## PMN Page 1 ; Page 1 of 18 

## U.S. ENVIRONMENTAL PROTECTION AGENCY

ES



## GENERAL INSTRUCTIONS You must provide all information requested in this form to the extent that it is known to or reasonably ascertainable by you. Make reasonable estimates ifyou do not have actual data. Before you complcte this form, you should read the "Instructions Manual for Premanufaeture Notification" (the Instructions Manual is availablc from the Toxic Substances ControlAet (TSCA) Information Service by calling 202.554-1404, or faxing 202-554-5603). Ifa userfcc has becn remitted for this notice (40 CFR 700.45), indieate in the boxes above the TS·uscr fcc identification number you have generated. Remember, your user fcc ID number must also appearon your corresponding fcc remittance, which is sent to EPA, Washington financial Management Center (3303), P.O. DDI.i'l\,f 

### A**1\TTT~** 

## &rTITRF, 1111111 1II11 11111

# III!I 11111 1111111111

# 1IIIIIIIIiIIIIIIIII! 111111111111111111 5 1 09000041:'0/::3 

# Company Sanitized

360399M. Pittsburgh, PA 15251-6399, Attn. TSCA Uscr fcc.
Part I-GENERAL INFORMATION You must provide the currentlycorrect Chemical Abstracts (CA) Name ofthe new chemical substance. even ifyou claim the identity as confidential. You may authorize anotherperson [0 submit chemical identif}' infonnation for you, but your submission will not be complete and the review will notbegin until EPA receivesthis information. A letter in support ofyour submission should reference yourTS user fee identification number. You mus[ submit an original and two copies ofthis notice including all test data.. Ifyou claimed any infonnation as confidential, a single sanitized copy must also be submitted, Pal1l1-HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE Ifthere are several manufacture, processing. or use operations to be described in Part II, sections A and B ofthis notice. reproduce the sectionsas needed.

Part Ill-LISTOF AITACHMENTS Attach additional sheets ifthere is not enough space toanswer a question funy. Label each continuation sheet**~ith** the corresponding section heading. In Part lItlist these attachments, any test data orotherdata and any optional infmmation included in the notice.
OPTIONAL INfORMATION You may indude any information that you wanl EPA to consider in evaluatJng the new substance. On page 11 oftbis**form~** space has been provided for you to describe pollution prevention and recycling information you may have regardingthe new substance So-called "binding"boxes are included throughout this form for you to indicate your willingness to be bound to certain statements you make in this**section~** such as use, production volume. protective equipment. This option is intended to reduce delays that routinely accompany the development ofconsent orders: or Significant New Use Rules. Except in the case ofexemption applications (such as TMEA, LVE, LOREX) where certain information provided in such notification is binding on the submitter when the Agency approves theexemption application. checkinga binding box in this notice does not by itselfprohibit the submitter from later deviating from the information (except chemical identity) reported in the form. CONFIDENTIALITY CLAIMS You may claim any information in this notice as confidential. To assert a claim on the fonn, mark (X) the confidential box next to the information that you claim asconfidential, To assert a claim in an attachment, circle orbracket the information you daim as confidential. Ifyou claim information in the notices asconfidential you must alsoprovide a sanitized version ofthe notice (including attachmentsi. Foradditional instructionson claiming tflfonnatlon as cOflfidential. read the Instructions Manual. 

# [8J Mark (x) ifany infonnalion in this notice is claimed as confidential, TEST DATA AND OTHER DATA You arc required to submit all test data in yourpossession or control and to provide a description ofall other data known to orreasonably ascertainable by you, ifthese data 

### arc related to the health and environmcntal effects on the manufacture, processing, distribution in commerce, usc. or disposal ofthe new chemical substance. Standard literature citations may 

### be submitted for data in thc open scientific litcrature. Complete test data (written in English). not summaries ofdata must 

### be submitted ifthey do not appear in the open literature. You should clearly identify whethertcst data is on the substanceoron an analog. Also, the chemical composition oflhc tested material should becharacterized. Following arc examples oftcst data and otherdata. Data should be submitted according to the requirements of§720.50 ofthe Premanufaeture Notification Rule (40 CfR Part 720).

Test Data (Check Below any included in this notice) EnVironmental fate data 

# 0 Yes Otherdata 

# D Yos Health effects data 

# 0 Yes Risk assessments 

# E1 Emlironmental effectsdata 

# 0 Yes Structure/activity relttKmSbipSD PhysicaliChemical Properties· 

# 0 Yes Test data not in the possession or control ofthe submitter

# D A physical and chemical properties worksheet is located on the last page ofthis form. TYPE OF NOTICE (Che<:k Only One) 

# o PMN (Premanufacture Notice) 

# D INTERMEDIATE PMN (submitted in sequence with final product PMN) 

# D SNUN (Signiticant New Use Notice) 

# D TMEA (TesfMarketing Exemption Application) 

# D LVE (Low Volume Exemption) 

### !if 40 CFR 723.50(,)(1) 

# D LOREX (Low R.le.selLow**E~posure** Exemption)@40CfR 723.50(e)(2) LVE Modification LOREX Modific.tion 

# D D IS THIS A CONSOLIDATED PMN" Yes 

# o

EPA FORM 7710-25 (Rev. 5-95) Replaces previous editions ofEPA Form 7710-25.

