**r-------·~----'1--~~-----------------------------------------------------------------------------------------------------.** 

## '**r---~u·-.s~.-EN-V--IR_O_N_M_E_N_T_A_L--PR_O_T_E_C_T_I_O_N_A_G_E_N_C_Y** 

## ____**~--------A-G_E_N_C_Y_U_S_E** 

## __

O_N_L_Y
______**~** 

# &EPA PREMANUFACTURE Date ofrecei t 

### NOTICE FOR NFWf'HFMTf'AT.**~TTH~TANC'P~** 

# lllllllllllilllllllllllllliIIIIIIIIIIIIIIiIIIIil!il!IIIIIIiiI

# ili1!111:11111 )N

5 I 0 8 0 0 0 0 5 I 2 I**~** 

## Enterthe total number ofpages inthe Premanufacture Notice

Part I GENERAL INFORMATION You must provide the currently correct Chemical Abstracts (CA) Name ofthe new chemical substance, even ifyou claim the identity as confidentiaL You may authorize another person to submit chemical identity information for you, but your submission will not be complete and the review will notbegin until EPAreceives this information. A letter in support ofyour submission should reference your TS user tee identification number. You must submit an original and two copies ofthis notice including all test data. Ifyou claimed any information as confidential, a single sanitized copy must also be submitted. Part II 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 sections as needed. Part III LIST OF ATTACHMENTS Attach additional sheets ifthere is not enough space to answer a question fully. Label each continuation sheet with the corresponding section heading. In Part III, listthese attachments, any test data or other data and any optional information included in the notice. OPTIONAL INFORMATION You may include any information thatyou want EPA to consider in evaluating the new substance. On page 11 ofthis form, space has been provided for you to describe pollution prevention and recycling information you may have regarding the new substance. So-called "binding" boxes are includedthroughout 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 SignificantNew 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 the exemption application, checking a bindingbox in this notice does not by itselfprohibitthe 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 form, mark (X) the confidential box next to the information that you claim as confidentiaL To assert a claim in an attachment, circle orbracket the information you claim as confidential. Ifyou claim information in the notices as confidential, you must also provide a sanitized version ofthe notice, (including attachments). For additional instructions on claiming information as confidential, read the Instructions Manual. OMark(x) ifany information in this notice is claimed as confidential.



### Page i'

TEST DATA AND OTHER DATA You are required to submit all test data in your possession or control and to provide a description ofall other dataknown to orreasonably ascertainable by you, ifthese data are related to the health and environmental effects on the manufacture, processing, distribution in commerce, use, ordisposal ofthe new chemical substance. Standard literature citations may be submitted for data in the open scientific literature. Complete test data (written in English), not summaries ofdata. must be submitted if they do not appear in the open literature. You should clearly identifY whether test data is on the substance or on an analog. Also, the chemical composition ofthe tested material should be characterized. Following are examples oftest data and other data. Data should be submitted accordingto the requirements of§720.50 ofthe Premanufacture Notification Rule (40 CFR Part 720). Test Data (Check Below any included in this notice)

• Environmental fate data Oves •Other data Oves • Health effects data Oves Risk assessments • Environmental effects data DYes Structure/activity relationships • Physical/Chemical Properties*

### ~Yes Test data not in the possession or control ofthe submitter *A physical and chemical properties worksheet is located on the lastpage ofthis form. TYPE OF NOTICE (Check Only One) 0PMN (Premanufacture Notice) 1:8JINTERMEDIATE PMN (submitted in sequence with final product PMN) OsNUN (SignificantNew Use Notice) 0TMEA(Test Marketing Exemption Application) 0LVE (Low Volume Exemption)@40 CFR 723.50(c)(1) 0LOREX (Low Release/Low Exposure Exemption)@ 40 CFR 723.50(c)(2) OL VE Modification 0LOREXModification IS THIS A CONSOLIDATED PMN? Oves # ofchemicals orpolymers
__ __ (Prenotice Communication# required, enter# on page 3)



### 1 I

### \Public reporting burden for this collection ofinformation is estimated to average II0 hours perresponse, includingtime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection ofinformation. Send comments regarding the burden estimate orany other aspect ofthis collection ofinformation, including suggestions for reducing this burden, to Director, Collection Strategies Division (2822), U.S. Environmental Protection Agency, I200 PennsylvaniaAve., N.W., Washington, D.C. 20460; and to the Office of Management and Budget, Paperwork Reduction Act (2070-00I2), Washington, D.C. 20503. 

