1 of 8 ENCLOSURE 1 

### INFORMATION COLLECTION REQUEST FOR Flexible Polyurethane Foam Production We are conducting this Information Collection Request (ICR) to assist the EPA Administrator in developing emission standards for Flexible Polyurethane Foam under Clean Air Act (CAA) section 112. We are sending this ICR to you under the authority of Section 114 of the CAA.

BACKGROUND: We are required by section 112(f)(2) of the Clean Air Ac t (CAA) to assess the risk remaining (residual risk) eight years after the applicat ion of maximum achievable control technology (MACT) standards under section 112(d). If we find the residual risk fails to protect public health with an ample margi n of safety or to prevent (taking into consideration various factors) adverse environm ental effects, we are required to promulgate more stringent standards. The Flexible P olyurethane Foam MACT standard was promulgated in October 1998 (see 63 FR 53980). We are preparing to initiate our residual risk review. Please not e this survey is for flexible polyurethane foam production only and does not cover flexible polyurethane foam fabrication, other than identifying if flexible polyurethane foam fabrication is conducted as a co-located operation. Section 114(a) of the CAA gives us the authority to require you to provide us with information for the following purposes:

1. Developing or assisting in the development of the following:
a. State implementation plans (§§ 110 and 111(d)); b. New Source Performance Standards (NSPS) (§ 111);
c. National Emissions Standards for Hazardous Air Pollutan ts (NESHAP) (§ 112); d. Solid waste combustion or other related solid waste regula tions (§ 129); 2. Determining whether any person is in violation of any stan dards or requirements developed under the authorities cited above; or 3. Carrying out any provision under the CAA (except certain pr ovisions under Title II).2 of 8



### The Administrator may require that those persons identifi ed above do the following so the Administrator may have the information nec essary for the items listed in #1-3:

 make reports;

 establish and maintain records;

 install, use, and maintain monitoring equipment, and use a udit procedures, or methods;

 sample emissions (in accordance with such procedures or methods, at such locations, at such intervals, during such periods, and i n such manner as we shall prescribe);

 keep records on control equipment parameters, production vari ables or other indirect data when direct monitoring of emissions is imp ractical;

 submit compliance certifications in accordance with s ection 114(a)(3); and

 provide such other information as we may reasonably require

. We seek information on existing flexible polyurethane foam prod uction sources in this survey in order to collect information needed to conduc t the residual risk review required by section 112 of the Act.

DIRECTIONS FOR COMPLETING THIS SURVEY: You must complete and return this survey by December 6, 2011. You must identify clearly any response(s) that you consider to be con fidential business information (CBI). Any responses not so identified will be included in a pub licly available database. You may refer to Enclosures , 3, 4, 5, and 6 to learn how we will treat CBI as well as what information you may be asked t o submit later to substantiate a claim of confidentiality. DEFINITIONS: For the purposes of this ICR only, use the following definitio ns: Auxiliary blowing agent, or ABA, means a low-boiling point liquid added to assist foaming by generating gas beyond that resulting from the isocya nate-water reaction. Flexible polyurethane foam means a flexible cellular polymer containing urea and carbamate linkages in the chain backbone produced by reacti ng a diisocyanate, polyol, and water. Flexible polyurethane foams are open-cel led, permit the passage of air through the foam, and possess the strength and flexib ility to allow repeated distortion or compression under stress with essentially complete recovery upon removal of the stress. Flexible polyurethane foam process means the equipment used to produce a flexible polyurethane foam product. For the purpose of this survey, th e flexible polyurethane3 of 8



### foam process includes raw material storage; production equip ment and associated piping, ductwork, etc.; and curing and storage areas.