## PMN Page 2 ; Page 2 of 18 Public reportingburden for this collection ofinfonnation isestimated to average 110 hours per response, including time for reviewing instructions, searchingexisting data sources, gathering and maintaining the data needed. and completing and reviewingthe collection of infonnation. Send comments regarding the burden estimate or any otheraspect ofthis collection ofinfonnation, including suggestions for reducing this burden, to Direetor, Collection Strategies Division (2822), U.S. Environmental Protection Agency, 1200 Pennsylvania Ave., N.W., Washington, D.C. 20460; and to the Office ofManagement and Budget. Paperwork Reduction Act (2070-00 12), Washington, D.C. 20503. 

# CERTIFICATION
- A Printed copy ofthis signature page, with original signature, must be submitted 

### I certify that to the best ofmy knowledge and belief: I. The company named in Part I, section A, subsection I a ofthis notice fonn intends to manufacture or import for a commercial purpose, otherthan in small quantities solely for research and development, the substance identified in Part I, Section B. 2. All infonnation provided in this notice is complete and truthful as ofthe date ofsubmission. 3. I am submitting with this notice all test data in my possession orcontrol and a description ofall otherdata known to or reasonably ascertainable by me as required by §720.50 ofthe Premanufacture Notification Rule. Additional Certification Statements: Ifyou are submitting a PMN, Intennediate PMN, Consolidated PMN, or SNUN, check the following user fee certification statement that applies: 

# oThe Company named in Part I, Section A has remitted the fee of$2500 specified in 40 CFR700.45(b), or 

# o The Company named in Part I, Section Ahas remitted the fee of$1000 for an Intennediate PMN (defined 

## @40 CFR 700.43) in accordance with 40 CFR 700.45(b), or 

# o 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). Ifyou are submitting a low volume exemption (LVE) application in accordance with40CFR 723.50(c)(I) or a Low release and low exposure exemption (LoRex) application in accordance with 40 CFR 723.50(c)(2), check the following certification statements: 

# o The manufacturer submitting this notice intends to manufacture orimport the new chemical substance for commercial purposes, other than in small quantities solely for research and development, under the tenns of40 CFR723.50. 

# oThe manufactureris familiar with the tenns ofthis section and wiII comply with those tenns; and 

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

# o Ifthis application is for an LVE in accordance with 40 CFR 723.50(c)(I), the manufacturer intends to commence manufacture ofthe exempted substance for commercial purposes within I year ofthe date ofthe expiration ofthe 30 day review period. Theaccuracy ofthe statementsyou make in this notice should renect yourbestpredictitm ofthe anticipated facts regarding the chemicat subsrante described herein. AllY knowing and willful misinterpretation is subjectto criminalpenaltypursuant to 18 USC 1001. Confidential ignature . ofAu . ed

### om at (Original Signaature Requiredl .. f) Date 

### Ta:::;;\ i'-1A-IJ 

### A.C«;::= 1<.,.,. 

### AtJ>:>':2.EA,

# !?'Au2S'\~\**~\** 2...

### :3! 

# 0'1 

# D**~~~agent** -(ifapplicable) Dare 

# o

EPA FORM 7710-25 (Rev. 5-95) Page 2

## PMN 

## Page 3 ; Page 3 of 18 Confidential lao Person Submitting Notice (in C.S.) 

# ______ _________D Company

b. Agent (if applicable) 

### LAMBERTI USA Inc. Mailing address (number and street) 

### Highway 59 at Mfbiza Road (Country Road 212) State 

### Hungerford, Texas Name

Mailing Postal

street) 

### Telephone (include area code)
C.

### lfyouare<111,mitt~;;~;;no~tT.ic;e~a~s~p;a~rt~o~f~a~j~o;'in;t~~bl~rJls~~lo~I~,~k7(Xx)lith~i~sbbo~x.~:::::::::::::::::::::::::::::::::::::::::::~":l~r Joint Submitter(if applicable)

2. Technical Contact (in U.S.) Name ofauthorized official 

### Colombo Maurizio Company 

### LAMBERTI S.p.A. Mailing address (number and street) 

### Via Piave, 18 Province, Country 

### Italy Name ofauthorized official 

### Balestrini Andrea Company 

### LAMBERTI USA Inc. Mailing address (numberand street) Postal Code 

### I-21041

Highway 59 at Mlniza Road (Country Road 212)

4.

