ~ )( "'· >< 

X ~ x '1o X 

>( % 

,. 

~ % 

,. 'Yo 

% 'E. 

% ,.. 

D Mark (X) this box if you attach a continuation sheet. 

c. Please identify which method you used to develop or obtain the spedfied chemical identity Information reported in this notice. (check one). D Method 1 (CAS Inventory Expert Service- a copy of the identification report D Method 2 (other source) 

obtained from CAS Inventory Expert Service must be submitted as 

an attachment to this notice) 

d. The currently correct Cllemical Abstracts (CAl name for the polymer that is consistent with TSCA Inventory listings for similar polymers. X: 

e. Provide a correct representative or partial chemical structure diagram, as complete as can be known, if one can be reasonably asc:ertained. 

.. X 

' 

. 

' D Mark (X) this bo5df you attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) PageS 
Part I -GENERAL INFORMATION-- Continued 

~ Section B - CHEMICAL IDENTITY INFORMATION - Continued 

3. Impurities 

(a) -Identify each Impurity that m.oy be reuonably anlidpated to be preseDtln the chemlw SQbaiMce • mu•factund for mmmadal plllpOIM!IL 

P10vlde the CAS 'Re&blry N•mber If .ov.ailable. U lhe..,...., 1U\Identlfled lmparlliea, enter "anldenllfled." 

(b) -Estimate the maximum weight "- of each Impurity. If theft...., nldellllfled lmpurlllea, ealiauote their total wei& lot "-· 

Impurity and CAS Registry Number Maximum 

~ :.1 percent (a) (b) 

% X 

9'. 

% 

% 

% 

% 

'JI'. 

D Mark (X) this box if you attach a continuation sheet. 

4. Synonyms- Enter any chemical synonyms for the new chemical substance identified In subsection 1 or 2. ~~ ~;l 

X 

D Mark (X) this box if you attach a continuation sheet. 

5. Trade identification- List trade names for the new chemical substance identified ln subsection 1 or 2. 

X 

D Mark (X) this box if you attach a continuation sheet. 

6. Generic chemical name-If you claim chemical identity as confidential, you must provide a generic chemical name for your substancr 

that reveals the spedfic chemical identity of the new chemical substance to the maximum extent possible. 

Refer to the T5CA Chemical Substance Inventory, 1985 Edition, Appendix B for guidance on developing 

generic names. 

Polyglycerin alkyl ether 

D Mark (X) this box II you attach a continuation sheet. 

7. Byproducta any byproducts resulting from the manufacture, processing, use, or disposal of the new chemical substance. Provide the C 

Registry Number if available. ~ 

.. Byproduct CAS Registry Number 

(1) (2) d~~ ~i 

X 

>( 

' >( 

. 

D Mark ()() this bOx if you attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) Page6 
Part I -GENERAL INFORMATION- Continued 

~ Section C -PRODUCTION, IMPORT, AND USE INFORMATION: 

Mark 00 the "Confidential" box next to any item you daim as confidential. 

1. Production volume- Estimate the maximum production volume during the first 12 months of production. Also estimate the 

maximum production volume for any consecutive 12-month period during the first three years of production. Estimates should be on 

100% new chemical substance basis. For a Low Volume Exemption appliclllion, if you choose to have your notice reviewed at a lower produc ion 

volume than 10,000 kg/yr, specify the volume and mark (x) in the binding box. If granted, you are bound to this volume .. 

Maximum first 12-month production (kg/yr) 

(100% new chemical substance basis) 

Maximum 12-month production (kg/yr) 

(100% new chemical substance basis) 

Confidential 

X 

Bind in 

Opt! om 

Mukl) 

2. Use Information -You must make separate confidentiality claims for the description of the category of use, the percent of production volume 

devoted to each category, the formulation of the new substance, and other use information. Mark (X) the "Confidential" Box next to any item you 

claim as oonfidential. a. (I)- Describe each intended category of use of the new chemical substance by function and application. 

(2)- Mark (X) this column if entry in oolumn (1) is confidential business information (CBO. 