HAP ABA means methylene chloride, or any other HAP compound used as an auxiliary blowing agent. Initial startup means the first time a new or reconstructed affected so urce begins production of flexible polyurethane foam. Rebond foam means the foam resulting from a process of adhering small particles of foam (usually scrap or recycled foam) together to make a u sable cushioning product. Various adhesives and bonding processes are used. A typic al application for rebond foam is for carpet underlay. Rebond foam process means the equipment used to produce a rebond foam product. For the purpose of this subpart, the rebond foam process include s raw material storage; production equipment and associated piping, ductwork, etc.; and curing and storage areas. Recovery device means an individual unit of equipment capable of and used fo r the purpose of recovering chemicals for use, reuse, or sale. R ecovery devices include, but are not limited to, carbon adsorbers, absorbers, and condense rs. Slabstock flexible polyurethane foam means flexible polyurethane foam that is produced in large continuous buns that are then cut into t he desired size and shape. Slabstock flexible polyurethane foam production line includes all portions of the flexible polyurethane foam process from the mixhead to the poi nt in the process where the foam is completely cured. Storage vessel means a tank or other vessel that is used to store diisocy anate or HAP ABA for use in the production of flexible polyurethane foa m. Storage vessels do not include vessels with capacities smaller than 38 cubic met ers (or 10,000 gallons).

CONFIDENTIAL BUSINESS INFORMATION (CBI) : Please indicate if any CBI is included in this survey re sponse: Y  N4 of 8 

### Flexible Polyurethane Foam Production Survey Form

PART I. OWNER INFORMATION For questions 3 through 5, provide a separate Part I form for each facility, if you own or operate more than one facility. 1. Name of Legal Owner: Hickory Springs Manufacturing Company a. Address: 235 2 nd 

### Avenue NW b. City: Hickory c. State: North Carolina d. Zip: 28601 e. County: Catawba 2. Facility Name: Hickory Springs of California, Inc., Portland Plant
3. Complete street address of facility (physical location): a. Address: 3900 NE 158 th 

### Avenue b. City: Portland c. State: Oregon d. Zip: 97230 e. County: Multnomah f. Longitude and Latitude coordinates [in decimal degrees w ith five significant figures to the right of the decimal place (e.g., 38.27941, -85.64371)] : 45.551174, -122.498383 4. Facility Contact: a. Name (First Name, Last Name): Kevin Trafton b. Title: Plant Manager c. Telephone Number: (503) 255-4650 Ext ____________ d. Fax Number: (503) 253-9216 e. E-mail address: ktrafton@hickorysprings.com f. Primary NAICS code for the facility: 326155 of 8



### 5. Flexible Polyurethane Foam Production
We believe that you own or operate a facility that engages in production of slabstock, molded or rebond flexible polyurethane foam. If you believe that this survey does not pertain to you, please indicate your reas on below:

Plant is permanently shut down. Please also identify the da te the Foam Production plant was shut down and what steps were taken to cl ose the Foam Production plant. Include date the permit was inactivat ed.

________________________________________________________________

________________________________________________________________

________________________________________________________________
No slabstock, rebond, or molded flexible polyurethane foam prod uction plant is located at this facility.

If you do not operate a flexible polyurethane foam producti on plant (i.e., you check either box for question 5), we will review that in formation and respond as to whether you need to complete any other part of the survey
Please mail, fax, or e-mail Part I to:

U.S. EPA Mailroom Attn: Sharon Nizich Mail Code: D243-04 Research Triangle Park, NC 27711 Phone: 919 541 2825 Fax: 919 541-5450 Email address: Nizich.sharon@epa.gov6 of 8



### PART II. GENERAL FACILITY INFORMATION

1

. Please provide the following general information for each flexible polyurethane foam production plant: a. Number of employees at the facility where the fle xible polyurethane foam production is located: 53 b. Number of employees at the parent company, organization or institution (e.g. municipality, university, etc.) that owns the facility: 2,511 (company-wide) c. Is the legal owner a small entity as defined by the R egulatory Flexibility Act?
Refer to the Small Business Administration’s Size Sta ndards at: http://www.sba.gov/sites/default/files/Size_Standards_ Table.pdfY  N Unknown [insert the following if applicable] d. Any other co-located operations and if so, what type of opera tion? Fabrication of flexible polyurethane foam and rebond operat ions. e. Are any operations on site subject to federal and Stat e emission standards and if yes, which standards? No
f. Is the facility a major source or area source? Major sources are all activities located on contiguous area under common control where the aggregate potential to emit for the activities exceeds ten (10) tons per year of a single HA P or twenty-five (25) tons per year of a combination of HAPs. No