## CERTIFICATION I certify that to the best ofmy knowledge andbelief: 1. The company named in Part I, section A, subsection 1 a ofthis notice form 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 informationprovided in this notice is complete and truthful as ofthe date ofsubmission. 3. I am submitting with this notice all test data in my possession or control and a description ofall other data known to orreasonably

ascertainable byme as required by §720.50 ofthe PremanufactureNotification Rule. Additional Certification Statements: 

# D Ifyou are submitting a PMN, Intermediate PMN, Consolidated PMN, or SNUN, checkthe following user fee certification statementthat applies: 

# D The Company named in Part I,

### Secti~n A has remitted the fee of$2500 specified in 40 CFR700.45(b), or

### ~ The Companynamed in Part I, Section A has remittedthe fee of$1000 for an Intermediate PMN (defined@ 40 CFR 700.43) in accordance with40 CFR700.45(b), or 

# D The Company named in Part I Section A is a small business concernunder 40 CFR700.43 and has remitted a fee of$100 in accordance with 40 CFR700.45(b). Ifyou are submitting a low volume exemption (LVE) application in accordance with 40 CFR723.50(c)(l) or a Low release and low exposure exemption (LoRex) application in accordance with 40 CFR723.50(c)(2), checkthe following certification statements: 

# D The manufacturer submitting this notice intends to manufacture or import the new chemical substance for commercial purposes, otherthan in small quantities solely for research and development, underthe terms of40 CFR723.50. 

# D The manufacturer is familiar with the terms ofthis section and will comply with those terms; and 

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

# D Ifthis application is for an LYE in accordance with 40 CFR723.50(c)(1), the manufacturer intends to commence manufacture of the exempted substance for commercial purposes within 1year ofthe date ofthe expiration ofthe 30 day review period.

The accuracy ofthe statements you make in this notice should reflect your best prediction ofthe anticipated facts regarding the chemical substance described herein. Any knowing and willful misinterpretation is subjectto criminal penalty pursuant to 18 USC 1001. Signature and title ofAuthorized Official (Original SignatureRequired) Date Signature ofagent (ifapplicable) Date

Page Confidential

X



### 2

### Ia.Person Submittin g Notice (in U.S.)

b. Agent (if applicabl 

### e)

c. Ifyou are submittingthis notice as part ofajoint submission, mark (X) this box.--------------. Joint Name ofauthorized official Position Submitter (if applicable) 1-c-=-om-p-an_y
__________________ ..J...._
_______________ _ 

### Mailing address (number and street)



### 2. Technical Contact (in U.S.)



### 3. Ifyou have had a prenotice communication (PC) concerning this notice and EPA assigned a PC Numberto the notice, enter the number. 

### 4. Ifyou previously submitted an exemption application for the chemical substance covered bythis notice, enter the exemption number assigned by EPA. Ifyou previously submitted a PMN for this substance enterthe PMN number assigned byEPA (i.e. withdrawn or incomplete). 

### 5. Ifyou have submitted a notice ofBonafide intent to manufacture or import for the chemical substance coveredbythis notice, enterthe notice number assigned by EPA. 

### 1. Manufacture Only 

### 6. Type ofNotice- Mark (X) 

# D Binding Option Mark

Page Mark(X) 

# - ifnone 

## ...

# •



# - Mark(X) 

# •
... ifnone



# - Mark (X)


## ...

# • ifnone Import Only 

# D Binding 

### 3. 0Both Option Mark Contidential

# ~**~**

# ~

3

### Section B- CHEMICAL IDENTITY INFORMATION: You must provide acurrently correct Chemical Abstracts (CA) name ofthe substance based on the ninth Collective Index (9CI) ofCAnomenclature rules and conventions. 

### the "Confidential" box nextto item

1. 