(3)- Indicate your willingnees to have the Information provided in column (1) binding. 

(4)- Estimate the percent of total production for the first three years devoted to each category of use. 

(5)- Mark 00 this column If entry in column (4) Is confidential business Information (CBI). 

(6) -Estimate the percent of the new substance as formulated in mixtures, suspensions, emulsions, solutions, or gels 

as manufactured for commercial purposes at sites under your control associated with each category of use. 

(7)- Mark (X) this column if entry in mlumn (6) is confidential businees information (CBI). 

(8)- Indicate %of product volume expected for the listed "use" sectors. Mark more than one box if appropriate. Mark 

00 to indicate your willingness to have the use type provided In (8) binding. 

(9) - Mark (X) this column If entry(ies) in mlumn (8) is (are) confidential business information (CBO. 

Category of use (1) CBl Bhwllaa 

Optloa 

M.ukW 

Produclion% 

CBI %in 

FormCBI % of substance expected per use f:BI 

(by function and application I.e. a dispersive dye for 

finishing polyester fibers) ulation 

(8) 

(2) (3) (4) (5) (6) (7) 

i!>ite- 11..0n- Indus- Com- Binding 

limited sumer trial mercial Option (9) 

'10 X % X 

'10 % 

'10 % 

'10 '10 

'10 % 

% % 

% % 

•u you have identified a "consumer" use, please provide on a continuation sheet a detailed description of the use(s) of this chemical 

substance in consumer products. In addition include estimates of the concentration of the new chemical substance as expected in 

consumer products and describe the chemical reactions by which this substance loses its identity in the consumer product. 

0 Mark 00 this box il you attach a continuation sheet. 

b. Generic 

use 

description 

If you claim any category of use description in subsection 2a as confidential, enter a generic description of that 

category. Read the Inatructions Manual for examples of generic use descriptions. 

Additive for a lubricant 

D Mark 00 this box il you attach a continuation sheet. 

X 

3. Hazard Information- lndude in the notice a copy of reasonable facsimile of any hazard warning statement, label, material safety data sheet, Blndti'f! 

• or o_lher informati"!' which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective • ~~ 

1 

,_.., eqwpment or practi~ for the safe handling, transport, use, or disposal of the new substance. Ust in part III hazard information you in dude. 

I LJMark 00 this box if vou attach hazard Information. X 

FORM EPA 7710-25 (Rev. 5-95) Page7. 
Part II -HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

Section A-INDUSTRIAL SITES CONTROLLED BY TilE SUBMriTER 

Complete section A for each type of manufadure, proc:easing, or use operation Involving the new chemical.ubatance at industrial sites you 

Importers do not have to complete this section for operation• outside the U.S.; however, you may still have reporting requirement• if there are 

further industrial proce11ing or use operations after import. You must describe these operations. See Instructions manuaL 

of the site at which the will occur. 

Name 

Site address (number and street) 

Oty, County, State, ZIP Code 

If the same operation will occur at more than ooe site, enter the number of sites. Identify the 

additional sites on a continuation sheet, and 1f any of the sites have sl.gnlflamtly different )llooproduc:tion rates or opet:ations, include all the Information requested in this section for those 

sites as 

Mark ()() this box if 

b. TypeMark()() 

1. Batch 

attach a continuation sheel 

0 Manufacturing 

2. Continuous 

0 Processing 

Hours/batch 

Hotm~/day 

0 Use 

Batches/ year 

Days/year 

d. Process description D Mark (X) to indicate rour willingne .. to have your procua de..:ription binding. 

(1) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport containers (speciiy-e.g. 5 gallon 

gallon drum, rail car, tank truck, etc.). 

(2) Provide the identity, the approximate weight (by kg/ day or kg/batch on an 100% new chemical substance basis), and entry point of all 

materials and feedstocks (Including reactants, solvents, and catalysts, etc), and of all products, recycle streams, and wastes. Indude deanlng 

chemicals (note frequency If not used dally or per batch.). 

(3) Identify by number the points of release, lndudlng small or lntermltlanl releases, to the environment of the new chemical substance . 