5.

6. City, State 

### Hungerford, Texas Postal Code 

### 77448 (PC) concerning this notice and EPA assigned a PC Numberto the notlce, enter :::th:;.e.:,:n:;um:::b:;eT;:..'--

____ Ifyou prevlously submitted an exemption application for the cbemical substance covered by this**notice~** enter the exemption number assigned by EPA. tfyou previOUSly submitted a PMN for this substance enter the PMN number assigned EPA (I.e, withdrawn or II Tfyou for the chemical substance covered by this notice. enterthe notice number assigned by EPA. • I. Type ofNotice
- Mark (X) Manufacture Only 

# o 

# o Binding Option 1 2
. I I I I Position 

### Health 

### & Product Safety Manager

City, State 

### Albizzate (VA) 

### Telephone (include country orarea code) 0039 0331 715226 Position 

### Technical Manager



# o o Telephone (include area code) 281 342 565

Import Only Mark (X) ifnone Mark (X) ifnone Mark (X) ifnone
Binding Option Mark I 13. I I 

# D Both

EPA FORM 7710-25 (Rev. 5-95) Page 3

## 121002/003 06/25/2009 THU 14:13 FAX 979 532 3749 

## Lamberti U.S.A



## PMN Page 4 ; Page 4 of 18 Sectlett B - CHEMICAL IDENTITYINFORMATION:

l. 

### a. Class

### ofsubstance
-Marie (X) 

### or b. 

### Chemical

## name (Cunently**~I** 

### Chemical Abs1l8CI8 (CA)Name 

### !hilt

### is consistent wi1h 

### TSCA lnventoIY

### listings for

### similarsubstances. For Class 1 substances a CA Index Name mllSl

### beprovided. ForCIaR 2suIl6_

### eitheraCA IndexName orCA PreferredNlIllltmustbe

### provided. which ever is appropriate

### basI:don CA 9CInomem:brturerules and

### oonventiou). 

### 1

# ~Propanone r

# 1·!l.i;:16kydb~J~15~hen¥~~~~)i6i~h**~t.:(~1idxY:2** -metnil-"

c. Please identifY which method you used 10

### develop orobtain

### the 'l'ecitiedchemical identity informatioo repOrled 

### in thisnotice: (checkone). 

# O Method I, (CAS InventOty Expert Service
­ 8 

### copyofthe !dentiticatioo 

# r;'1 Method 2 (OtherSource) 

### reportobtained 

### ftom the CAS InvenlOryExpert 

### Service5 mustbe

## ~ submitted as an alladlmeat 10 

### 1his notice) d. 

### Molecular formula C20 lf22 

## 05 CBI 

# D CAS RegislIY Number (ifa oumbe'f

### already ex:ifl1s 

### forthe IiUbstance)

### 7186a-:L5~O C, 

### Foraclass I substance. provide acomplete andcorrectcbemical structure 

### diagram. Foraclass 2substance, provide 

### acom:ct representative Or 

### partial chemical structurediagram. as complete as can be

### known. ifOIIe ClUl 

### be reasonably ascer1ained. 

### Pleasesee the 

### E-PMN Instruction Manual 

### for discussion ofnnat;ve format" diagram 

### softwarewhich eM

### be helpful in

### reviewing your substan<:e.



# o Mark (X) 

### Ibis

### box ifyou attadt a cooUnuation sheet. 

### CoofidentiaJ 

# D

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

### Page4

### PMN Page 4a ; 

## Page 5 of 18 For a class 2 substance
- (1) List the immediate precursor substances with their respective CAS Registry Numbers. (2) Describe the nature ofthe reaction or process. (3) Indicate the range ofcomposition and the typical composition (where appropriate).

e. (l) Listthe immediateprecursor substances with theirrespective CAS Registry Numbers. 

## ConfiName (CAS#) 

### dential 

# D

e. (2) Describe the nature ofthe reaction or process. 

# D

e. (3) Indicate the range ofcomposition and the typical composition (where appropriate). 

# D

] Mark (X) thisbox ifyou attach a continuation sheet. EPA FORM 7710-25 (Rev. 5-95) Page 4a

## PMN 

## Page 5 ; Page 6 of 18 PartI - GENERAL INFORMAnON
­ Continued Section B ­ CHEMICAL IDENTITY INFORMATION
­ Continued 

### 2. Polymers (For a definition ofpolymer, see the Instructions ManuaL) Confidential a. Indicate the number-average weight ofthe lowest molecular weight composition ofthe polymer you intend to manutacture. 

