,---------------.-.--.-----------------------------------+--i 

Fcmn Approved. OlLa No. 2lI'JO.OO12. ApprovalExpins 

ft EPA PREMANUFACTURE o NOTICE 

AGENCYlt~E ONLY 

FOR NEW CHEMICAL SUBSTANCES 

DOCUMENT CONTROL OmCER 

OFFICE OF POLLUTION PREVENTION 

AND TOXIC SUBSTANCES, 7407 

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

Enter the total number of pages 

in the Premanufadu.re Notice 

I_ '",." 

Company Sanitized 

o y_....ptV¥We alllafomllitlOll reqlHllleiClla .iIIIe_to tit. ateat tUt It Ia DOW1l to 01' --..blyallC.'leltaiuble by ,... M.ake __Ie .u.... IfJOIl 

lIot meadlI. d_ 

oBeforeyo. _pl.....t-.f_.hoald IUd the wlD.ltnadlOlll Mlilul forr-aaaf&tllae NoIIflcatIOIl- (Ihe lDItrtIdlou Maullaw~1e flum the 

SubsUIICII:I Omltol Ad (I'SeA) 1IIfonuIi_ Serrice by cdl.... 201-5M-1tcM. or fDle,201-sst-StCD) • 

•If a uer fee ha been_ltted for tILIiIeotlce (.60 CFR 100.45), IIIdk.lte Ia tile "-above the TS-IIlIer 'aeldeatificll1oJla..bvyo. Iuwe paeralled. 

Remember, YOU''''f.ma.mber autaboappur _fourClOl'ftApOedial fee _lBuell\, wllkh • IeIlt to: EPA,HQ Acm.etllls OpentioaaBl'IIlclt , ....... "..••. P.o. 360399M,. PfltIb1lJKh,PA 15251-6399, Alta. TSCA lIMrF_ 

Part 1-CENDAL INFOllMATION 

Yoe _. prcwlde the _ItywmId Oemlcd A.btItndI (CA) Name oftile 

e_dl_lc:iIII ......ce, _If,.,. claim th.ldeallty _ CDIIftclellllal. Yoa may 

aatllOlbe _otII.. to .11....eM...... iclelltlty laIe_atJ_ for fOIl, bllt 

you...,..Ioa will aotbeClOmplele ad tM JniIrw will_Ma".aWEPA 

rec:reIYeIt tItI. ..Ie...... A........ppod ofyolll'....u..toa aboaAd 

ftIfeJace youTS _ fee klatifialiOlla..ber. Y_...._.U_odJInal 

ad two ClOpieI ofthJa IIotkIe ..chadlDB aD tell d...If J01I cI.al..t ..,. 

iDfonutioa III coafideaHaJ. a ...Ie Mllitiud copy .... aIIo be "'mltled. 

Part D - HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

Jf there am aevdmuaf&tll...~."orue0,,"'_10bedt!OlCl'ibed Ie 

Part D, -=tlou A ucI Boftit. aotice, reprodace tile MClJo__aeeded. 

hrtm- USTOF AlTAOIMENTS 

Aitadl adcIltIoaalllheela If tbae. aot nlOUP apaae to _era qllelltiatl fully. 

Label eada coatIautioa .heel willi tIte co_poacIlDllMdIoII heallla" III P.t 

ID,11It u.e IItIIdImnllll, an,...ciliaor__data _d ..,. optioul 

iDformatloa ladaded la the aattce. 

OPTIONAL INFORMATION 

SCKalIed "bIMinI" box__iad.ded lit_shoat tht. 101m lel'mll to ladlate 

YOlirwiUlllp_1D be ""lidto cedala .......yoa __I..... aotIelI\,.acIt 

• -,pi'04Iadloa ...01_, protediYe eqldpmeat ••• nu. opt!all ...teaded to 

-­ dela.,. tItat IOIlUaeIy _.,..,.abe de'ftJopmeat of_torden 01' 

S....flamt N_lJae a ..... Except laabe _ of _ptIoa.,plladloM (ndl_ 

TMEA, LVI. LOREX)wltan mdIIJIl__atloa pnw:Ided I••Ildillotiftalloe II 

blll41n10ll tile .....Itter wh_ tM Asf!llCJ apr--tit. _pllOIlapplICillIOll, 

dledda.abladla. box .. tht. aotIce4tHa.aId by ltaelf plOWblt the ...bmliter 

fm. biarderi.ltllll flOm tIte laformatJoa (_pidl_kaI kiatil)') reported la 

the leflll. 