### g. Type of plant. Check all that apply.Molded Flexible Polyurethane Foam  Slabstock Flexible Polyurethane Foam  Rebond Foam Production h. Please list information concerning storage tanks at thi s facility, including size, contents, estimated emissions of emitted pollutants, and p iping characteristics. Utilize a flow diagram if necessary. See ATTACHMENT A.7 of 8



### 2. Please provide a flow diagram of the process units associ ated with the flexible polyurethane foam production process at your faci lity. Label each process unit and emission point with a unique identif ication code and complete the table below. The flow diagram should display an identification code for streams entering (raw materials/feedstocks) and exiting the process un it (product streams), and emission streams. The flow diagram should also display a n identification code for add-on control devices and streams entering and exiting the add-on control devices. Where applicable, include in-process streams, waste streams, wastewater streams, and emission release points in the flow diagram. Identification code Description of item submitted with survey response EQUIP-001 Raw materials associated with flexible polyurethane foam manufacturing. Tank details are provided in Attachment A. EP-01 through EP-05 Emissions associated with flexible polyurethane foam manufacturing process. EP-06 through EP-08 Emissions associated with the curing of the foam buns during temporary storage. AA-002 Emissions associated with the fabrication operatio ns.

PS-001 Final bedding or furniture component products for delivery to customers.8 of 8



### 3. List Federal air pollution control regulations applicabl e to each process unit.

Process unit name Process unit

identification code Federal air pollution control regulation PU Foam Mfg AA-001 40 CFR 63.11416(b) PU Foam Fab AA-002 40 CFR 63.11416(e)Enclosure 2

Location:

2010 2009 2008 2010 2009 PU Foam Mfg AA-001 20,118,661 16,237,604 20,842,583 Board Feet 240 hrs 240 hrs Process unit name Production Amount Production units (e.g., gallons, pounds) PART III. FEEDSTOCK, RAW MATERIAL, AND PRODUCTION INFORMATION 1. Please complete the following table for production information for each process unit.

Average time each product was manufactured (e.g., days, or hours) Process unit name Hickory Springs Manufacturing Company, Portland, OREnclosure 2

2008

240 hrs PART III. FEEDSTOCK, RAW MATERIAL, AND PRODUCTION INFORMATION 1. Please complete the following table for production information for each process unit.

Average time each product was manufactured (e.g., days, or hours) Hickory Springs Manufacturing Company, Portland, OREnclosure 2

2010 2009 2008 PU Foam Mfg TDI mi Pounds 913,798 740,834 954,266 2. Please complete the following table for Raw Materials/feedstocks entering each process unit. Include only HAP-containing feedstock.

Process unit name Raw

material/feedstock Raw material/feedstock amount Raw material/feedstockEnclosure 2

Raw material products/feedstock Auxiliary Blowing Agents Chemical Compounds % of each chemical compound 2,4-TDI 80% 2,6-TDI 20% Acetone Acetone Acetone 100% Polyols - - Polyether poyol 100% Surfactant - - Silicone 100% Catalyst - - Amine catalyst 100% Colorant - - Dyes 100% 3. Provide composition information for feedstock/raw materials.

Toluene Diisocyanate (mi) - -Adhesive Name HAP Contained HAP Content (wt%)

4. Are any HAP-containing adhesivies utilized in repair of foam as part of the production process?

None UsedEnclosure 2

Annual Usage (lbs) 4. Are any HAP-containing adhesivies utilized in repair of foam as part of the production process?

None UsedXylenes (Mixture of o, m, and p Isomers)

Methyl Isobutyl Ketone 2,4-Toluene Diisocyanate Methylene Chloride Toluene Ethyl Benzene Styrene Diethanolamine Benzene Bis(2-Ethylhexyl)Phthalate Glycol Ethers Methanol 4,4'-Methylenediphenyl Diisocyanate p-Dioxane 1,2-Epoxybutane Cumene Vinyl Acetate Triethylamine Chloroform Acetonitrile Phenol Cyanide & Compounds Hexane Formaldehyde p-Xylene Acetaldehyde Acrylonitrile Ethylene GlycolEnclosure 2a

Hours Per (e.g., week,

month, year) AA-001 1971 Not available 25 years Not available 20 week Owner Name: _Hickory Springs of California, Inc.________________________________ Facility Name: __Portland Plant________________________________________ Process Unit ID: _AA-001________________________________________ PART IV. GENERAL FLEXIBLE POLYURETHANE FORAM PRODUCTION INFORMATION

Process unit ID Year unit

originally installed Original captial

cost of unit(s) Remaining useful life

of unit Maximum design

capacity (e.g., lbs/day) Please complete the following questions for each Flexible Polyurethane Foam Production process unit. You are not expected to generate new information for this survey. Only supply data that are readily available to you.

