**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 1** Company name: Company address:
Responding official name: Responding official title: Certifying official name: Certifying official title: Certif ying official contact information: Email: Telephone : I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsib le for gathering the information, I certify that the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Certifyi ng official signature Date

___________________________________________________________________________ ________ 1.a. Manufacture, import, or export of products Did your company

manufacture, import, or export a product (or products) containing mercury or mercury compounds in the y ears 2010, 2013, and/ or 2016? No ; if possible, describe why (e.g., permanentl y ceased such activity)
Yes 1.b. Manufacturing process es Did your company

use mercury

or mercury

compounds in a manufacturing process (or processes) (e.g., as commercial chemical products, including cataly sts, preservatives, reactants, reagents ) in the y ears 2010, 2013, and/or 2016? No; if possible, describe why (e.g., permanentl y ceased such activity)
Yes **IF YOU**  **SELECTED “NO”**  **IN RESPONSE**  **TO QUESTIONS**  **1.A. AND**  **1.B., THEN**  **DO NOT**  **COMPLETE ANY**  **ADDITIONAL SECTIONS**  **OF THIS**  **QUESTIONNAIRE. IF**  **YOU SELECTED**  **“YES” IN**  **RESPONSE TO**  **QUESTIONS 1.A.**  **AND/ OR**  **1.B. ,**  **THEN PROCEED**  **TO SECTION**  **2 .** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 2**  In the table below, please check the box for each product category for which your compan y manufactured, imported, or exported a product or products in the y ears 2010, 2013, and/or 2016. If you manufactured, imported or exported a mercury - containing product that does not fall within the listed product categories, then check the box for “ Miscellaneous mercury

- added products.” Categories of Mercury

- added Products If you checked a box at left, then proceed to: Batteries Section # 3 Cosmetics (including skin lightening soaps and creams) Section # 4 Dental amalgam Section # 5 Formulated products ( e.g., commercial chemical products, including catal ysts, preservatives, reactants, reagents) Section # 6 Li ghting , lamps , bulbs (including neon lighting and backlighting display s) Section # 7 Pesticides , biocides, topical antiseptics (including paint) Section # 8 Pumps Section # 9 Measuring instruments (e.g. , barometers, thermometers) Section # 10 Switches, relay s, sensors, valves (including thermostats) Section # 11 Misc ellaneous mercury - added p roducts (e.g., a product containing mercury not otherwise described in the above categories) Section # 12 Products derived from the use of mercury or mercury compounds in a manufacturing process Section #13 Certain Uses Within Categories of Mercury

- added Products: Please check each of the boxes below that apply to product category (ies) selected above, if the manufactured, imported, or exported product(s): Is (are) essential for civil protection or military uses; Is (are) used onl y for research, calibration of instruments, as a reference standard, or as a vaccine; or Contain ( s ) only

trace contaminants of mercury

.**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 3: Batteries**  Did your company

manufacture batteries that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury

compounds i n each of the following ty pes of battery per ye ar(s): (Use either metric or U.S. customary units ) Button cell, silver 2010 2013 2016 Button cell, zinc

- air 2010 2013 2016 Button cell, alkaline 2010 2013 2016 Stacked button cell batteries 2010 2013 2016 Manganese oxide 2010 2013 2016 Silver oxide 2010 2013 2016 Mercuric oxide 2010 2013 2016 Button cell, mercuric oxide 2010 2013 2016 Button cell, zinc carbon 2010 2013 2016 Large methylmercury batteries 2010 2013 2016 Other batteries 2010 2013 2016 If “other,” then provide a general description of the batteries: Did your company

manufacture an y button cell batteries wi th merc ury content of 2% or greater ? No; please proceed to question ( 2) of this section

. Yes If yes, then provide the approximate percentage of button cell batteries provided for question (1)a

. of this section in each of the following ye ars: 2010

__________ 2013 __________ 2016 __________ Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of batteries manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes M ercury or mercury

compounds used by your company to manufacture batteries in each of the following ye ars: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Did your company

import mercury

or mercury

compounds to be used in the production of batteries manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by

your company to manufacture batteries in each of the following years: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your company

import batteries containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported battery

per ye ar(s): (Use either m etric or U.S. customary units) Button cell, silver 2010 2013 2016 Button cell, zinc