CONPlDENTIAt.rrY ClAIMS 

Yoa ru.y ddm .y"fomudl_ i.tWa IICItb _ coafideatUl. To _rt a cIaI. 

- tIte tv......uk 001McoaOdeaUIl box aa.t 10 doe 1a,.,...1111_ tIuIt yo. cIaI. - ClOIlfJcIeaIlal. To _II a cLai. Ie _ lItbdIm..t, drde01' bracket the 

IalenRlUoa J01I dam III COIIfldeatlai. If)'Oll dalp IpfgmaUOI I, thc pgUq u 

c:pn6da IIU. XO!I mg. aIep pmyJdt ..HaW"" yep!" of I'C 1Q!kc./iadgdigl ilfAmnll). For addltJoaall.....dlOlll _ dallllla,lllfonaatloll _ 

ClOOfldeatl.-l,. read tile lutnldiouMaul. 

o Mark 00 If..,.IafonnatlonIn tIlla Ilotlce II c:I.WIled .. ClOllfidelltla1. 

o LVE Modlfk:atloa 

IS nus A CONSOLIDATED PMN7 0 V­

, ofdl_bla 

(Pnmodce Com...u..katloa , n!qub:",d, ...ler' o. ,.e 3) 

Replaces previous editions of EPA Form 

U. S. ENVIRONMENTAL PROTECTION AGENCY 


TEST DATA AND O'IHER DATA 

Yoa are nqubed 10 __It aD tell"'" JOIlrr--loa or coab:vl 

_d to prvvldea dacrlpllOll of aD other....kMw1l1D or ___1y 

--Wullie by m ..iftl&eled.._ NIIled to tIte kNltIt ad 

avilO-.-taI effecb of tM ....fllCh...,-ill"dlab:lltllUoa 

Ia CD_--,-.01' dllpoaalof.e._droeaiClll .......ce. staadud 

Btennredtatloaa..,.be ......ed for d..Ia tM opea rdeatifk 

lItenbae. Complete II:It datalwdtlg ..EN""') aot gmmada ofd_ 

..." gh.ilttdlfthc.J do !lGt II'JZCM' Ia the _ "mbll. Y_ROald 

deady Icknttfyw......tell cilia ta _ tile .alllIaIIce orOIl ..1IJIIIIos. AIao, 

the chemkal CQIIlpoldtloa of til. t..w.....daJ _aJ4 be claanw:talzed. 

Fola-t..__pksoftell data ad other data. Data...d be 

•...,.Itted accord.... to tile req.'-eataof §72O.!IO of tMl'Ialanf&tllae 

NoUHailOIl aale ,.0 CFR Pad 120), 

• EllYilOameatai fate d... 0 Yea 'OOerdata Yea 0 

0 
Yea
 • Kuliit effwciJ d... Rlak_eata 

Yea • Ea¥ilDlUlleatai effedl d.. 0 StracbuaIac:ti¥1ly 

o Phyalc::lllClt_kaI PIIUpeItI- ·0 Yea Teal cilia aot la tlte 

Of' coatrol of tIM! 

•A pltyliClll &Ild dlemlcd plOpeIIi___lied ta loaded 011 tile t.I JNII'! 

of tht. tvflll. 

TYPE OF NOTICE 

[iJ 

o 

o 

o 

o 

o 

EPA FORM 771()'25 (Rev. 5-95) 
-.-----~.----------------------------------------------------------------------------r_, 

PubJic reporting burden for this collection ofinformation is estimated to average 110hours per response, Including time for reviewing --~-~ 

searching existing data 1O\lfCeI, gathering and mamtalnlng the data needed. and completing and reviewing the collection of Infonnatlon. Send 

comments regarding the burden estimate or any other aspect of this collection of information. Including suggestiona for redudng this burden, 

to ClU., Information Pdky Branch. PM-m, U.s. Environmental Protection Agency, 401 M. St., S.W." Washington, D.C. 20460; and to the Office ( 

Management and Budget, - k RedudiOl\ Act (2(170..0012), Washington, D.C. 200m. 