.. 

D Mark 00 this boi.if you attach a continuation sheet. 

FORM EPA 7710.25 (Rev. 5-95) Pa~8 
Part II- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE- Continued 

~ Section A- INDUSTRIAL SITES CONTROLLED BY TiiE SUBMTITER -Continued 

2. Occupational Expowre- You must make ~ate confidentiality claims for the description of worker activity, physical form of the new chemical 

substance, number of workers exposed, and uralion of activity. Mark (X) the "Confidential" box next to any item you claim as confidential. 

(1)- Describe the activities (e.g. bag dumping, tote filling, unloading d.rwns, sampling, cleaning, etc.) in which workers may be exposed to the 

substance. 

(2)- Mark (X) this column II entry in column (1) is confidential business information (CBI). 

(3)- Describe any protective equipment and engineering controls used to protect workers. 

(4) and (6)- Indicate you willingness to have the information provided In column (3) or (5) binding. 

(5) - Indicate the physical form(s) of the new chemical substance (e.g. solid: crystal, granule, powder, or dust) and % new chemical substance (if par of 

a mixture) at the time of exposure. 

(7)- Mark (X) this column if entry in column (5) is confidential business information (CBI). 

(8)- Estimate the maximum number of workers Involved In each activity for all sites combined. 

(9)- Mark (X) this column If entry In column (8) is confidential business information (CBI). 

(10) and (11)- Estimate the maximum duration of the activity for any worker In hours per day and days per year. 

(12)- Mark (X) this column If entries In columns (10) and (1 1) are confidential business information (CBI). 

Worker activity CBI Protective Eq•lpmenll ~lndlaa YhyllcaliOIDI(I) ~lad lila CBI I of CBI Maximum duration :BI 

(e.g. bag dumping, filling drums) Enalneerlna Control• pptioa (e.g.soUd:powder) bptloa Wlll'kert ~iuk(x) and~ new r-f"arkW Expoeed Hrs/day Days/yr 

_m (2} (3} (4) 11Ub8~CI! (6}_ f7l (8) (9) (10) (11) 12) 

D Mark (X) this box if you attach a continuation sheet. 

3. Environmental Releaee and DI.po.al- You must make separate confidentiality clalms for the release number and the amount of the new chem i:al 

substance released and other release and disposal information. Mark (X) the "Confidential" box next to each item you claim as confidential. 

(1) - Enter the number of each release point identified in the process description, part II, section A, subsection ld(3). . 

(2) - Estimate the amount of the new substance released (a) directly to the environment or (b) into control technology (in kg/ day or kg/batch). 

(3) - Mark (X) this column if entries In columns (1) and Q) are confidential business information (CBI). 

(4) - Identify the media ol release i.e. stack air, fugitive air (optional-see Instruction Manual), surface water, on-site or off-site land or lncineratio , 

PO'IW, or other (please specify) to which the new substance will be released from that release point. 

(5) - a. Describe control technology, if any, ,and control efficiency that will be used to limit the release of the new substance to the environment. 

For releases disposed of on land_ characterize the disposal method and state whether it is approved for disposal of RCRA hazardous waste. 

On a continuation sheet, for each site describe any additional disposal methods that will be used and whether the waste is subject to 

secondary or tertiary on-site treatment. b. Estimate the amount released to the environment after control technology (in kg/ day). 

(6) - Mark (X) this column if entries In columns (4) and (5) are confidential business information (CBI). 

(7) - Identify the destination(s) of releases to water. Please supply NPDFS (National Pollutant Discharge Elimination System) numbers for dire< 

dischargers or NPDFS numbers of the POTW (Publicly Owned Treatment Works). Mark (X) if the POlW name or NPDES 11 is confidential 

business information (CBI). 

Release Amount of new substance CBI !Media of Control technology and efftdency (you may wish to optionally attach efficiency data) !:BI 

Number released release 1 Bindlnl! (1) (2a) Qb) eo~o ltodtolr 

(3) (4) (Sa) : Mark(><) (Sb) 6) 

I 

I .. I 

l I 

I 

L 

I 

I 

I 

I 

I 

I 

•·' I ... ~ . 