# D Indicate maximum weight percent oflow molecular weight species (not including residual monomers, reactants, or solvents) below 500and below 1,000 absolute molecularweight ofthat cOlllposition. Describe the methods ofmeasurement or the basis for your estimates: GPCU 

# o·'r (SpecifY below) 

### (i) lowest number average molecular weight: 

# I (ii) maximum weight % below 500 molecular weight: (iii) maximum weight % below 1000 molecular weight: 

# 0 Mark (X) this box ifyou attach a continuation sheet. 

### b. You must make separate confidentiality claims for monomer orotherreactant identity, composition information, and residual information. Mark (X) the "Confidential" box next to any item you claim asconfidential (I) Providethe specific chemical name and CAS Registry ]\iumber (ifa numberexists) ofeach monomer orother reactant used in the manufacture of the polymer. 

### (2) 

# - Mark (X) this column ifentry in column (I)is confidential. (3) 

# - Indicate thetypical weight percent ofeach monomerorother reactant in the polymer. (4)
- Choose "yes" from drop down menu ifyou want a monomerorotherreactant used at two weight percent or less to be listed aspart ofthe polymer description on the TSCA Chemical Substance Inventory. (5) Mark (X) this column ifentries in columns (3) and (4) are confidential. (6) Indicate the maximum weight percent ofeach monomer or other reactant that may bepresent as a residual in thepolymer as manufactured for commercial purposes. i (7) 

## - Mark (Xl thiscolumn ifentry in column (6) is confidential. Monomerorotherreactant and CAS Registry Number Confi- Typical Include in Confi- Maximum Confidential composition identity dential residual dential (I) (2) (3J (4) (5) (6) (7) 

# D %

# DD % 

# D %

# 0 D %

# il
%

# DD % 

# I 

# D %

# 0 D %

# D D % 

# JlL %

# D D %

# I 

# D % i 

# D %

# 0 

# D % 

# c:::::J % ;---­ % 

# I 

# I

- 

# C=I % % 

# I I 

# c:::::J % ;---­ % 

# c:::::J % % 

# I I L--I 

# c= % 

# [:=J % 

# [ % 

# CJ % 

# I I

- 0 Mark (X) this box ifyou attach a continuation sheet. EPA FORM 7710-25 (Rev. 5-95) Page 5

### PMN Page Sa; 

## Page 7 of 18 c. Please identify which method you used to develop orobtain the specified chemical identioormation reported in this notice (checkone), 

### CHI 

# o Method I (CAS Inventory Expert Service - a copy ofthe identification report Method 2 (othersource) obtained from CAS Inventory Expert Service must be submitted as an attachment to this notice) 

# D d, The currently correct Chemical Abstracts (CA) name for the polymerthat is consistent with TSCA Inventory listings for similar polymers. 

# D

CAS Registry Number (ifa number already exists for the substance) 

# [ 

# ]
e. Provide a correctrepresentative orpartial chemical structure diagram, 

### as complete 

### as can beknown, ifone 

### can bereasonably ascertained.. Please see the E-PMN Instruction Manual for discussion ofHnative format" diagram software which Can be helpful in reviewing your substance. 

# D

ark (X) this box 

### ifyou attach a continuation sheet.

EPA FORM 77\0-25 (Rev. 5-95) Page SaImpurities

attach a continuation sheet. 

### PMN Page 

## 6 : Page 8 of 18

(a) Identify each impurity that may be reasonably anticipated to be present in the chemical substance as manufactured for commercial purpose. Provide the CAS Registry Number ifavailable. Ifthere are unidentified impurities, enter "unidentified." Estimate the maximum . . Maximum Confi· percent dential



### % 

# D % 

# D

Confi· dential 

# D Mark (X) this box ifyou attach a continuation sheet. 

### 5. Trade identification List trnde names for the new chemical substance identified in subsection 

### I or 

### 2. 

### ESACURE KIP 160 ESACURE 2006 LFC 

### 2006 

# o Mark (X)this box ifyou attach a continuation sheet. 

### 6. name· Ifyou claim chemical identify as confidential, you mustprovide a generic name for your substance that reveals the specific chemical identity ofthe newchemical substance to the maximum extentpossible. Refer to the TSCA Chemical Substance Inventory, 1985 Edition, Appendix B for guidance on developing generic names. 

### N/A

resulting from the manufacture, processing. use, or disposal ofthe new Provide the CAS Registry CAS Number Confi· 

# D D D

EPA FORM 7710-25 (Rev. 5-95) Page 6

## PMN 

## Page 7 ; Page 9 of 18 

# PartI - GENERAL INFORMATION
- Continued Section C - PRODUCTION. IMPORT AND USE INFORMATION: Mark X the "Confidential"box next to an item ou claim as confidential. I. 