### Class 1 or2 chemical substances (for definitions ofclass 1and class 2 substances, see the Instructions Manual) a. Class ofsubstance

- Mark (X) 1

# IIClass 1 or 

# 211 Class

# 2
b. Chemical name (Currently correct Chemical Abstracts (CA) Name that is consistent with TSCA Inventory listings for

similar substances. For Class 1 substances a CA Index Name must be provided. For Class 2 substances either a CA Index Name or CA Preferred Name mustbe provided, whichever is appropriate based on CA 9CI nomenclature rules and

c. Please identify which method you used to develop or obtain the specified identity information reported in this notice:

(check one)

## ~Method 1 (CAS Inventory Expert Service- a copy ofthe Identification 

# D Method 2 (Other Source) report obtained from the CAS Inventory Expert Service must be submitted as an attachment to this notice) d. Molecular formula and CAS Number (ifa number already exists for the substance)

CAS# 

# -
e. For a class 1 substance, provide a complete and correct chemical structure diagram. 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). (4) Provide a correct chemical structure as canbe known, ifone can be reasonably ascertained.

Page Confidential X
X

X
X



### 4

# ..--·--UL. 

# 2. 2008- 2:**10P~** 

## NO. 

# 091-P. Soct.ion 8- CHEMICAL IDENTITYINFORMATION-

### Contin'll.ed (fora ofpolymer, see 

### ofthe 

### lowestmolecularweight 

### you

.,........,........,.oflow

### molecularweight 

### species (not

### inclwlingresidual

### monomers, reaetants, or

c. Please wbich you 

### usedto 

### develop orobtain the



### notice. (checkone) • Method 1(CAS InventoryExpert Service-a 

### copy ofthe identificationreport 

### obtainedfrom 

### CAS Inventocy 

### Expert Sel"Vicemustbesubmittedas an attachment to

as 

### c:an beknown, 

### one canbe

### reasonably



### TS·WN08AP 

## Page 5

### Section B- CHEMICAL IDENTITY INFORMATION- Continued 3. Impurities (a)- Identify each impurity that may be reasonably**anticipat~d** to be present in the chemical substance as manufactured for commercial purposes. Provide the CAS Registry Number ifavailable. Ifthere are unidentified impurities enter "unidentified." (b) -Estimatethe maximum weight % ofeach impurity. Ifthere are unidentified impurities, estimate their total weight %. Impurity and CAS Registry Number 

### (a)

attach a continuation sheet. 

### 4. Synonyms- Enter any chemical synonyms for the new chemical substance identified in subsection I or 2.

attach a continuation sheet.

attach a continuation sheet. Maximum percent



### % % % % % Confidential



# D

6. Generic chemical name- ifyou claim chemical identity as confidential, you must provide a generic chemical name for your substance that reveals the specific chemical identity ofthe new chemical substance to the maximum extentpossible. Refer to the TSCA Chemical Substance Inventory, 1985 Edition, Appendix B for guidance on developing generic names. Alcohol propoxylate 

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

### 7. Byproducts- Describe any byproducts resulting from the manufacture, processing, use or disposal ofthe new chemical substance. Provide the CAS Number ifavailable.

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

Page Confidential



## 6

## Part I GENERAl INFORMATION -Continued

# ~ Section C- CHEMICAL IDENTITY INFORMATION- Continued**Ma}"~(X)** the "Confidential" boxnext to any item you claim as confidential. 

### 1. Production volume- Estimate the 

### maximum production volume during the first 12 months ofproduction. Also estimate the maximum production volume for any consecutive 12-monthperiod during the first three years ofproduction. Estimates shouldbe on 100% new chemical substance basis. For a low volume Exemption application, 

### if you choose to haveyournotice reviewedat a lowerproduction volume than 10,000 kglyr, specify the volume andmark (x) in the box. 

## If 6• w ...**~w,** you are boundto this volume. Maximum first 12-monthproduction (kg/yr) Maximum 12-monthproduction (kg/yr) Conti- Binding Option (100% new chemical substance basis) (1 00%new chemical substance basis) dential Mark (x) 

# --**~** 

# [ 2. Use Information- You must make separate confidentiality claims for the description ofthe category ofuse, the percent ofproduction volume devoted to each category, the formulation ofthe new substance, and otheruse information. Mark (X) the "Confidential" Box next to any item you claim as confidential. a. (1)- Describe each intended category ofuse ofthe new chemical substance by function and application.