(7) Mark (X) the 0 · l'01W provide name(s) below: CBI O Navigable D Other- Specify provide NPDES #I I ( BI 

destination(s) of - ~ waterway 

releases to water.· ' 

D Mark (X) this-~ if you attach a continuation sheet. 

FORM EPA 7710.25 (Rev. 5-95) Page9 
Part II- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE- Continued 

~ Section B- INDUSTRIAL SITES CONTROLLED BY OTHERS 

Complete section B for typical processing or use operations involving the new chemical substance at sites you do not cxmtrol.Importers do not have to 

complete this section for operations outside the US.; however, you must report any processing or use activities after imporl See the Instructions 

Manual. Complek 11 separr~k section B fur eadt type of proussing, ur use operation inml'lling the new chemiall substana. If the same operation is perforn ed 

at more than one site desaibe the typical operation common to these sites. Identify additional sites on a cxmtinuation sheet. 

1. Operation Description - To claim information in this section as confidential, circle or bracket the specific information that you claim as confidential 

(1) - Diagram the major unit operation steps and chemical conversions, including interim storage and transport cxmtainers (specify- e.g. 5 gallon pi ~. 

55gallon drums, rail cars, tank trucks, etc). On the diagram, identify by letter and briefly describe each worker activity. (2)- Provide the Identity, 

the approximate weight (by kg/day or kg/batch, on an 1009:. new chemical substance basis), and entry point of all feedstocks (including reactants 

solvents and catalysts, etc) and ol all products, recycle streams, and wastes. Include cleaning chemicals (note frequency if not used daily or per 

batch). (3) -Identify by number the points of release, including small or intermittent releases, to the environment of the new chemical substance. 

(4) Please enter the It ol sites (remember to Identify the locations of these sites on a cxmtinuation sheet): 

i Of Sites 

The new chemical substance (5kg/batch) 

~1 Mineral oil (950kg/batch)--"> [ l--1 >2 

Other lubricating additives (45kg/batch)----4 rdrum char~-;1 

l 

3 

D Mark 00 this box if you attach a continuation sheet. 

2. Worker Expo8Ure/Environment.al Rele .. e 

(1)- From the diagram above, provide the letter for each worker activity. Complete 2-8 for each worker activity described. 

(2) - Estimate the number of workers exposed for all sites combined. 

(4)- Estimate the typical duration of exposure per worker in (a) hours per day and (b) days per year. 

(6)- Describe physical form of exposure and 9:. new chemical substance (if In mixture), and any protective equipment and engineering controls us ~ to protect workers. 

(7)- Estimate the percent of the new substance as formulated when padcaged or used as a final product. 

(9)- From the process diagram above, enter the number of each release point. Complete 9-13 for each release point identified. 

(10)- Estimate the amount of the new substance released (a) directly to the environment or (b) into control technology to the environment 

(In kg/ day or: kg/batch). 

(12)- Describe media of release I.e. stack air, fugitive air (optional-see Instructions Manual), surface water, on-site or: off-site land or incineration, 

PO'IW, or other (specify) and control technology, if any, that will be used to limit the release of the new substance to the environment. 

(14)- Identify byproducts which may result from the operation. 

(3), (5), (8), (11), (13) and (15)- Mark 00 this column if any of the proceeding entries are confidential business information (CBO. 

Letter l#ol CBI Duration CBI Protective Equip. I 9:.in CBI Release Amount of CBI Media of Release PJI 

of Workers ol Engineering Controls/ Form- Number New &.Control 

Act- Exposed Exposure Physical Form and 9:. ulation Substance Technology 

ivity new substance Released 

I 

l10a) : ClOb) (1) (2) (3) (4a) I C4b> (5) (6) (7) (8) (9) '(11 (12) 13) 

I I 

I .. X I )( x I )( I 

I ! 