CERTIFICATION 

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

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

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

Part (, Section B. 

2. 	 All information provided in this n9lice is complete and truthful as of the date of submission. 

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

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

Additional Certification Statements: 

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

statement that applies: 

o 	The Company named in Part I, Section A has remitted the fee of $2500 specified in 40 CPR 700.45 (b), or 

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

accordance with 40 CPR 7OO.45(b), or 

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


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


Ifyou are submitting a low volume exemption (LVE) application in accordance with 40 CFR 723.50 (c) (1) or a Low 

release and low exposure exemption (loREX) application in accordance with 40 CFR 723.50 (c) (2), check the following 

certification statements: 

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


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


of 40 CFR 723.50. 


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

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

o Ifthis application is for an LVE in accordance with 40 CPR 723.50 (c)(l), the manufacturer intends to commence 


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


30 day review period. 


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

substance described herein. Ally knowing and willful misinterpretation is subject 10 aiminal penalty pursuant 1018 USC 1001. r--- -.d-en-ti-i.I-l-t eonfi

Sign,ature and title of Authorized Offidal (Origin.al Signature R.equired) Date 

Signature of agent - (if appUcable) Date 

FORM EPA 7710-25 (Rev. 5-95) 	 Page 2 
Part I - GENERAL INFORMATION 

Section A - SUBMI'IIER IDENnFICATION 

1.. Person 

Submitting 

Notice 

(in US.) 

Qty, State, ZIP Code 

b. AgentOf Nameofauthorized offtdal 

applicable) 

MailiI'Ig address (number and street) 

Qty, State, ZIP Code 

Telephone 

c. If you are submitting this nol:l.ce as part of • joint submlssion, mark 00 this box. ---------------1.... 

Joint Name 01 authorized offidal Position 


Submitter 


ruappllcab~ -C~;;----------------------~-----------------------------

Mailingaddress (number and street) 

City, State, ZIP Code 

Telephone 

2. Teclmical 

Contact 

(in US.) 

Name 

Company 

Position 

Mailingaddress (number and street) 

City, State, ZIP Code 

Telephone 	I 

I 

If you have had a prenot1ce communication (PC) conoeming this notice 


and EPA assigned. • PC Number to the notice, enter the number. 
 Mark (X) 

ifnooe ------:)10 .... D

If you previously !lUbmitted an exemption applicatiQl\ fO£ the chemical 


substance covered. by this notice, enter the exemption number assigned. 


by EPA. Ifyou previously 8Ubm1tted. a PMN for this substance enter the 
 Mark 00 

PMN number assigned.by EPA (i.e. withdrawn or incomplete). lfnone --)10" D

--oJI)Io... 

If you have submitted. • notice 01 Bona fide intent to manufacture or Mark 00 import for the chemical !lUbstance covered. by this notice, enter the lfnone ------:,..... D

notice number assigned by EPA 	 )10 

Manufacture 2. 	 Import Type of Notice - Mark 00 1.0 	 0 

Only 	 Only 3. o Both Binding Option O BindingOption o Mark (x) Mark (x) 

FORM EPA 7710-25 (Rev. 5-95) 3 
Part I -- GENERAL INFORMATION -- CONTINUED 

Section B -- CHEMICAL IDENTITY INFORMATION: You must provide a currently correct Chemical Abstracts name of the substance 

based on the ninth Collective Index (9CI) ofCA nomenclature rules and conventIOns. 

I 

i. 

Mark (X'I the "Confidential" box next to an item ou claim as confidential, 

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

If another person will submit chemical identity information for you (for either item I or 2), mark (X) the box at the right 

the name, and address of that in a continuation sheet. 