- air 2010 2013 2016 Button cell, alkaline 2010 2013 2016 Stacked button cell batteries 2010 2013 2016 Manganese oxide 2010 2013 2016 Silver oxide 2010 2013 2016 Mercuric oxide 2010 2013 2016 Button cell, mercuric oxide 2010 2013 2016 Button cell, zinc carbon 2010 2013 2016 Large methylmercury batteries 2010 2013 2016 Other batteries 2010 2013 2016 If “other,” then provide a general description of the batteries: Did your company

import any

button cell batteries with mercury content of 2% or greater ? No; please proceed to question (5) of this section

. Yes If yes, then provide the approximate percentage of button cell batt e ries reported for question (4)a

. of this section in each of the following ye ars: 2010 __________ 2013 __________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW 2016 __________ Did your company

export batteries containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported battery

per ye ar(s): (Use either metric or U.S. customary units) Button cell, silver 2010 2013 2016 Button cell, zinc

- air 2010 2013 2016 Button cell, alkaline 2010 2013 2016 Stacked button cell batteries 2010 2013 2016 Manganese oxide 2010 2013 2016 Silver oxide 2010 2013 2016 Mercuric oxide 2010 2013 2016 Button cell, mercuric oxide 2010 2013 2016 Button cell, zinc carbon 2010 2013 2016 Large methylmercury batteries 2010 2013 2016 Other batteries 2010 2013 2016 If “other,” then provide a general description of the batteries: Did your company

export any

button cell batteries with mercury content of 2% or greater ? No; please proceed to question (6) of this section ; Yes If yes, then provide the approximate percentage of button cell batt e ries reported for question (5)a

. of this section in each of the following ye ars: 2010 __________ 2013 __________ 2016 __________ Additional comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPO**  **RT ANY**  **ADDITIONAL PR**  **ODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 4: Cosmetics** Did your company

manufacture cosmetics that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of cosmetics per ye ar(s): (Use either metric or U.S. customary units) Skin care products (creams, soaps, lotions) 2010 2013 2016 Other cosmetics 2010 2013 2016 If “other,” then provide a general description of the cosmetics: Did your company

manufacture an y cosmetics with mercury content of greater than 1 ppm ? No; please proceed to question (2) of this section

. Yes If yes, then provide the approximate percentage of th e number provided for question (1)a

. of this section in each of the following years: 2010 __________ 2013 __________ 2016 __________ Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of cosmetics manufactured b y your company in 2010, 20 13, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture cosmetics in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of cosmetics manufactured b y your company in 2010, 2013, or 2016? No; pleas e proceed to question (4) of this section

. Yes**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture cosmetics in each of the following years: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your company

import cosmetics containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported cosmetics per year(s): (Use either metric or U.S. customary units) Skin care products (creams, soaps, lotions) 2010 2013 2016 Other cosmetics 2010 2013 2016 If “other,” then provide a general description of the cosmetics: Did your company

import any

cosmetics with mercury

content of greater than 1 ppm ? No; please proceed to question (5) of this section

. Yes If yes, then provide the approximate percentage of c osmetics reported for question (4)a

. of this section in each of the following years: 2010 __________ 2013 __________ 2016 __________ Did your company

export cosmetics containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported cosmetics p er year(s): (Use either metric or U.S. customary units) Skin care products (creams, soaps, lotions) 2010 2013 2016 Other cosmetics 2010 2013 2016 If “other,” then provide a general description of the cosmetics:**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Did your company

export any

cosmetics with mercury

content of greater than 1 ppm ? No; please proceed to question (6) of this section ; Yes If yes, then provide the approximate percentage of c osmetics reported for question (5)a

. of this section i n each of the following years: 2010 __________ 2013 __________ 2016 __________ Additional comments:

___________________________________________________________________________

___________________________________________________________________ ________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMPOR** 