I I 

2 x I )( )( I X I I I 

-. I 3 I 

X. I X X X 

I ~ I I• 

I I 

I . I 

(14)- Byproducts: 5) 

' >( 

0 Mark (X) this box if you attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) PagelO 
OPTIONAL POLLUTION PREVENTION INFORMATION 

To claim information in this section as confidential circle or bracket the specific information that you claim as confidential. 

In this section you may provide information not reported elsewhere in this form regarding your 

efforts to reduce or minimize potential risks associated with activities surrounding 

manufacturing, processing, use and disposal of the PMN substance. Please include new 

information pertinent to pollution prevention, including source reduction, recycling activities 

and safer processes or products available due to the new chemical substance. Source reduction 

includes the reduction in the amount or toxicity of chemical wastes by technological 

modification, process and procedure modification, product reformulation, raw materials 

substitution, and/ or inventory control. Recycling refers to the reclamation of useful chemical 

components from wastes that would otherwise be treated or released as air emissions or water 

discharges, or land disposal. Descriptions of pollution prevention, source reduction and 

recycling should emphasize potential risk reduction subsequent to compliance with existing 

regulatory requirements and can be either quantitative or qualitative. The EPA is interested in 

this information to assess overall net reductions in toxicity or environmental releases and 

exposures, not the shifting of risks to other environmental media or non-environmental areas 

(e.g., occupational or consumer exposure). In addition, information on the relative cost or 

performance characteristics of the PMN substance to potential alternatives may be provided. 

All information provided in this section will be taken into consideration during the review 

of this substance. See the revised Instructions Manual that includes a Pollution Prevention 

manual for guidance and examples. 

Describe the expected net benefits, such as (1) an overall reduction in risk to human health or the environment; (2) a reduction in 

the volume manufactured; (3) a reduction in the generation of waste materials through recycling, source reduction or other 

means; (4) a reduction in potential toxicity or human exposure and/or environmental release; (5) an increase in product 

performance, a decrease in the cost of production and/or improved operation efficiency of the new chemical substance in 

comparison to existing chemical substances used in similar applications; or (6) the extent to which the new chemical substance 

may be a substitute for an existing substance that poses a greater overall risk to human health or the environment. 

The benefits of using Adeka Kiku ·lube FM ·618C 

Adeka Kiku·lube FM-618C works on the lubricating surface as an anti-wear agent, 

anti-oxidant, extreme pressure additive and friction modifier even in low concentration 

such as 0.1"" 1.0 mass%. 

It contributes to less wear of lubricating equipment and especially to fuel saving 

because of its friction reducing performance. It also improves life of oils . 

.. These are to be helpful to the environment of the earth . . 

1 

.. :o·.t 

. -. 

0 Mark (X) this b-Ox .if you attach a continuation sheet. 

FORM EPA 7110-25 <Rev. 5-95) Page 11 
Part III --LIST OF ATTACHMENTS 

Attach continuation sheeiS for sections of the form and test data and other data (including physical/ chemical properties and 

strut:ture/activily information), and optional information after this page. Oearly identify the attachment and the section of the form to 

which it relates, U appropriate. Number consecutively the pages of the attachments. In the column below, enter the inclusive page 

numbers of each attachment. 

Mark 00 the "Confidential" box next to any attachment name you claim as confidential. Read the Inatructiona Manual for 

guidant:e on how to claim any information In an attachment as confidential. You must include with the sanitized copy of the notice 

form a sanitized version of any attachment In which you claim Information as confidential. 

Attachment name Attachment 

~: fipage number(s) ~a! 

Material Safety Data Sheet (MSDS) 14~18 

19 X 

20 >< 

21~22 X 

23 X 

24~25 x 

.. I 

' 

. - J 

' 

D Mark (X) this bOx If you'attach a continuation sheet. Enter the attachment name and number. 