Typical unit operation 1. Please provide the following information for each Flexible Polyurethane Foam Production process unit:
a. Provide general information for each process unitEnclosure 2a Owner Name: _________________________________________ Facility Name: ______________________________ Process Unit ID: _____________________________

AA-001 No air pollution control devices trains. b. Provide information on upgrades to each flexible polyurethane foam production process unit and associated air pollution control

Description of upgrades made to air pollution control devices associated with the Description of upgrades made to the process unit Year(s) upgrade was made Process unit ID Year(s) upgrade was madeEnclosure 2a

Process Unit ID Total operating and

maintenance costs 2008 2009 2010 AA-001 Owner Name: _____________________ Facility Name: _______________________________________ Process Unit ID: ____________________________________

No Air Pollution Control Devices c. Using the format on this page, include operating and maintenance cost information for each process unit. Definitions for different types of costs are taken from EPA Air Pollution Control Cost Manual at http://epa.gov/ttn/catc/products.html#cccinfo2. Include yearly emissions information in the following table (include source of information).

Emission Point Process Unit ID HAP Pollutant Tons per year 2006 Tons per year

2007 Tons per year

2008 Tons per year

2009 EP-01 AA-001 2,4-Toluene Diisocyanate EP-02 AA-001 2,4-Toluene Diisocyanate EP-03 AA-001 2,4-Toluene Diisocyanate EP-04 AA-001 2,4-Toluene Diisocyanate EP-05 AA-001 2,4-Toluene Diisocyanate 0.022* 0.013* 0.019* 0.014* unit. Owner Name: __________________________________________ Facility Name: ____________________________ Process Unit ID: ___________________________

Include storage tanks or any auxiliary equipment on site, per unit ID and label each as type of* Emissions are for TDI Mixed Isomers (2,4 and 2,6-TDI).Enclosure 2a

Tons per year 2010

0.014* Owner Name: __________________________________________ Facility Name: ____________________________ Process Unit ID: ___________________________Enclosure 2a

f. For pollutants measured with continuous emissions monitoring systems (CEMS), please submit a copy of the most recent Relative Accuracy Test Audit (RATA) for the last 30 day period including those days where manual testing was conducted. b. Describe emission release point(s) that were tested: __________________________________________________ c. Date of test: ______________________________________ d. Specify the test method(s) used: ___________________________________________________________________

_________________________________________________________________________________________________ e. Submit a copy of the test reports. Owner Name: __________________________________________ Facility Name: ____________________________ Process Unit ID: ___________________________

3. Provide information on each emission test conducted at each specific process unit. Please copy this page and provide the following information for each test conducted at anytime in the last 5 years.

a. Identify the Process Unit ID: ___________________________________ No emissions testing perfomed at facility.Enclosure 2a

___________________________________________________________________________________

__________________________________________________________________________________ g. Model No: ________________________________________________________________________
h. Original installed cost of the control device (capital cost of the control plus installation cost):

__________________________________________________________________________________ d. Type of control device: _____________________________________________________________ Process Unit ID: ___________________________

(e.g., ductwork, piping, foundation/supports, site preparation): __________________________

___________________________________________________________________________________

___________________________________________________________________________________ following information for each unit:

f. Manufacturer: _____________________________________________________________________ a. Process Unit ID: _____________________________________________________________________ There are no air pollution control devices at the facility.

i. List the elements that are included in the installed cost estimate in question IV.5.h e. Year installed: _____________________________________________________________________ Owner Name: ______________________________ Facility Name: ____________________________