**T, OR EXPOR** 

**T AN**  **Y ADDITIONAL** 

**PRODUCT (S)**  **CONT AINING MERCUR** 

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 5: Dental Amalgam** Did your compan y manufacture dental cements and fillings that contain mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in eac h of the following ty pes of dental cements and fillings per year(s): (Use either metric or U.S. customary units) Dental cements and fillings 2010 2013 2016 Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of dental cements and fillings manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture dental cements and fillings in each of the following y ears: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mer cury

compounds to be used in the production of dental cements and fillings manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture dental cements and fillings in each of the following y ears: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import dental cements and fillings containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported dental cements and fillings per ye ar(s): (Use either metric or U.S. customary units) Dental cements and fillings 2010 2013 2016 Did your company

export dental cements and fillings containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported dental cements and fillings per ye ar(s): (Use either metric or U.S. customary units) Dental cements and fillings 2010 2013 2016 Additional comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPO**  **RT ANY**  **ADDITIONAL PR**  **ODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 6: Formulated Products** Did your company

manufacture formulated products (e.g., commercial chemical products, including catal ys ts, preservatives, reactants, reagents) that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of formulated products per y ear(s): (Use either metric or U.S. customary units) Cataly sts 2010 2013 2016 Preservatives 2010 2013 2016 Reactants 2010 2013 2016 Reagents 2010 2013 2016 Other formulated products 2010 2013 2016 If “other,” then provide a general description of the formulated products: Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of formulated products manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture formulated products in each of the following y ears: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of formulated products manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture formulated products in each of the following ye ars: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Did your compan y import formulated products containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported formulated products per ye ar(s): (Use either metric or U.S. customary units) Cataly sts 2010 2013 2016 Preservatives 2010 2013 2016 Reactants 2010 2013 2016 Reagents 2010 2013 2016 Other formulated products 2010 2013 2016 If “other,” then provide a general description of the formulated products: Did your company

export for

mulated products containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported formulated products per ye ar(s): (Use either metric or U.S. customary units) Cataly sts 2010 2013 2016 Preservatives 2010 201 3 2016 Reactants 2010 2013 2016 Reagents 2010 2013 2016 Other formulated products 2010 2013 2016 If “other,” then provide a general description of the formulated products:
Additional comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIO NAL**  **COMMENTS, THEN P LEASE PROCEED TO**  **ANY ADDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOU** **NDS IN**  **A MANUF** 

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 7: Lighting, Lamps, Bulbs** Did your company

manufacture lighting, lamps, or bulbs (including neon lighting and backlighting display s) that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of l ighting, lamps, or bulbs per year(s): (Use either metric or U.S. customary units) Linear fluorescent 2010 2013 2016 Compact fluorescent 2010 2013 2016 Cold cathode fluorescent 2010 2013 2016 External electrode fluorescent 2010 2013 2016 Mercury high pressure vapor 2010 2013 2016 High intensity

discharge 2010 2013 2016 Mercury short arc 2010 2013 2016 Neon 2010 2013 2016 Other lighting, lamps, bulbs 2010 2013 2016 If “other,” then provi de a general description of the lighting, lamps, or bulbs: Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of l ighting, lamps, or bulbs manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture l ighting, lamps, or bulbs in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of l ighting, lamps, or bulbs manufactured b y your compan y in 2010, 2013, o r 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture l ighting, lamps, or bulbs in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW 2013 __________ 2016 __________ Did your company

import l ighting, lamps, or bulbs containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported l ighting, lamps, or bulbs per ye ar(s): (Use either metric or U.S. customary units) Linear fluorescent 2010 2013 2016 Compact fluorescent 2010 2013 2016 Cold cathode fluorescent 2010 2013 2016 External electrode fluorescent 2010 2013 2016 Mercury high pressure vapor 2010 2013 2016 High intensity

discharge 2010 2013 2016 Mercury short arc 2010 2013 2016 Neon 2010 2013 2016 Other lighting, lamps, bulbs 2010 2013 2016 If “other,” then provide a general description of the lighting, lamps, or bulbs: Did your company

export l ighting, lamps, or bulbs containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported l ighting, lamps, or bulbs per ye ar(s): (Use either metric or U.S. customary units) Linear fluorescent 2010 2013 2016 Compact fluore scent 2010 2013 2016 Cold cathode fluorescent 2010 2013 2016 External electrode fluorescent 2010 2013 2016 Mercury high pressure vapor 2010 2013 2016 High intensity

discharge 2010 2013 2016 Mercury short arc 2010 2013 2016 Neon 2010 2013 2016 Other lighting, lamps, bulbs 2010 2013 2016 If “other,” then provide a general description of the lighting, lamps, or bulbs:**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Additional comments:

_____________

______________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS,**  **THEN PLEASE PROCEED TO**  **ANY A**  **DDITIONAL CA**  **TEGORIES YOU CHECK** **ED IN THE T ABLE IN S**  **ECTION 2. IF**  **Y OUR COMP** 

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING PROCESS(ES) , THEN DO NOT COMPLE**  **TE ANY**  **ADDITIONAL SE**  **CTIONS OF**

**THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Secti on 8: Pesticides, Biocides,**  **Topical Antiseptics (including Paint)**  Did your company

manufa cture pesticides, biocides, or topical antiseptics (including paint) th at contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of pesticides, biocides, or topical antiseptics per ye ar(s): (Use either metric or U.S. customary units) Agricultural applications 2010 2013 2016 Interior/exterior paints 2010 2013 2016 Other pesticides , biocides, and topical antisept ics 2010 2013 2016 If “other,” then provide a general description of the pesticides, biocides, or topical antiseptics : Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of pesticides, biocides, or topical antiseptics manufactured b y yo ur compan y in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture of pesticides, biocides, or topical antiseptics in each of the following ye ars: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of pesticides, biocides, and topical antiseptics manufactured b y yo ur company in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If y es, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture pesticides, biocides, or topical antiseptics in each of the following ye ars: (Use either metric or U.S. customary units) 2010 __________ 2013

__________ 2016 __________ Did your company

import pesticides, biocides, or topical antiseptics containing mercury or mercury compounds in 2010, 2013, or 2016?**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported pesticides, biocides, or topical antiseptics per year(s): (Use either metric or U.S. customary units) Agricultural applications 2010 201 3 2016 Interior/exterior paints 2010 2013 2016 Other pesticides, biocides, and topical antiseptics 2010 2013 2016 If “other,” then provide a general description of the pesticides, biocides, or topical antiseptics : Did your company

export pesticides, biocides, or topical antiseptics containing mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported pesticides, biocides, or topical antiseptics per year(s): (Use either metric or U.S. customary units) Agricultural applications 2010 2013 2016 Interior/exterior paints 2010 2013 2016 Other pesticides, biocides, and topical antiseptics 2010 2013 2016 If “other,” then provide a general description of the pesticides, biocides, or topical antiseptics :
Additional comments:

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________ _________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUN**  **DS OR USE MERCUR Y**  **OR ME**  **RCUR**

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 9: Pumps** Did your company

manufacture pumps that contain mercury or mercury

compounds in 2010, 2013, or 2016 ? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of pumps per y ear(s): (Use either metric or U.S. customary units) Pumps 2010 2013 2016 Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of pumps manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If y es, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture pumps in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of pumps manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture of pumps in each of the following years: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your company

import pumps containing mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported pumps per y ear(s): (Use either metric or U.S. customary units)**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Pumps 2010 2013 2016 Did your company

export pumps containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question ( 6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported pumps per y ear(s): (Use either metric or U.S. customary units) Pumps 2010 2013 2016 Additional comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TION AL**  **COMMENTS, THEN PL EASE PROCEED TO**  **ANY ADDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 10: Measuring Instruments** Did your company

manufacture measuring instruments that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of measuring instruments per year(s): (Use either metric or U.S. customary units) Barometer 2010 2013 2016 Fever thermometer 2010 2013 2016 Flow meter 2010 2013 2016 Hydrometer 2010 2013 2016 Hygrometer/ps ych rometer 2010 2013 2016 Manometer 2010 2013 2016 Non
- fever thermometer 2010 2013 2016 Py rometer 2010 2013 2016 Sphygmomanometer 2010 2013 2016 Other measuring instruments 2010 2013 2016 If “other,” then provide a general description of the measuring instruments : Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of measuring instruments manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture measuring instruments in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 ________

__ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of measuring instruments manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture of measuring instruments in each of the following ye ars: (Use either metric or U.S. customary

units)**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW 2010 __________ 2013 __________ 2016 ___