FORM EPA 7710.25 (Rev. 5-95) Page 12 . 
PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET 

To assist EPA's review of physical and chemical properties data, please complete the following worksheet for data you provide 

and include it in the notire. Identify the property measured, the page of the notire on which the property appears, the value 

of the property, the units in which the property Is measured (as necessary), and whether or not the property is claimed as confidential. The physical state of the neat substance should be provided. These measured properties should be for the neat (100% 

pure) chemicalaubstanoe. Propertiea that are measured for mixtures or formulations should be so noted ('r. PMN substance in_ ).You 

are not required to submit this worbheet; however, EPA strongly recommends that you do so, as it will simplify review and ensure 

that oonfidential information is properly protected. You should submit this worksheet as a supplement to your submission of test 

data. This worksheet is not a substitute for submission of test data. 

Property Value Meaa1ftd Confi 

Mark (X} if Page or dentia 

provided number Uti mote 

(a) 10 (b) (c) Mark( 

(MorE) (d) 

Physical state of neat aubstanoe __ (s) __ 0) --(R) 

Vapor pressure "C @Temperature Torr 

Density /relative density )( g/an3 X 

Solubility 

@ "C Temperature 

Solvent g/L 

Solubility in water @Temperature ·c ·c 

Melting_ tern~_ lure •c 

Boiling/ sublimation temjlei"Biure @ orr pressure 

X 19'"'-'23 X Spectra 

Dissociation oonstant 

Particle size distribution 

Octanol/water partition ooelfident 

Henry's Law oonstant 

Volltallzation from water 

Volltalization from soil 

.. . pH @ ooncentration 

Rammability >< X 

Explodability 

Adsorption I ooeffident .... t 

- Other-Spedfy 0. . 

' 

.. 0. 

0. 

page 13 
MATERIAL SAFETY DATA SHEET 

ADEKA K I KULUBE 

PRODUCT NAME FM-o 1 ~c 

P A G E : 1/5 

DATE PREPARED:19/June/2000 

DATE REVISED 

M S D S No. : 39475 

1. Identification of the substances/preparation and the company/undertaking 

Identification of the substance or preparation 

Product identifier: ADEKA KIKULUBE FM-618C 

General use ADDITIVE 

Formula : trade secret 

Identification of the company or undertaking Company 

Asahi Denka Kogyo K.K. 

3-14,Nihonbashi-Muromachi 

2-chome, Chuo-ku, 

Tokyo 1 03, Japan 

TEL 81-3-3249-3530 FAX 81-3-3249-3540 

EMERGENCY TELEPHONE NUMBERS: 

ASAHI DENKA EUROPE GmbH 

Oststrasse 154, 40210 Dusseldorf. Germany 

TEL 49-211-179-2450 FAX 49-211-171-0470 

Local distributor: 

ASAHI DENKA Europe GmbH 

TEL 49-211-179-2450 FAX 49-211-171-0470 

2.Composition/lnformation on ingredients 

1) Component 

COMPONENT CAS No 

:Chemical name & Structure 

Alkyl eter with polyhydric alcohol 

Exposure Limit Value 

Einecs No EEC(mg/m 3

) MAK(mg/m 3

) 

T Ether 100 trade secret trade secret None None . 

2)Classification 

Classification 

Not applicable 

. .. .. . 

. . 

Indication 

Not applicable 

Symbol 

Not applicable 

page 14 

R-Phrase 

Not applicable 

... :-· . 

S-Phrase 

Not applicable 
MATERIAL SAFETY DATA SHEET 

P A G E : 2/5 

ADEKA K I KULUBE 

FM-o 1 ~c 

DATE PREPARED:19/June/2000 

DATE REVISED 

PRODUCT NAME 

M S D S No. 

3.Hazards identification 

* * * * * * * * * * * * * * * *EMERGENCY OVERVIEW* * * * * * * * * * * * * * * * No significant hazards are identified. * 

**************************************** 

effects 

No significant health hazards identified. 

: 39475 

Potential health 

Skin contact 

Eye contact 

Inhalation 

Ingestion 

Chronic effects 

May cause pain and slight transient(temporary) irritation. 

Vapors are unlikely due to physical properties. 

Oral toxicity has not been determined. 

No relevant information found. 

4. First aid measures 

Skin contact: Wash off immediately with plenty of soap and water. 