### Production volume
- Estimate the maximum production volume during the first 12 months ofproduction. Also estimate the maximum production volume for any consecutive 12-month period during the first three years ofproduction. Estimates shouldbeon 100% new chemical substancebasis. Fora Low Volume Exemption application, ifyou choose to have yournotice reviewed at a lower production volume than 10,000 k r, s eci the volume and mark x in the bindin box. If nted, ou are bound to this volume Confidential 

## Maximum first 12-month production (kg/yr) Maximum 12-month production (kg/yr) (100% new chemical substance basis) (100% new chemical substance basis)
2. Use Information
- You must make separate confidentiality claims for the description ofthe category ofuse, the percentofproduction volume devoted toeach category, the formulation of the new substance, and other use information. Mark (X) the "Confidential" Box next to any item you claim as confidential. a. (I) --Describeeach intended category ofuse ofthe new chemical substance by function and application. (2) -Mark (X) this column 

### ifentry column (I) is onfidential business information (CBI). (3) --Indicate your willingness to have the information provided in column (I)binding. (4) --Estimate thepercent oftotal roduction for the first three years devoted to each category ofuse. (5) --Mark (Xl this column ifentry in column (4) is confidential business information (CBI). (6)-­ stimate the percent ofthe new substance as formulated in mixtures, suspensions, emulsions, solutions, or gels as manufactured for commercial purposes at sites under ourcontrol associated with each category ofuse. (7) --Mark (X) thiscolumn ifentry in column (6) is confidential business information (CBJ). (8) --Indicate 

### % of roduct volume expected for the listed "use" sectors. Mark more than one box ifappropriate. Mark (X) to indicate your willingness to have the use type provided in (8) indin 9 --Mark X this column ifent ies in column 8 is are confidential business infonnation CBI .

# cate~~~e~~:edV: 

# i!:**fi~~S~:~; ;~~y:;iel:c;.~~r·**  a CBI

# ;~: :;;;, CBI Fonnu CBI 0/3 lalion



## * non dispersive use {xi (2) (3) (4) (5) (6) (7)

%


### % Site­ % ofsubstance expected per use (8)**Cons~** Indus- Comlimited umer trial mercia! CBI 

## Co-photoinitiator for UV-curable pigmentated inks· Co-photoinitiator for photoresists, optical fibers and printed plates· Co-photoinitiator for UV-curable coatings· Co-photoinitiator for uv-curable adhesives and other coatings*

• Ifyou have identified a "consumer"use, please provide on a continuation sheeta detailed description ofthe use(s) ofthis chemical substance in consumerproducts.

In addition include estimates orlheconcentration ofthe new chemical substance as expected in consumerproducts and describe the chemical reactions by which this substance loses its identity in the consumerproduct. Mark (X) this box ifyou attach a continuation sheet. b. Generic use description Ifyou claimany category ofusedescription in subsection 2a as confidential, enter a generic description ofthat category. Read the Instruction Manual for examples ofgeneric USe descriptions.

Mark (X) this box ifyou attach a continuation sheet. 3. Hazard Information -Include in the notice a copy ofreasonable facsimile ofany hazard warning statement, label, material safety data sheet, or other

infonnation which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective equipment or practices for the safe handing, transport, use. ordisposal ofthe new substance. List in part III hazard information you include. Mark (X) this box ifyou attach hazard information. Binding Option Mark {x}

EPA FORM 7710-25 (Rev. 5-95) Page 7

## PMN 

## Page 8 ; Page 10 of 18



# D Use Batches/year 

# D Days/year 

# D 2. Continuous d. Processdescription Mark

## (Xl to indicate your willingness to have your process description binding. (1) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport containers (specify. e.g. 5 gallon pails, 55 gallon drum, rail car, tank truck, etc.). (2) Provide the identity, the approximate weight (by kg/day or kglbatch on

### a 100% new chemical substancebasis), and entry point ofall starting materials and feedstocks (including reactants, solvents, catalysts, etc.), and ofall products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot used daily or perbatch.). (3) Identify by number the pointsofrelease, including small orintennittent releases, to the environment ofthe new chemical substance. Ifreleasing to two media at the same step, assign a second release number for the second medium. 

## see Att.#4
- Processing Information

attach a continuation sheet. 

## Section A
-- INDUSTRIAL SITESCONTROLLED BY THE SUBMITTER Mark 

## (Xl the "Confidential" box next to any itemyou claim as confidential

Confi

### dential 

### op1erauon involving the new ehemieal substance at industrial sites you the U.S.; however, you may still have reporting requirements if nrtu"p·«.na or

### use**"n/·r~lr.nr** •• 

### ofthe site at which the will 

## . .



## see Att.#3
- Manufacturing Information Site address (numberand street)



### Ifthe same operation will occur at more than one site, enterthe number ofsites. IdentilY the additional sites on a continuation sheet, and ifany ofthe sites have significantly different production rates oroperations, include all the information requested in this section for those sites as attachments.