4. For each flexible polyurethane foam production process unit, provide the following

__________________________________________________________________________________ information regarding air pollution control devices. Please copy this page and provide the

b. Does the process unit have a control device that reduces air pollution : _____ Yes _____ No
c. Describe the release point(s) that are being controlled (e.g., equipment or unit operation where the release point is located): __________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________Operating cost information 2008 2009 2010 Control device ID: Total operating costs Electricity costs Wastwater treatment costs Fuel costs Water costs Waste disposal costs Process unit operating labor costs Monitoring, recordkeeping, and reporting
Other (please describe):

________________ Other (please describe):

________________ control device. j. Use the following table to provide the annual cost for operating and maintenance of eachEnclosure 2a

Process unit ID Measures or modification made to minimuze emissions Estimated emission reduction (lb/yr)

AA-001 Maintenance procedures for pumps,

hoses, pipelines Unknown Owner Name: _______________________________ Facility Name: ________________________ Process Unit ID: _______________________

5. For each process unit identify measures (e.g., annual tune-ups or burners, good comubtion practices, pollution prevention measures, or any other emission control approaches that reduce HAP emissions) or modifications made to the process unit to reduce emissions:Enclosure 2a

No emission reduction techniques have been performed at the facility.

Emission reduction technique descriptions Pollutants affected Reduction efficiency

________________________ _______________________ ____________________

________________________ _______________________ ____________________

________________________ _______________________ ____________________

________________________ _______________________ ____________________

________________________ _______________________ ____________________

________________________ _______________________ ____________________

___________________________________________________________________________________________

___________________________________________________________________________________________

7. Please submit a copy of any cost information you have for the modification or emission reduction method (other than add-on control devices) listed above. ___________________________________________________________________________________________

___________________________________________________________________________________________ f. What is annual parameter monitoring cost?

___________________________________________________________________________________________ e. At what frequency is parameter monitor quality assurance/control (e.g., calibration) performed? Owner Name: __________________________________________ Facility Name: ____________________________

______________________________________________________________________________________________ c. At what frequency is parameter monitoring done? ______________________________________________
d. Describe initial and ongoing parameter monitoring quality assurance/control: 6. Other emission reduction techniques. Include any information about changes made in raw material usage to Process Unit ID: ___________________________

reduce emissions, such as substitutions or product reformulation.

a. Complete fo each emission reduction technique utilized that is not a contro device.

b. What parameters are monitored to ensure operation of the emission reduction technique?Enclosure 2a

Other than normal day-to-day start up and shutdown cycles, no emergency shutdown/start-up events have occurred during the past 3 years.

Emission source(s) causing event Description

of event Permit

conditions exceeded (Y/N) Date of

Event Duration

of each event (hours) Was the event

covered by a contingency plan for controlling emissions? (Y/N) Estimates

of emissions during event (pounds) Basis for

emissions estimate Any monitoring

data or control system parameter monitoring collected during event? (Y/N) a. Please indicate number of times over the last 3 years that a shutdown and start-up event has occurred: ____________________________________________
b. Complete the following table for each shutdown and start-up event occurring over the last three years. Owner Name: __________________________________________ Facility Name: ____________________________ Process Unit ID: ___________________________
8. Please provide the following information for each process unit during start-up and shutdown operation:No existing procedures are utlized or followed to minimize emissions during normal start-up

and shutdown activities.

(either stand-alone or contrained within the periodic excess emissions report) to your permitting aurhority? ___No_________________________________________________________ _______________________________________________________________________________ i. What were the test conditions at the time of testing ? ________________________________

_______________________________________________________________________________

_______________________________________________________________________________

of the flexible polyuretuane foam production process unit.
k. Are you required to submit periodic and immediate start-up and shutdown reports _______________________________________________________________________________ j. Please submit a copy of any test data you have conducted during any start-up or shutdown _______________________________________________________________________________ Enclosure 2a

c. Please list the procedures that are followed or any activities that occur during start-up and shutdown at this process unit to minimize emissions (e.g., turn off unit, monitor pressure):

d. Is the emission profile of the flexible polyurethane foam production unit differenet during start-up and shutdown than during normal operating conditions? _____ Yes _____No

e. If the answer to Part IV 9.d. is yes, please explain, in detail, how and why emissions are different

__________________________________________________________________________________

__________________________________________________________________________________ f. Do you have test data that show emissions durint start-up or shutdown? __ Yes _X_ No

_______________________________________________________________________________ h. Please identify the emissions test method(s) used during start-up or shutdown.