I. Class 1 or 2 chemical substanees (for definitions of class I and class 2 substances, see the Instructions Manual) 

a. Class of substance -- Mark (X) I 0 Class I or 2 DClass 2 

b. Chemical name (CUrrently correct Chemical Abstraets (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 must be 

provided, whichever is appropriate based on CA 9CI nomenclature rules and conventions.). 

Confidential 

X 

X 

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

(cheek one). 

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

report obtained from the CAS Inventory Expert Service must be 

submitted as an attachment to this 

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

NA X 

e. For a class I substance, provide a complete and eorrect chemical structure diagram. For a class 2 substance (I) List the immediate 

precursor substances with their respective CAS Registry Numbers. (2) Describe the nature ofthe reaction or process. (3) Indicate the range 

of composition and the typical composition (where appropriate). (4) Provide a correct representative or partial chemical structure diagram, X 

as complete as can be known, if one can be reasonably ascertained. 

attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) Page 4 
Part I -- GENERAL INFORMATION -- Continued 

Section B -- CHEMICAL IDENTITY INFORMATION -- Continned 

2. Polymers (For a definition of polymer, see the Instructions Manual.) 

a. Indicate the number-average weight of the lowest molecular weight composition of the polymer you intend to manufacture. 

Indicate maximum weight percent of low molecular weight species (not including residual monomers, reactants, or solvents) below 

500 and below 1000 absolute molecular weight of that composition. 

Describe the methods of measurement or the basis for your estimates: apcD Other D: Specify: Calculated 

i) lowest number average molecular weight 

II) maximum weight % below 500 molecular weight 

iii) maximum weight % below 1000 molecular weight 

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

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

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

(1) - Provide the specific chemical name and CAS Registry Number (9f a number exists) of each monomer or other reactant used in the 

manufacture of the polymer. 

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

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

(4) Mark (X) the identity column if you want a monomer or other reactant used at two weight percent or less to be listed as part of the 

polymer description on the TSCA Chemical Substance Inventory. 

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

(6) - Indicate the maximum weight percent of each monomer or other reactant that may be present as a reSidual III the polymer as 

manufactured for commercial purposes. 

- Mark this column if in column is confidential. 

Confi- Typical Identity Confi- Maximum 

dential Composition Mark (X) dential Residual 

% % 

% % 

% % 

% % 

% % 

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

I 

Confidential 

Confidential 

c. Please identify which method used to develop or obtain the specified chemical identity information reported in this notice. (check one). 

D Method 1 (CAS Inventory Expert Service - a copy of the identification report D Method 2 (other source) 

obtained from the CAS Inventory Expert Service must be submitted as 

an attachment to this 

d. The currently correct Chemical Abstracts (CA) name for the polymer that is consistent with TSCA Inventory listings for similar 

polymers. 

e. Provide a correct representation or partial chemical structure diagram, as complete as can be known, if one can be reasonably 

ascertained. 

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

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

I 

Part I -- GENERAL INFORMATION -- Continued 

Section B -- CHEMICAL IDENTITY INFORMATION -- Continued 

3, Impurities 

(a) -- Identify each impurity that may be reasonably anticipated to be present in the chemical substance as manufactured for commercial purposes, 

ProVlde , t e A h C S Registry 1" urn bfl er laval a ble, If t h ey are um 'd entl 'fied' I Impuntles, enter "um 'd enlJ 'fied 1 " 

(b)-- Estimate the maximum weight % of each impurity. If there are unidentified impurities, estimate their total weight %, 

I ' 

Impurity and CAS Registry Number 

(a) 

[ ] Mark (X) this box if you attach a continuation sheet 

4. Synonyms -- Ente ! 

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

5, Trade identification -­

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

6. Generic chemical name -- (fyou claim chemical identity as confidential, you must provide a generic chemical name for your substance 

that reveal s the specific chemical identity of the new chemical substance to the maximum extent possible, 

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

generic names. 