1. Batch substance; Maximum kg/day (100% new chemi,.1 Hours/day substance)

EPA FORM 7710-25 (Rev. 5·95) Page 8

## PMN Page 8a; Page 

## 11 of 18 Confidential 

# D

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

### Page 8a

### PMN Page 9 ; Page 12 of 18 Part 11- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE -- Continued Section A INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER - Continued 2. Oecupational Exposure
- You must make separnteconfidentiality claims for the description ofworker activity, physical fonn ofthe new chemical substance, number of works exposed, andduration ofactivity. Mark (X) the "Confidential" 

### box next to any item you claim as confidential. (I) Describe the activities (i.e. bagdumping, tote filling, unloading drums, sampling, cleaning, etc.) in which workers may be exposed to the substance. (2) Mark (X) this column ifentry in column (I)isconfidential business infonnation (CBI). (3) -- Describe anyprotectiveequipmentand engineeringcontrols used toprotect workers. (4) and (6) Indicate your willingness to have the infonnation provided in column (3) or (5)binding. (5)
-- Indicate the physical fonn(s) ofthe new chemical substance (e.g., solid: crystal. granule. powder. ordust) and % new chemical substance (ifpart ofa mixture) at the time ofexposure. (7) Mark (X) this column ifentry in column (5) is confidential business infonnation (CBI). (8) -- Estimate the maximum number ofworkers involved in each activity for all sites combined. (9)
-- Mark (X) this column ifentry in column (8) is confidential business infonnation (CBI). (10) and (II) Estimate the maximum durntion ofthe activity for any worker in hours perday and days peryear. (12)
-­ Mark (X) this column ifentries in columns (l 0) and Ill)are confidential business infonnation (CBI). Worker activity CBt Protective Equipment! Binding Physical Bind.ng 

### est #of 

### IeBI Maximum duration CSI forms(s) (i.e.• bagdumping. filling drums) Engineering Controls Oprion and% new Option Workers Brs/day Dayslyr Mark!x) substance Mark (x) Exposed 

# I (9) (I) (2) (3) (4) (5) (6) (7) 

### (8) ) (10) (II) (12) 

## See Att.#5 

# D Occupational Exposure Information

# D D D D - 

# ---­ r-­ 

# D

L....­ '-­ 

# D 

# D - 

# D -

-= r-­ 

# D Mark (Xl this box ifyou attach a continuation sheet. EPA FORM 7710-25 (Rev. 5·95) Page 9

## PMN Page 9a; Page 13 of 18 3. Environmental Release and Disposal-- You must make separate confidentiality claims for the release number and the amount ofthe new chemical substance released and other release and disposal infonnation. Mark (X) the "Confidential" box next to each item you claim as confidential. (1) -- Enter the number ofeach release point identified in the process description. part II. section A, subsection Id(3). (2)
-- Estimate the amount ofthe new substance released (a) directly to the environment or (b) into control technology (in kg/day or kglbatch). (3)
-- Mark (X) this column ifentries in columns (I) and (2) are confidential business infonnation (CBI). (4) --Identifythe media (stack air, fugitive air (optional.see Instruction Manual), surface water, on·site or off-site land or incineration, POTW, or other (specify» to which the new substance will be released from that release point. (5) --a. Describe control technology, ifany, and control efficiency that will be used to limit the release ofthe new substance to the environment. For releases disposed ofon land, characterize the disposal method and state whether it is approved for disposal ofRCRA 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 aftercontrol technology (in kg/day). (6)
-- Mark (X) this column ifentries in columns (4) and (5) are confidential business infonnation (CHI). (7) --Identifythe destination(s) ofreleases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct discharges or NPDES numbers ofthe POTW (Publicly Owned Treatment Works). Mark (X) ifthe POTW name orNPDES # is confidential business infonnation (CHI). Release Number

(I) Amount ofnew substance released CHI (3) Medium of release e.g.slilckair

(4) Control technology and efficiency (you may wish to optionally attach efficiency data) CBI (6) (2a) (2b) (5a) Binding Mark X (5b) 