Eye contact Flush eyes with large amounts of water until irritation subsides. If irritation 

persists, get medical attention. 

Inhalation Not expected to present a significant inhalation hazard under anticipanted 

condition of normal use. 

Ingestion See a physician immediately. 

5.Fire-fighting measures 

Flammable properties: 

Flashpoint and Method 

Flammable Limits(% by volume) 

,·Autoignition Temperature 

Suitable extinguishing media 

190"C (C. 0. C), 374° F 

No data available 

No data available 

Carbon dioxide, dry chemical powder, alcohol or polymer foam 

Extinguishing media must not be used for safety reason : None 

Exposure hazards: CO on incomplete combustion. 

Protective eg~jpment :Firemen should wear normal protective equlpmentCfull bunker gear) and 

positive-pressure self-contained breathing apparatus. } 

... 

page 15 
MATERIAL SAFETY DATA SHEET 

P A G E : 3/5 

ADEKA K I KULUBE 

FM-o1~C 

DATE PREPARED:19/June/2000 

DATE REVISED 

PRODUCT NAME 

M S D S No. : 39475 

G.Accidenral release measures 

Personal precautions 

Environmental precautions 

Methods for cleaning up: 

Personal protective equipment must be worn. Do not breathe dust. 

:Prevent solid from entering sewers, watercourses, or low areas. 

Large spill: Eliminate source of ignition. Clean up all spills immediately. 

of dust during clean up(use dustless methods such as vacuums). 

Small spill: Sweep up and discard. 

7.Handl ing and storage 

Hand! ing : Do not breathe powders. Avoid contact with skin, eyes or clothing. 

Avoid generation 

Storage : Keep away from heat, sparks, and open dlame. Store in the origin container 

securely closed and not exceeding 401:. 

8.Exposure controls/personal protection 

Exposure controls: Avoid generating and inhaling dust. Local exhaust ventilation shoud be 

used. Keep container closed when not in use. 

Personal protective equipment 

Respiratory protection :Wear suitable particle filter mask when exposed to dust. 

Eye protection Chemical safety goggles 

Hand protection Chemical resistance gloves 

Skin protection Skin contact can be minimized by wearing protective clothing. 

Body protection Anti-static electrical work clothes, anti-static electrical boots. 

9.Physical and chemical properties 

Appearance Pale yellow liquid 

Odor Slight odor 

Boiling point No data available F,~ash point and Method 1901: (C. 0. C) · Flammability(solid, gas) Not flammabile 

Autoflammability No data available 

Explosive properties No data available 

Oxidizing properties No data available 

Vapor pressure (Pa) Not applicable 

Kinematic Viscosity (mm2/s) 50,.......70 

Density at 25"C (g/cnD 0. 90 

Sol ubi li ty:-wat~r solubility Negligible 

-h·t solubility , : Appreciable .Partition c.oefficient:n-octanol/wa(er:No date available .. . . . . 

page 16 

........ 

. , 
MATERIAL SAFETY DATA SHEET 

ADEKA K I KULUBE 

P A G E : 4/5 

DATE PREPARED:19/June/2000 

DATE REVISED 

PRODUCT NAME FM-ol~C M S D S No. : 39475 

10.Stabi I ity and reactivity 

Condition to avoid :Direct sunlight, high temperature. 

Materials to avoid : Alkalies. 

Hazardous decomposition products: Carbon monoxide. 

information 

: No evidence of irritant effects from normal handling and use. 

11. Toxicological 

Skin contact 

Eye contact 

Inhalation 

Ingestion 

Sensitization 

Carcinogenicity 

:This substance is not expected cause prolonged or significant eye irritation. 

LC 50 : No data available 

Oral toxicity has not been determined. 

This product is not known and reported to be sensitive. 

This product is not known and reported to be carcinogenic by any reference 

source including IARC,NTP and EEC. 

Mutagenicity : This product is not known or reported to be mutagenic. 

Reproductive 

Narcosis 

toxicity :No relevant information found. 

: No relevant information found. 