_______ Did your company

import measuring instruments containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following ty pes of imported measuring instruments per year(s): (Use either metric or U.S. customary units) Barometer 2010 2013 2016 Fever thermometer 2010 2013 2016 Flow meter 2010 2013 2016 Hydrometer 2010 2013 2016 Hygrometer/ps ych rometer 2010 2013 2016 Manometer 2010 2013 2016 Non
- fever thermometer 2010 2013 2016 Py rometer 2010 2013 2016 Sphygmomanometer 2010 2013 2016 Other measuring instruments 2010 2013 2016 If “other,” then provide a general description of the measuring instruments : Did your company

export measuring instruments containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please pro ceed to question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported measuring instruments per year(s): (Use either metric or U.S. customary units) Barometer 2010 2013 2016 Fever thermometer 2010 2013 2016 Flow meter 2010 2013 2016 Hydrometer 2010 2013 2016 Hygrometer/ps ych rometer 2010 2013 2016 Manometer 2010 2013 2016 Non
- fever thermometer 201 0 2013 2016 Py rometer 2010 2013 2016 Sphygmomanometer 2010 2013 2016 Other measuring instruments 2010 2013 2016**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW If “other,” then provide a general description of the measuring instruments :
Additional comments:

___________________________________________________________________________

___________________________________________________________________________

______________________________________________________________________ _____ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 11: Switches, Relays, Sensors, Valves** Did your company

manufacture switches, relay s, sensors, or valves that co ntain mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of switches, relay s, sensors, or valves per ye ar(s): (Use either metric or U.S. customary units) Ti lt switch 2010 2013 2016 Vi bration switch 2010 2013 2016 Float switch 2010 2013 2016 Pressure switch 2010 2013 2016 Te mperature switch 2010 2013 2016 Displacement relay 2010 2013 2016 We tted reed relay 2010 2013 2016 Contact relay 2010 2013 2016 Flame sensor 2010 2013 2016 Thermostat 2010 2013 2016 Other switches, relay s, sensors, valves 2010 2013 2016 If “other,” then provide a general description of the switches, relay s, sensors, or valves : Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of switches, relay s, sensors, or valves manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture switches, relay s, sensors, or valves in each of the following ye ars: (Use either metric or U.S. customary units) 2010

__________ 2013 __________ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of switches, relay s, sensors, or valves manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question ( 4) of this section

. Yes**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture of switches, relay s, sensors, or valves in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import switches, relay s, sensors, or valves containing mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed to question ( 5) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported switches, relay s, sensors, or valves per year(s): (Use either metric or U.S. customary units) Ti lt switch 20 10 2013 2016 Vi bration switch 2010 2013 2016 Float switch 2010 2013 2016 Pressure switch 2010 2013 2016 Te mperature switch 2010 2013 2016 Displacement relay 2010 2013 2016 We tted reed relay 2010 2013 2016 Contact relay 2010 2013 2016 Flame sensor 2010 2013 2016 Thermostat 2010 2013 2016 Other switches, relay s, sensors, valves 2010 2013 2016 If “other,” then provide a general description of the switches, relay s, sensors, or valves : Did your company

export switches, relay s, sensors, or valves containing mercury or mercury compounds in 2010, 2013, or 2016? No; please proceed t o question (6) of this section

. Yes If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported switches, relay s, sensors, or valves per year(s): (Use either metric or U.S. customary units) Ti lt switch 2010 2013 2016 Vi bration switch 2010 2013 2016 Float switch 2010 2013 2016 Pressure switch 2010 2013 2016 Te mperature switch 2010 2013 2016 Displacement relay 2010 2013 2016**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW We tted reed relay 2010 2013 2016 Contact relay 2010 2013 2016 Flame sensor 2010 2013 2016 Thermostat 2010 2013 2016 Other switches, relay s, sensors, valves 2010 2013 2016 If “other,” then provide a general description of the switches, relay s, sensors, or valves :
Additional comments:

___________________________________________________________________________

_________________________________________ __________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.**  **IF Y**  **OUR COMP**

**ANY DID NOT MANUF**  **ACTURE, IMPOR** 

**T, OR EXPOR** 

**T AN**  **Y ADDITIONAL** 

**PRODUCT (S)**  **CONT AINING MERCUR** 

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 12: Mi scellaneous Mercury**  **- Added Products**  Did your company

manufacture mercury

- added products not otherwise described in the categories described in the table in Section 2 that contain mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide a general description of the product and the total amount o f mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of mercury - added products manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture mercury - added products in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 _______