(2)- Mark (X) this column ifentry in column (1) is confidential business information (CBI). (3)- Indicate your willingness to have the informationprovided in column (1) binding. (4)- Estimate the percent oftotal production for the first three years devoted to each category ofuse. (5)- Mark (X) this column ifentry in column (4) is confidential business information (CBI) (6)- Estimate the percent ofthe new substance as formulated in mixtures, suspensions, emulsions, solutions, or gels as manufactured for commercial purposes at sites under your control associated with each category ofuse. (7)- Mark (X) this column ifentry in column (6) is confidential business information (CBI) (8)

- Indicate % ofproduct 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) binding. (9)- Mark (X) this column ifentry(ies) in column (8) is (are) confidential business information (CBI) Category ofuse (I) Binding Produc- %in % ofsubstance expected peruse (by function and application i.e. a dispersive dye CBI Option CBI Form- CBI CBI for "'· polyester fibers) IMark(x) tion% ulation (8) (I) (2) (3) (4) (5) (6) (7) Site- Con-* Indus- Com-

# ~~~~~; (9) limited sumer trial mercia!**~** 

## D .%**~** .%**~** 

# •**~** % % % % % % % % % % 

### =:J. % % *Ifyou have identified a "consumer" use, please provide on a continuation sheet a detailed description ofthe use(s) ofthis chemical substance in consumerproducts. In addition include estimates ofthe concentration ofthe new chemical substance as expected in consumer products and describe the chemical reactions by which this substance loses its identity in the consumer product. 

# D Mark (X) this box ifyou attach a continuation sheet. b. Generic Ifyou claim any category ofuse description in subsection 2a as confidential, enter a generic description ofthat category. use Read the Instructions Manual for examples ofgeneric use descriptions. description Chemical intermediate 

# D 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 Binding data sheet, or other information which will beprovidedto any person who is reasonably likely to be exposedto this substance Option regardingprotective equipment orpractices for the safe handling, transport, use, or disposal ofthe new substance. List in part III Mark hazard information you include. (x) 

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

# D

Page 

### 7

### Part II- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE • Mark (X) the "Confidential" boxnext 

### Section A- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER to any item you claim as confidential. Complete section A 

### for each type ofmanufacture, processing, oruse operation involvingthe new chemical substance at industrial sites you control. Importers do not have to complete this section for operations outside the U.S.; however, you may still have reporting requirements if there are further industrial oruse after You must describe these · See Instructions manual. 1. ofthe site at whichthe will occur.

Ifthe same operation will occur at more than one site, enter the number ofsites. Identify 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
2. Continuous Use Batches/year Confidential

d. Process description Mark (X) to indicate your willingness to have yourprocess description binding. (1) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport containers (specity-e.g. 5 gallon pails, 55 gallon drum, rail car, tank truck, etc.). (2) Provide the identity, the approximate weight (by kg/day orkg/batch on an 100% new chemical substance basis), and entry point ofall starting materials and feedstocks (includingreactants, solvents, and catalysts, etc.), and ofall products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot used daily orperbatch). Identify bynumber the points ofrelease, including small or intermittent releases, to the environment ofthe new chemical substance.

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

### 8

### TS#WN08AP , Submitter'- Continuation sheet for 1 d (process description):

Page 

### 9

### Part II- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE • Mark (X) the "Confidential" box next 

### SectiOn A- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER to any item you claim as confidential. Complete section A for each type ofmanufacture, processing, oruse operation involvingthe new chemical substance at industrial sites you control. Importers do nothave to complete this section for operations outside the U.S.; however, you may still have reportingrequirements if there are further industrial · oruse · after · You must describe these See Instructions manual. 1.

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

1. Batch
2. Continuous Use Batches/year Confidential

d. Process description Mark (X) to indicate your willingness to have yourprocess description binding. (3) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport containers (specity-e.g. 5 gallonpails, 55 gallon drum, rail car, tanktruck, etc.). (4) Provide the identity, the approximate weight (by kg/day or kg/batch on an 100% new chemical substance basis), and entrypoint ofall starting materials and feedstocks (including reactants, solvents, and catalysts, etc.), and ofall products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot used daily orperbatch). Identify by numberthe points ofrelease, including small or intermittent releases, to the environment ofthe new chemical substance.