_______________________________________________________________________________

_______________________________________________________________________________ g. If yes, when and why did you conduct such testing? __________________________________ Owner Name: ___________________________ Facility Name: ____________________________ Process Unit ID: ___________________________

_______________________________________________________________________________Enclosure 2a

Longitude Latitude Owner Name: ___________________________ Facility Name: ____________________________ Process Unit ID: ___________________________

9. Stack Relase Parameters for Emission Points Please provide the following information for all emission release points for use in righ modeling

Data Not Available Diameter of release point (feet) Location of release point (decimal degrees, minimum 5 digits beyond

decimal) Emission Point Process Unit ID Height of release point (feet) Exit of velocity

of vent release point (feet/second) Exit

temperature of vent/flue gas (F)Height of release point Release Height Longitude Latitude (ft) (ft)

Notes on Modeling Data:

Coordinates: For geographic coordinates, provide either latitude and longitude or UTM coordinates with zone. Latitude and longitude should be provided in decimal degrees, with 6 digits to right of decimal point, and an indication of the associated NAD (North American Datum, either NAD27 or NAD83. If left blank, NAD83 will be

Latitude: Measure in decimal degrees of the angular distance on a meridian north or south of the equator. Positive (+) data point for N. America. Include (+) sign. Ex. +78.123456. For point sources this represents the center of the source; for fugitive sources this is the southwest corner if thefugitive angle is zero, or the western most corner if the fugitive angle is greater than zero.
Longitude: Measure in decimal degrees of the angular distance on a meridan east or west of the prime meridian Negative (-) data point for N. American. Includle (-) sign. Ex. -123.234561. For point sources this represents the center of the source; for fugitive sources this is the southwest corner if the fugitive angle is zero, or the western most corner if the fugitive angle is greater than zero. Not Currently Available apply. Notes on modeling data definitions are below. Owner Name: ___________________________ Facility Name: ____________________________

10. Non point releases. Please include a listing of fugitive releases, including the following information per release point. Please include "no releases" if this question does not

Location of release point (decimal degrees, minimum 5 digits beyond decimal) Emission Point Process Unit

IDAngle of Rotation: Angle of rotation specifies the rotation of the source from north

(in the clockwise direction). The location coordinates (UTM or latitude and longitude) should reflect the southwest corner of the area source. The x-dimension should reflect the length of the source in the easterly direction, or in the southeasterly direction if the source is rotated. The y-dimension should reflect the length in the northerly direction, or the northeasterly direction if the source is rotated. Longitude: Measure in decimal degrees of the angular distance on a meridan east or west of the prime meridian Negative (-) data point for N. American. Includle (-) sign. Ex. -123.234561. For point sources this represents the center of the source; for fugitive sources this is the southwest corner if the fugitive angle is zero, or the western most corner if the fugitive angle is greater than zero.Angle of Rotation

x (length, ft) y (width, ft) (degrees) Not Currently Available apply. Notes on modeling data definitions are below. Owner Name: ___________________________ Facility Name: ____________________________

10. Non point releases. Please include a listing of fugitive releases, including the following information per release point. Please include "no releases" if this question does not

Dimension of SourceEnclosure 2a

_______________________________________________________________________________ n. What control devices are upstream of the scrubber? _________________________________
o. What control devices are downstream of the scrubber? ______________________________ l. Average outlet gas temperature for each scurbber: ________________________________ o F
m. Please describe the source and quality of the water fed to the scrubber (e.g., effluent water with a total solids content of _____): _________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________ k. Mist eliminator: _____ Yes _____ No _______________________________________________________________________________

_______________________________________________________________________________ c. Type of scrubber: _______________________________________________________________
d. Design pollutant-laden gas inlet flow rate: ______acfm

e. Design pollutant-laden gas inlet temperature: ________ o F
f. Scrubbing medium (describe): ____________________________________________________
g. Influent scrubbing medium pH: ___________________________________________________
h. Effluent scurbbing medium pH: ___________________________________________________
i. Scrubber water flow: _________________________________________________ gals/min (?)
j. Scrubber pressure drop (across each scrubber--provide units): _________________________ b. Please list the pollutants that the scrubber is intended to reduce or remove. Owner Name: ___________________________ Facility Name: ____________________________ Process Unit ID: ___________________________

11. Scrubber
a. Does the flexible polyurethane foam production process unit have a scurbber?

_____ Yes ___X__ NoEnclosure 2a
Process Unit ID: ___________________________

No Carbon Adsorbers at the facility.