# D Att.#6 

### - 

### Environmental Release and Disposal Information 

# D .--­

'--­ 

# D D -

- 

# D D -

- r-­ 

# D .--­

'--­ r--­ 

# D .--­

'--­ 

# [ 

# D D D 

# D D [ 

# D D 

# D D D (7) Mark (X) the destination(s) ofreleases to water. NPDES 

## # CBI 

# D POTW--provide name(s) 

# D 0 Navigable waterway-­ provide name(s) 

# D D Other--Specify 

# D ] Mark (X) this box ifyou attach a continuation sheet.

EPA FORM 7710-25 (Rev. 5-95) Page 9a

## PMN 

## Page 10; Page 14 of 18 

## Part 11- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE
-- Continued Section B
-- INDUSTRIAL SITES CONTROLLED BY OTHERS Complete section B for typical processing oruse operations involving the new chemical substance at sites you do not control. Importers do not have to complete this section for operations outside the U.S.; however, you must report any processing or use activities after import. See the Instructions Manual. Complete a separate section Bfor each type of processing, oruse operation involving the new chemicalsubstance. Ifthe same operation is performed at more than one site describe the typical operation common to these sites. Identify additional sites on a continuation sheet. l(a). Operation Description
-- To claim information in this scction as confidcntial, circlc or brackct thc specific information that you claim as confidential. (I)
-­ Diagram the major unit operation steps and chemical conversions, including interim storage and transport containers (specity
- e.g. 5 gallon pails, 55 gallon drums, rail cars, tank trucks, etc). On the diagram, identity by letter and briefly describe each worker activity. (2)
-­ Either in the diagram or in the text field I(b) below, provide the identity, the approximate weight (by kg/day or kg/batch, on an 100% new chemical substance basis), and entry point ofall feedstocks (including reactants, solvents and catalysts, etc) and all products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot used daily orper batch). (3)
-­ Either in the diagram or in the text field l(b) below, identity by number the points ofrelease, including small or intermittent releases. to the environment ofthe new chemical substance. (4) Please enter the # ofsites (rememberto identify the locations ofthese sites on a continuation sheet): # ofsites 

### CBI 

# o

Diagram the major unit operation steps and chemical 

# conversions
...

l(b). (Optional) This space is for a text description to clarity the diagram above. 

### see Att.#7
- Processing Information (other sites) 

# o

] Mark (X) this box ifyou attach a continuation sheet. EPA FORM 7710-25 (Rev. 5-95) Page 10

## PMN Page 10a ; Page 15 of 18 2. Worker Exposure/Environmental Release (I)
-- From the diagram above, provide the letter for each worker activity. Complete 2-8 for each worker activity described. (2)
-- Estimate the number ofworkersexposed for all sites combined. (4)
-- Estimate the typical duration ofexposure per worker in (a) hours per day and (b) days peryear. (6)
-- Describe physical fonn ofexposure and % new chemical substance (ifin mixture), and any protective equipmentand engineeringcontrols, ifany, used to protect workers. (7)
-- Estimate thepercent ofthe new substance as fonnulated when packaged orused as 

### a final product. (9)
-- From the process diagram above, enterthe number ofeach release point. Complete 9-13 for each releasepoint identified. (10)
-­ Estimate the amount ofthe new substance released (a)directly to the environment or(b) into control technology to the environment (in kg/day orkglbatch). (12)
-- Describe media ofrelease i.e. stack air, fugitive air(optional-see Instructions Manual), surface water, on-site oroff-site land or incineration. POTW, orother(specify) andcontrol technology, ifany, that will be used to limit the release ofthe new substance to the environment. (14)
-­ Identify byproducts which may result from the operation. (3), (5), (8, (II), 13) and (15)
­ Mark (X) this column ifany ofthe proceeding entries are confidential business information (CBI). Leue # of CHI Duration Of CBI 

## Protective Equip. /Engineering Controls/Physical Form and/ 

## % new substance % ill CSI

of Worke!> Exposure FonnActi- Exposed ulation vity (I) (2) (3) (4a) (4b) (5) (6) (7) (8) 

# D D 

# 0 I[ 

# D D D r-­ 

# Q [ 

# I[ ] Release Amount of CHI 

## Media ofRelease & 

## Control Technology Number New Substance Released (9) lOa (lObi 12 13 

# 1 

# 0 L 

# 0 101 0 14)
-- Byproducts: (15) 

# D 0 Mark (X)Ihis box ifyou attach 

### a continuation sheet, 

# OPTIONAL POLLUTION PREVENTION INFORMATION To claim information in the following 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 orminimize potential risks associated with activities surrounding manufacturing, processing, use and disposal ofthe PMN substance. Please include new information pertinent to pollution prevention, including source reduction, recycling activities and saferprocesses orproducts available due to the new chemical substance. Source reduction includes the reduction in the amount ortoxicity ofchemical wastes by technological modification, process and procedure modification, product reformulation, raw materials substitution, and/or inventory control. Recycling refers to the reclamation ofuseful chemical components from wastes that would otherwise be 

## treated or released as air emissions or water discharges, or land disposal. Descriptions ofpollutionprevention, source reduction and recycling should emphasize potential risk reduction subsequent to compliance with existing regulatory requirements and can be eitherquantitative or qualitative. The EPA is interested in the information to assess overall net reductions in toxicity or environmental releases and exposures, not the shifting ofrisks to other environmental media ornonenvironmental areas (e.g., occupational or consumer exposure). In addition, information on the relative cost orperformance characteristics of the PMN substance to potential alternatives may be provided. All information provided in this section will be taken into consideration duringthe review ofthis substance. See PMN Instructions Manual and Pollution Prevention Guidance manual for I/;uidance and examples.