Metallic Dio) 

Maximum 

percent 

(b) 

Confidential 

X 

X 

I 

i 

X 

X 

X 

X 

X 

I 

! 

i 

i 

X 

X 

X 

I 

I 

Contidential 

X 


o Mark (X) thiS box If you attach a continuation sheet 

7, Byproducts -- Describe any byproducts from the manufacture, processing, use, or disposal of the new chemical substance. Provide the CAS 

Re istr Number if available, 

Byproduct CAS Registry Number ContiI 2) dential 

X 

X 

X 

o Mark (X) this box If you attach a continuation sheet 

Part I -- GENERAL INFORMATION -- Continued 

FORM EPA 7710-25 (Rev, 5-95) Page 6 
Part I -- 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 of production. Also estimate the maximum 

production volume for any consecutive 12 month period during the first three years of production. Estimates should be on 100% new chemical 

substances basIs. For Low Volume Exemption application, if you choose to have your notice reviewed at a lower production volume than 

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

Maximum first 12-month production (kg/yr) Maximum 12-month production (kg/yr) eonfi- Binding 

(100% new chemical substance basis) (100% new chemical substance basis) dential Option 

Mark (X) 

X 

i 

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

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

claim as confidentiaL 

a. (1) --Describe each intended category of use of the new chemical substance by function and application. 

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

0) --Indicate your willingness to have the information provided in column (1) binding. 

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

(5) --Mark (X) this column ifentry in column (4) is confidential business information (CEI). 

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

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

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

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

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

(9) --Mark eX) this column if entry(ies) in column (8 is (are) confidential business information (CBl). 

I Category of use (I) eBr Binding Produc­ eBr °/0 in eBI % ofsubstance expected per use eBI 

i (by functional and applicatIOn, i.e., a dispersive dye Option tion% Fonn­ (8) 

for finishing polyester jibers) Mark (x) ulation 

(2) (3 ) (4) (5) (6) (7) Site- Con- Indus- Com- Binding (9) limited sumer+ trial mercial Option 

X X X 100 X 

X X X 100 X 

X X X X 

i 

I 

I 

i 

X X X X J 

i 

i 

i 

I i * If you have Identified a "consumer" use, please proVide on a contmuatIOn sheet a detailed descnptlOn of the use(s) of thIs chemIcal substance In I,o""m" prod,,,,, I. "'d;,;o. ;.c1,d, "tim"" ofth, ,".".",tio' ofth, "'w ,h,m;c,1 "b",." '" <>p,,"" ;. ,"."mcr pcod,,,, ~d d~cr;b, 

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

D "vI ark (x) this box if you attach a continuation sheet. 

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

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

description 

Additive for coatin2s, inks, adhesives and composites. 

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

3. Hazard rnfonnation Include in the notice a copy of the reasonable facsimile of any hazard warning statement, label, material safety data sheet, or Binding 

other information which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective equipment or Option 

practices for the safe handling, transport, use, or disposal of the new substance. List in part III hazard infonnation you include. Mark (X) 

Mark (x) this box if you attach hazard information. D 

FORM EPA 7710-25 (Rev. 5-95) 	 Page 7 
Part II -- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

i Section A __ INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER: Mark (X) the "Confidential" box next to 

claim as confidential. 

Complete section A for each type of manufacture, processing, or use operation involving the 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 ifthere are further 

You must describe these See instructions manual. 

Confiwill occur. dential 

Name x 

Site Address (number and street) 

City, County, State, ZIP Code 

I 	 If the same operation will occur at more than one site, enter the number of sites. Identity the # of sites 

Additional sites on a continuation sheet, and ifany of the sites have significantly different 

Production rates or operations, include all the information requested in this section for those 

Sites as attachments. 

industrial' after 

I. 

of the site at which the 

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

b. Type-­

Mark (X) Use 

c. Amount and Duration -- Complete 1 or 2 as appropriate 

Maximum kg/batch (100% new chemical Hours/batch Batches/year x 

substance) 

I. Batch 

Maximum kg/day (100% new chemical Hours/day 	 Days/year 

substance) 

2. Continuous 

d. Process description: Mark (X) to indicate your willingness to have your process description binding. 	 x 

(I) 	 Diagram the ma,ior 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 appropriate weight (by kg/day or kg/batch on a 100% new chemical substance basis), and entry point of all 


starting materials and feedstocks (including reactants, solvents, and catalysts, etc.), and of all products, recycle streams. and wastes. 