12.Ecologocal information 

Ecological information: No data are available on the adverse effects of this material on the 

environment. 

13.Disposal 

Disposal 

consideration 

information: Burn in an adequate incinerator or bury in landfill in accordance with 

.. 

'· 

14. Transportation 

UN NO 

IMDG CODE 

Marine pollutant 

. .. . . 

. . 

all applicable regulations. Any disposal practice must be in compliance with 

law and regulations. 

information 

Not applicable 

Not applicable 

Not applicable 

, . 

page 17 
MATERIAL SAFETY DATA SHEET 

P A G E : 5/5 

ADEKA K I KULUBE 

FM-b 1 ~C 

DATE PREPARED:19/June/2000 

DATE REVISED 

PRODUCT NAME 

15.Regulatory 

Labeling: 

EINECS 

information 

Symbol Not applicable 

R-Phrase Not applicable 

S-Phrase Not applicable 

~ registered 

16.0ther information 

REFERENCE: 

None 

[] not registered 

Technical contact point: Japan ASAHI DENKA KOGYO K. K. 

M S D S No. 

TEL 81-3-3892-2965 FAX 81-3-3819-4347 

Agent 

Others None 

Date revised None 

Others None 

: 39475 

To t~e"best of our knowledge, the information contained herein is accurate. However, neither ASAHI 

DENKA"KOGYO K. K nor any of its subsidi-aries assumes any liability whatsoever for the accuracy or 

completeness of the information contained herein. Final determination of suitability of any material 

is the sole responsibility of the user. All materials may present unknown hazards and should be used 

with caution. Although certain hazards are described herein, we cannot guarantee that these are the 

only hazards which exist. 

Last page 

{(IJ.t~& '{q111t~rm;(;; ........ t 

Name : Goro Yamamoto ·' Ti~le: General.·Manager 

·Lubricaifs Department Organic Chemicals Development Laboratory ASAHI DENKA KOGYO K.K 

page 18 
.. 

page 19 
.. 

page 21 
.. 

page 22 
.. 

page 23 
.. 

page 24 
( 

--- ~----~ -··-· "··- , .... " .. " -- -·-- . ,_ ... ~. ---.~ .. -.. -· ·~-· ----·-·-·~·----·-· --·· """~- ·---·-· '" 

ADEKA 

,.,{ 

ASAHI DENKA KOGYO K.K. 

ADEKA KIKULUBE 

Ash -less Friction Modifier 

ADEKA KIKULUBE is our product for lubricant additive. 

N6.000216 

"FM" series is ash-less friction modifier. You have three selections from FM series. 

Please choice best one for your purpose. 

ADEKA KIKULURE FM-210 (ester derivative) 

ADEKAKIKULUBE FM-618C (eter derivative) 

ADEKA KIKULUBE FM-832 (amine derivative) 

Tvnical Properties 

item unit FM-210 FM-618C 

Chemical ester derivative eter derivative Description 

Appearance White paste Pale yellow 

liquid 

Melting point ("C) 41 ........ 

Density 25"C(g/cm3) --- 0.90 

Kinematics 40"C (mm2/s) 11(100"C) 69 viscosity 

Flash point "C(COC) 220 200 

Acid value (mgKOH/g) 1.0 ---

Hydroxyl value (mgKOH/g) 222 298 

Total Basic (mgKOH/g) --- --- Number 

MITI Registered Registered 

Registration TSCA Registered In progress* 

EINECS Registered Registered. 

* FM-618C to TSCA inventory w1ll be registered by March 2001. 

Contact point 

R&D 

(Tokyo, Japan) 

Europe 

(Dusseldorf, Germany) 

Organic Chemicals R&D 

Tel: 81·3-3892·2965 

Fax: 81-3-3819·4347 

ASAHI DENKA EUROPE GmbH 

Tel: +49 211179 24 50 

Fax: +49 211171 04 70 

1 • ,r i 

·r 1 

F-832 

amine derivative 

Brown paste 

31 

0.92(40°C) 

69 

230 

---

---

2.9 

Registered 

Registered 

Regi~:~tered.