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

## PMN Page 11 ; 

## Page 16 of 18 Optional Pollution Prevention Information (Continued) 

### Describe the expected net benefits, such as (I) 

### an overall reduction in 

### risk to human health orthe environment; (2) a reduction in 

### the volume manufactured; (3) a reduction in 

### the generation ofwaste materials through recycling, source reduction or other means; (4) a reduction in 

### potential toxicity orhuman exposure and/orenvironmental release; (5) an increase in 

### product performance, a decrease in 

### the cost ofproduction and/or improved operation efficiency ofthe new chemical substance in 

### comparison to existing chemical substances used in 

### similar application; 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. CHI

# ~

L

# J Mark (X) this box ifyou attach a continuation sheet. EPA FORM 7710-25 (Rev. 5-95) Page 11

### PMN Page 12 ; Page 17 of 18 

# Part III -- LIST OF ATTACHMENTS Attach continuation sheets for sections ofthe form and test data and otherdata (including physical/chemical properties and structure/aetivity information), and optional information alterthis page. Clearly identify the attachment and the section ofthe form to which it relates, ifappropriate. Number consecutively the pages ofany paper attachments. In the column below, enter the inclusive page numbers ofeach attachment. Electronic attachments can be identified by filename. Mark (X) the "Confidential" box next to any attachment name you claim as confidential. Read the Instructions Manual for guidance on how to claim any information in an attachment as confidential. You must include with the sanitized copy ofthe notice form a sanitized version ofany attaehmentin which you claim information as confidential. # 

### Attachment name 

### MSDS 1 2 

### 3 4 

### 5 6 7 

### 8

1 

### 9

1 1 0

11 

### 12 13 14 

## Technical Bullettin 15 

## Air Pollution Reduction (Open literature) Attachment Filename

# ~ 6 

# D**~ ~** **~**

# ~**~ ~** 

# ~

# ~**~ ~** **~**

# ~**~** 2 

### 15 

# D D D D D r1 Mark (X) this box ifyou attach a continuation sheet. Enter the attachmentname and number. EPA FORM 7710·25 (Rev. 5·95) Page 12

## PMN Page 13 ; Page 18 of 18 PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET To assist EPA's review ofphysical and chemical properties data, please complete the following worksheet for data you provide and include it in the notice. IdentifY the property measured, the page ofthe notice on which the property appears, the value ofthe property, the units in which the property is measured (as necessary), and whether or not the property is claimed as confidential. Ifthe attachments are electronic, give the attachment number (found on page 12) at (b). The physical state ofthe neat substance should be provided. These measured properties should be for the neat (100% pure) chemical substance. Properties that are measured for mixtures or fonnulations should be so noted (% PMN substance in _). You are not required to submit this worksheet; however, EPA strongly recommends that you do so, as it will simplifY review and ensure that confidential infonnation is properly protected. You should submit this worksheet as a supplement to your submission oftest data. This worksheet is not a substitute for submission oftest data. Property

(a) Mark (X ir provided Page Value number

(b) (c) Measured 0 Estimate (M orE) Conti· dential Mark: (X)

(d) 

### Physical state ofneat substance 

# [X] I2i(S) 

### Dcn DCg) 

# 0 Vaporpressure @ 

### Temperature 

## °C 

# [X] Torr 

# 0 Density/relative density 

# [X] g/cm3 

# 0 Solubility @ Temperature 

## °C

Solvent 

# D giL 

# D Solubility in water@, Temperature 

## °C 

# [X] giL 

# 0 Melting temperature 

# [X] °C 

# 0 Boiling/ sublimation temperature@. torr pressure 

# [X] °C 

# 0 Spectra 

# [X] 

# 0 Dissociation constant 

# D D Particle size distribution 

# [X] 

# 0 Octanol / waterpartition coefficient 

# [X] 

# 0 Henry's Law constant 

# D D Volatilization from water 

# D D Volatilization from soil 

# D D pH@, concentration 

# D D Flammability 

# [X] 

# 0**E~lodability** 

# [X] 

# 0 Adsorption / coefficient 

# D D Other
- SpecifY 

# [X] 

# 0 0 Other
- Specify 

# [Xl D Mark (X) this box ifyou attach a continuation sheet. Enterthe attachment name and number. 

## ATTACHMENT PAGE 13