Include cleaning chemicals (note frequency if not used daily or per batch). 


(3) 	 Identity by number the points of release, including small or intermittent releases, to the environment ofthe new chemical substances. 

FORM EPA 7710-25 (Rev. 5-95) 	 Page 8 
Section A - INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER -- Continued 

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

substance, number of workers exposed, and duration of acti'l-ity. Mark (x) the "Confidential" box next to any item you claim as confidentiaL 

(I )--Describe the activities (i.e. bag dumping, tote filling, unloading drum;, sampling, cleaning, etc.) in which workers may be exposed to the 

substance. 

(2)--Mark (X) this colunm if entry in colunm (I) 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 infonnation provided in column (3) or (5) binding. 

(5)--lndicate the physical fonn(s) and % new chemical substance (if in mixture) of the new chemical substance at the time of exposure (i.e" solid: 

crystal, granule, powder, or dust) and % new chemical substance (ifin mixture). 

(7)--Mark (X) this colunm if entry in column (5) is confidential business infonnation (CBl). 

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

(9)--Mark (X) this colunm if entry in colunm (8) is confidential business infonnation (CBI). 

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

(12)--Mark (X) this column if entry in colunms (10) and (II are confidential business information (CBI). 

Worker activity CBI Protective Equipment! Binding Physical formes Binding CBI #of CBI Maximum duration CBI 

(i.e., bag dumping, filling Engineering Controls Option and % new Option Workers Hr/day Dayslyt 

drums) Mark(x) substance Mark (x Exposed 

(I) (2) (3) (4) (5) (6) (7) (8) (9) (10) (II) ( 12) 

X Face shield, safety X X X glasses, gloves 

X Face shield, safety 

glasses, gloves, 

X X X 

closed system 

Face shield, safety X 

glasses, gloves 

X X 

X Face shield, safety X X X 

glasses, gloves 

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

3. Environmental Release and Disposal -- You must make separate confidentiality claims for the release number and the amount of the new chemical 

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

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

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

(3 )..Mark (X) this column in entries in columns (I) and (2) are confidential business information (Cm). 

(4)--Identify the 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, if any, and control efficiency that will be used to limit the release of the new substance to the environment. 

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

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

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

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

(7)--tdentify the destination(s) of releases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct 

dischargers or NPDES numbers of the POTW (Publicly Owned Water Treatment Works). Mark (X) if the POTW name or NPDES # is 

confidential business information (CBr . 

Release Amount of new cm Media of Control technology and efficiency (you may wish to optionally attach efficiency data) CBt 

Number substance released release e g" Binding 

stack air Mark 

( 1 ) (2a) (2b) (3) (4) (5a) (x) (5b) (6) 

X 0 X 

I 

X X I 

(7) Mark ex) the D POTW provide names below: CBI D Navigable D Other-specify provide NPDES # cm 

destinations of - Waterway 

releases to water X 

[2S] Mark (X) this box if you attach a continuation sheet. 

FORM EPA 7710-25 (Rev. 5-95) Page 9 
Part II -- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE -- Continued 

Section B -- INDUSTRIAL SITES CONTROLLED BY OTHERS 

Complete section B for typical processing use operations involving the new chemical substance at sites you do not control. Optional for typical 

manufacturing or processing operations involving the new chemical substance at sites outside the U.S. that you do not control see Instructions 

Manual. Complete a separate section B for each type of processing, or use operation involving the new chemical substance. If the same operation is 

performed at more than one site describe the typical operation common to these sites. Identify additional sites on a continuation sheet. Optional for 

sItes outside the United States. - See Instructions Manual. 

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

( 1) 	 Diagram the major unit operation steps and chemical conversions, including interim storage and transport containers (specify 5 gallon pails, 

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

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

(including reactants solvents and catalysts, etc.) and of all products, recycle streams, and wastes. Include cleaning chemicals (note frequency 

ifnot used daily or per batch). 