# I:8J Mark (X) this box ifyou attach a continuation sheet. Page 

### 10

### TS#WN08AP
. Submitter!_ Continuation sheet for ld (process description):

Page 

### 11

### Section A- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER-- Continued Occupational Exposure- You must make separate confidentiality claims for the description ofworker activity, physical form ofthe new chemical substance, number ofworkers exposed, and duration ofactivity. Mark (X) the "Confidential" box next to any item you claim as confidential. (1)- Describe the activities (e.g. bag dumping, tote filling, unloading drums, sampling, cleaning, etc.) in which workers may be exposed to the substance. (2)- Mark (X) this column ifentry in column (1) is confidential business information (CBI). (3)- Describe any protective equipment and engineering controls used to protect workers. (4)- and (6)- Indicate your willingness to have the information provided in column (3) or (5) binding. (5)- Indicate the physical form(s) ofthe new chemical substance (e.g. solid: crystal, granule, powder, or dust) and%new chemical substance (ifpart ofa mixture) at the time ofexposure. (7)- Mark (X) this column ifentry in column (5) is confidential business information (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 information (CBI). (10) and (11)- Estimate the maximum duration ofthe activity for any worker in hours perday and days per year. -Mark this column ifentries in columns and are confidential business information CBI



# D D I


# D D I



## D 

# D I 

## D 

# D D D D D D D D D I 

# •
I 

# •

I 

# •

Environmental Release and

- You must make separate confidentiality claims for the release number and the amount ofthe new chemical substancereleased and other release and disposal information. Mark (X) the "Confidential" box nextto each item you claim as confidential. (1)

- Enterthe number ofeach release point identified in the process description, part II, section A, subsection 1 d(3). (2)- Estimate the amount ofthe new substance released (a) directly to the environment or (b) into control technology (in kg/day or kg/batch). (3)- Mark (X) this column ifentries in columns (1) and (2) are confidential business information (CBI). (4)- Identify the media ofrelease i.e. stack air, fugitive air (optional-see Instruction Manual), surface water, on-site or off-site land or incineration, POTW, or other (please specify) to which the new substance will be released from that release point. 

## D D

(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 of RCRA hazardous waste. On a continuation sheet, for each site describe any additional disposal methods that will be used and whether the waste is subject to secondary ortertiary on-site treatment. b. Estimate the amount released to the environment after control technology (in kg/day). (6)- Mark (X) this column ifentries in columns (4) and (5) are confidential business information (CBI). (7)- Identify the destination(s) ofreleases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct dischargers orNPDES numbers ofthe POTW (Publicly Owned Treatment Works). Mark (X) ifthe POTW name orNPDES #

(1) 

## I is confidential business information Amount ofnew substance released (2a) (2b) 

# - (3) 

## fZI (5b) 

# - Page CBI (6) 

## fZI 12

## . 

# 0 ' 

# 0 0 ' ' 

# 0 ' 

# 0 0 ' ' 

# 0 ' 

# 0 0 ' ' 

# 0 ' 

# 0 0 ' ' (7) Mark (X) the 

### [glporw provide name(s) below: CBI 

### [gl Navigable 

# 0 Other-Specify Provide NPDES # CBI destinations of 

### - waterway

releases to 

### [gl 

# - [gl

water. 

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

Page 

### 13c 

### Part II- 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 mustreport any processing or use activities after import. See the Instructions Manual. Complete a separate section B for eachtype ofprocessing, oruse operation involving the new chemical substance. 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. 1. 

### Operation Description- To claim information in this section as confidential, circle orbracketthe specific information that you claim as confidential. (1)- Diagram the major unit operation steps and chemical conversions, including interim storage and transport containers (specify e.g. 5 gallon pails, 55 gallon drums, rail cars, tank trucks, etc). On the diagram, identify by letter and briefly describe each worker activity. (2) -Providethe identity, the approximate weight (by kg/day orkg/batch, on an 100% new chemical substance basis), and entrypoint ofall feedstocks (including reactants, solvents, and catalysts, etc) and ofall products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot used daily orperbatch). (3)- Identify 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): #OF SITES



# D Mark (X) this box ifyou attach a continuation sheet. 2. 

### Worker Exposure/Environmental Release (1)- From the diagram above, provide the letter for each worker activity. Complete 2-8 for each worker activity described. (2)- Estimate the number ofworkers exposed for all sites combined. (4)- Estimate the typical duration ofexposure per worker in (a) hours per day and (b) days peryear. (6)