Legal Owner Name: Facility Name: Process Unit ID: Process Unit ID for controlled processes: Stack or Vent Height (ft) Stack or Vent Diameter (ft) Manufacturer/Model Original Installation Date Gas flow rate to condenser (acfm) Inlet gas temerature ( o F)
Compound Name Volume Fraction Compound Name Volume Fraction Compound Name Volume Fraction Compound Name Volume Fraction Organic compounds in inlet gas stream CARBON ADSORBER Owner Name: ___________________________ Facility Name: ____________________________

12. Carbon Adsorber Please include a copy of this table for each carbon adsorber controlling emissions from flexible polyurethane foam production process unit.

Describe any plans to replace or upgrade the adsorber Vendor guarantee on adsorber efficient (attach copy) Describe preventative maintenance procedures and frequency

List all monitoring methods used, including parameters and frequencyPolyolTolueneDiisocyanate*Water* Toluene diisocyanate, mixed isomers (CAS# 264-71-625).TDI tank vents are either equipped with vapor recovery or carbon absorbers are installed. Transfer pumps are either sealess or are submerged in neutral oil.** Acetone (no other blowing agent used)1There are no emission control devices associated with the emissions.Blowing Agent**SurfactantCatalystsColorantFlow Control SystemBun Cut-Off SawFoaming Tunnel (VARIMAX) Transition TunnelConveyorMixingHeadBottom PaperWrap Take-UpSide PlasticTake-UpBun Processing: Trimming,Slitting and AdhesiveOperations(MACT OOOOOO)Traversing HoodOver TunnelExhausts to Atmosphere1(EP-01 through EP-05)Location: Hickory Springs Manufacturing CompanyPortland Plant, Portland, OregonFlexible Polyurethane Foam ManufacturingBun Cooling, Curing &Temporary StorageCustomersProduct Stream (PS -001)Emission UnitsEQUIP-001Emission UnitAA-001Emission Unit AA-002Exhausts to Atmosphere1(EP-06 through EP-08)

### Bulk Storage Tanks

Facility: Portland, OR

Max. Date Const. O-Fill Field Cnst. Chemical TK # Position Capacity Installed Type Dim'sions Location Protection Sheltered Shop Fab. TDI 4 V 25,000 1988 Steel 11.5 x 34 OSTF Yes No SF

9 V 8,000 1971 Steel 10 x 14.5 Run Room Yes Yes SF

MDI 10 V 2,000 1985 Steel 6 x 11 Tk Unld. Area Yes SF

15 V 2,500 1994 Steel 7 x 8.5 Tk Unld. Area Yes Yes SF
Polyol 1 V 25,000 1988 Steel 11.5 x 34 OSTF Yes No SF

2 V 25,000 1988 Steel 11.5 x 34 OSTF Yes No SF 3 V 25,000 1988 Steel 11.5 x 34 OSTF Yes No SF 6 16,000 1971 Steel 16 x 11 OSTF Yes No ? 8 4,200 1971 Steel 10 x 7.5 Run Room Yes Yes SF 12 8,000 1989 Steel 10 x 14 Run Room Yes Yes SF 13 8,000 1989 Steel 10 x 14 Run Room Yes Yes SF

Acetone 46 H 8,000 1998 Steel 8 x 21.5 OSTF Yes No SF

Binder 16 2,500 1994 Steel 7 x 8.5 Tk Unld. Area Yes Yes SF

17 3,000 1994 Steel 7 x 8.5 Rebond Yes Yes SF

Ext. Oil 14 7,000 1994 Steel 12 x 8.5 Tk Unld. Area No Yes SF