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

(4) 	 Please enter the # of sites (remember to identify the location of these on a continuation sheet. 

Enter # of sites ­

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

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 of workers exposed for all sites combined. 

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

(6) Describe physical form of exposure and % new chemical substance (if in mixture), and any protective equipment and engineering controls, if 

any used to protect workers. 

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

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

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

(in kg/day or kglbatch). 

(12) Describe media of release {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, if any, that will be used to limit the release of the new substance to the environment. 

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

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

Letter # of CBI Duration 

of Workers of 

Act- Exposed Exposure 

ivity 

(1 ) (2) (3) (4a) (4b) 

X 

X 

I 

X 

I 

• X 

(14) Byproducts: 

CBI 

(5) 

X 

X 

X 

X 

Protective Equip. / 

Engineering Controls / 

Physical Form and % 

new substance 

(6) 

% in 

Formulation 

(7) 

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

FORM EPA 7710-25 (Rev. 5-95) 	 Page 10 

CBI 

(8) 

X 

X 

X 

X 

Release 


Number 


(9) 

Amount of CBI 

New 

Substance 

Released 

(lOa) (lOb) i (\\) 

X 

X 

Control 

Technology 

(12) 

CBl 

(13 ) 

X 

X 

(15) 
OPTIONAL POLLUTION PREVENTION INFORMATION 


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

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

efforts to reduce or minimize potential risks associated with activities surrounding 

manufacturing, processing, use and disposal of the PMJ\J substance. Please include new 

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

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

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

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

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

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

recycling should emphasize potential risk reduction subsequent to compliance with existing 

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

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

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

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

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

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

o f this substance. See Instructions Manual and Pollution Prevention Guidance manual for 

guidance and examples. 

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

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

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

performance, a decrease in the cost ofproduction and lor improved operation efficiency of the new chemical substance in 

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

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

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

FORM EPA 7710-25 (Rev. 5-95) Page 11 

i 
Part III -- LIST OF ATTACHMENTS 

Attach continuation sheets for sections of the form and test 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 of the form towhich it 

relates, if appropriate. Number consecutively the pages of the attachments. In the column below, enter the inclusive pagenumbers of 

each attachment. 

Mar k ( ) X th e" C on tid 1 entia" 1 b ox next to any attac hm ent name you c 1 . aIm as con fid' I entIa I d . Rea th e InstructlOns Manua forguidance on 

how to claim any information in an attachment as confidential. You must include with the sanitized copy of the noticeform a sanitized 

copy of any attachment in which you claim information as confidential. 

Attachment name Confipage number(s) 

Attachment 

dential 

X 


X 


X I 

X 

X 

X 

X 

X 

! 

D Mark (X) this box if you attach a continuation sheet. Enter the attachment name and number. 

FORM EPA 7710-25 (Rev. 5-95) Page 12 

I 
PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET 

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

and include it in t he notice. Identify the property measured, the page of the noticc on which the property appears, the value 

of the property, the units in which the property is measured (as necessary), and whether or not the property is claimed as 

confidential. The physical state of the neat substance should be provided. These measured properties should be for the neat (l00% 

pure) chemical substance. Properties that are measured for mixtures or formulations 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 information is properly protected. You should submit this worksheet as a supplement to your submission of test 

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

I 

Property Mark (X) if Page Value Measured ConfiproVIded number or Estimate dential 

(a) (b) (c) Mark (x) 

(M or E) (d) 

Physical state of neat substance i-(s)_(l) __(g) X 

i Vapor pressure @ Temperature °C torr 

! 

• Density I relative density glcm3 

ISolubility 

Temperature 

I 

Solvent giL 

! Solubility in water @ Temperature 

Melting temperature °C 

Boiling I sublimation temperature @ torr pressure 

Spectra 

Dissociation constant 

Particle size distribution 

Octanoll water partition coefficient 

Henry's Law constant 

Volatilization from water 

Volatilization from soil 

pH @ concentration 

FI ammabililY 

• Explodability 

! Adsorption! coefficient 

Other specify X I 

FORM EPA 7710-25 (Rev. 5-95) Page 13 
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31