- Describe the physical form ofexposure and % new chemical substance (ifin mixture), and any protective equipment and engineering controls used to protect workers. (7)

- Estimate the percent ofthe new substance as formulated when packaged or used as a final product. (9)

- From the process diagram above, enterthe number ofeachrelease point. Complete 9-13 for each release point 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 orkg/batch). (12)- Describe media ofrelease i.e. stack air, fugitive air (optional-see Instructions Manual), surface water, on-site or off-site land or incineration, POTW, or other (specify) and control 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), (11), (13) and (15)- Mark (X) this column ifany ofthe**proceedin~** entries are confidential business information (CBI). Letter Protective Equip./ %in Media ofRelease &

of #ofWorkers CBI Duration of CBI Engineering Controls/ Form- CBI Release Amount ofNew CBI Control CBI Act- Exposed Exposure Physical Form and% new ulation Number Substance Released Technology ivity substance (1) (2) (3) (4a) (4b) (5) (6) (7) (8) (9) (lOa) (lOb) (11) (12) (13) 

# D D D D D D D D D D D D D D D D D D D D (14)- Byproducts: (15) 

# D 

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

### 14

### OPTIONAL POLLUTION PREVENTION INFORMATION To claim information 

### in this section as confidential circle orbracketthe specific informationthat you claim as confidential. 

### In

### this section youmayprovide information notreported elsewhere inthis form regarding your efforts to reduce or minimize potential risks associated with activities surrounding manufacturing, processing, use and disposal ofthe PMN substance. Source reduction includes the reduction inthe 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 orreleased as air emissions orwater discharges, orland disposal. Descriptions ofpollution prevention, source reduction and recycling should emphasize potential risk reduction subsequent to compliance with existing regulatory requirements and canbe either quantitative or qualitative. The EPA is interested inthis information to assess overall net reductions in toxicity or environmental releases and exposures, notthe shifting of risks to other environmental media or non-environmental areas (e.g., occupational or consumer exposure). In addition, information onthe relative cost orperformance characteristics ofthe PMN substance to potential alternatives may beprovided. All information provided in this section will be taken into consideration during the review ofthis substance. See the revised Instructions Manual that includes a Pollution Prevention manual for guidance and examples. Describe the expectednetbenefits, such as (I) an overall reduction in risk to humanhealth 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 or human exposure and/or environmental release; (5) an increase in product performance, a decrease in the cost of production and/or improved operation efficiency 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 orthe environment.



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

### 15

### Part 

### III- LIST OF ATTACHMENTS Attach continuation sheets for sections ofthe form andtest data and other data (including physical/chemical properties and structure/activity information), and optional information after this page. Clearly identify the attachment and the section ofthe form to which it relates, if appropriate. Number consecutively the pages ofthe attachments. Inthe column below, enterthe inclusive page numbers ofeach attachment. Mark (X) the "Confidential" box next to any attachment name you claim as confidential. Read the Instructions Manual for guidance onhow to claim any information in an attachment as confidential. You must include with the sanitized copy ofthe notice form a sanitized version of any attachment in which you claim information as confidential. Attachment Name Attachmentpage Confnumber(s) dential Material Safety Data Sheet Attachment 1

# ~ CAS Inventory Expert Services Report Attachment 2

# ~ -WasteWater System Attachment 3

# ~ 

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

### 16

### PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET To assist EPA'sreview ofphysical and chemical properties data, please complete the following worksheet for data youprovide 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 ornot the property is claimed as confidential. The physical state ofthe neat substance should be provided. These measuredproperties should be for the neat (100% pure) chemical substance. Properties that are measured for mixtures or formulations shouldbe 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 information is properly protected. You should submitthis worksheet as a supplement to your submission oftestdata. This worksheet is not a substitute for submission oftest data. Property Mark (X) if provided Page number Value Measured or Estimate (MorE) Confidential Mark 

### (a) (b) (c) (X)

state ofneat substance 

### t

t

Dissociation constant Particle size distribution

'sLaw constant Volitalization from water Volitalization from soil concentration

M

Page 

### 17

# ATTACHMENT 1 Material Safety Data Sheet

# ATTACHMENT 2 CAS Inventory Expert Services Report

# ATTACHMENT 3 Waste Water System