___ 2016 __________ Did your company

import mercury

or mercury

compounds to be used in the production of mercury added products manufactured by your company

in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes , then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture mercury - added products in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW Did your company

import mercury - added products containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Did your company

export mercury - added products containing mercury or mercury

compounds in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Additional comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TION AL**  **COMMENTS, THEN PL EASE PROCEED TO**  **ANY ADDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN THE T**  **ABLE IN S ECTION 2.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **IF Y**  **OUR COMP**

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUN**  **DS IN**  **A MANUF** 

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIONS OF**  **THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Section 13: Products Derived from the Use of Mercury or Mercury Compounds in a Manufacturing Process**  Did your company

manufacture mercury

- added products derived from the use of mercury or mercury compounds in a manufacturing process including, but not limited to acetaldehyde production in which mercury or mercury

compounds are used as a cataly st; vinyl ch loride monomer production; sodium or potassium methylate or ethylate; or production of poly urethane using mercury

containing

- catal ys ts in 2010, 2013, or 2016? No; please proceed to question (4) of this section

. Yes If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Did your company

purchase in the United States mercury or mercury

compounds to be used in the production of mercury

- added prod ucts derived from the use of mercury or mercury

compounds in a manufacturing process manufactured b y your company in 2010, 2013, or 2016? No; please proceed to question (3) of this section

. Yes If yes, then provide the total amount of domestically purchased mercury

or mercury

compounds used by yo ur company to manufacture such mercury

- added products in each of the following ye ars: (Use either metric or U.S. customary units) 2010 __________ 2013 __________ 2016 __________ Did your compan y import mercury or mercury

compounds to be used in the production of mercury

added products derived from the use of mercury or mercury

compounds in a manufacturing process manufactured b y your company in 2010, 2013, or 2016? No; please proceed to que stion (4) of this section

. Yes**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW If yes, then provide the total amount of imported mercury or mercury

compounds used by your company to manufacture such mercury

- added products in each of the following ye ars: (Use either metric or U.S. customary

units) 2010 __________ 2013 __________ 2016 __________ Did your company

import mercury

- added products derived from the use of mercury or mercury compounds in a manufacturing process in 2010, 2013, or 2016? No; please proceed to question (5) of this section

. Yes If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Did your company

export mercury
- added products derived from the use of mercury or mercury compounds in a manufacturing process in 2010, 2013, or 2016? No; please proceed to question (6) of this section

. Yes If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per ye ar(s): (Use either metric or U.S. customary units) 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 2010 2013 2016 Additional comments:

___________________________________________________________________________**INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW ___________________________________________________________________________

___________________________________________________________________________ **IF THERE**  **ARE NO ADDI**  **TIONAL COMMENTS, THE**  **N PLEASE PROCEED TO ANY**  **A DDITIONAL**  **CA TEGORIES**  **YOU CHECK ED IN**  **THE T ABLE IN SECTION**  **2. IF**  **Y OUR COMP** 

**ANY DID**  **NOT MANUF**

**ACTURE, IMP OR** 

**T, OR EXPOR** 

**T ANY**  **A DDITIONAL** 

**PRODUCT(S) CONT**  **AINING MERCUR**

**Y O**  **R MERCUR**

**Y COMPOUNDS**  **OR USE MERCUR Y**  **OR ME RCUR** 

**Y COMPOUNDS**  **IN A**  **MANUF**

**ACTURING P ROCESS(ES), THEN DO**  **NOT COMPLETE**  **ANY ADD**  **ITIONAL SECTIO**  **NS OF**

**THIS QUESTIONNAIRE.** **INTERNAL, DELIBERATIVE**

**– USG USE ONLY**  **Questionnaire Collection of Information on Use of Mercury and Mercury Compounds in P**  **roducts and Processes**

OMB Control No. 2070

-NEW **Paperwork Reduction Act Notice** : The annual public burden for this collection of information is estimated to be 2,566 hours. Send comments regarding the burden estimate or an y other aspect of the collection of information, including suggestions for reducing the burden to: Director, Collection Strategies Division, Office of Environmental Information (OEI), U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Avenue, N.W., Washington, D.C. 20460. Include OMB number 2070

- NEW in any

correspondence. Do not send the completed form or requested form or requested information to this address. The actual information or form should be submitted in accordance with the accompan yi ng instructions, or as specified in the corresponding regulations.