# ,--------------- .-.--.-----------------------------------+--i Fcmn Approved. OlLaNo. 2lI'JO.OO12. 

### Approval Expins 

# ft

# EPA PREMANUFACTURE 

# o NOTICE AGENCY**lt~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 ofpages in 

## the Premanufadu.re Notice I_ '",." 

# Company Sanitized

oy_ .... ptV¥We alllafomllitlOll reqlHllleiClla .iII Ie_totit. ateat tUtIt Ia DOW1l to01' --..bly allC.'leltaiuble by ,...M.ake

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## m a.mber aut abo appur_fourClOl'ftApOedial fee _lBuell\,wllkh • IeIltto: EPA, HQAcm.etllls Opentioaa Bl'IIlclt ,......."..••. P.o. 360399M,. PfltIb1lJKh,PA 15251-6399, Alta. TSCA lIMrF_ Part 1- CENDALINFOllMATION Yoe _. prcwldethe_Ity wmId Oemlcd A.btItndI (CA) Nameoftile e_ dl_lc:iIII ......ce,

# _If,.,. claim th.ldeallty_ CDIIftclellllal. Yoa may aatllOlbe_otII
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### hrtm- USTOFAlTAOIMENTS Aitadl adcIltIoaalllheela If tbae. aotnlOUP apaae to _era qllelltiatl fully. Label eada coatIautioa .heel willi tIte co_poacIlDllMdIoIIheallla" III P.t ID,11It

## u.e IItIIdImnllll, an, ... cilia or

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### 4tHa.aId by ltaelf plOWblt the ...bmliter fm. biarderi.ltllll flOm tIte laformatJoa (_pi dl_kaI kiatil)') reported la the leflll. CONPlDENTIAt.rrYClAIMS Yoa ru.y ddm .y

# "fomudl_ i. tWaIICItb _ coafideatUl. To _rt a cIaI.

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### dalp IpfgmaUOI I, thc pgUqu c:pn6da IIU. XO!I mg. aIeppmyJdt .. HaW"" yep!" ofI'C 1Q!kc./iadgdigl ilfAmnll). ForaddltJoaall.....dlOlll _ dallllla,lllfonaatloll _ ClOOfldeatl.-l,. read tile lutnldiou Maul.



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

# o L VE 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. ENVIRONMENTALPROTECTION AGENCY

TESTDATA AND O'IHERDATA Yoa are nqubed 10

__It aD tell"'" JOIlrr--loa or coab:vl _d to prvvldea dacrlpllOll of aD other .... kMw1l1D or

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# of.e._ droeaiClll .......ce. staadud Btennredtatloaa..,. be ......ed for d
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### thc.J do !lGt II'JZCM' Ia the_ "mbll. Y_ROald deadyIcknttfyw ...... tell ciliata_ tile .alllIaIIce orOIl .. 

### 1IJIIIIos. AIao, the chemkalCQIIlpoldtloa of til.t..w .....daJ

# _aJ4 be claanw:talzed. Fola-t.. __pks oftell dataad other data. Data
...d be •...,.Itted accord....totile req.'-eata of§72O.!IO of tMl'Ialanf&tllae NoUHailOIl aale

# ,.0 CFR Pad 120),


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

# 0 0 0 Yea • Kuliit effwciJ d ... Rlak_eata 

### Yea • Ea¥ilDlUlleatai effedl d .. 

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# ·0 Yea Teal cilia aot latlte Of'coatrol oftIM!

•A pltyliClll &Ild dlemlcd plOpeIIi

___lied ta loaded 011 tilet.I JNII'!

of tht. tvflll. TYPE OFNOTICE



# [iJ 

# o 

# o o o o

EPA FORM 771()'25 (Rev. 

### 5-95)

### -.-----~.----------------------------------------------------------------------------r_, PubJic reportingburdenfor 

### this collection of

### information is estimated to

### average 

### 110 hours 

### 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 

### commentsregarding the burden estimate 

### or any other aspect 

### of 

### this collection of

### information.

### Including suggestionafor 

### 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

### thatto the best 

### ofmyknowledge and belief: 1. Thecompanynamed in Part 

### I, section A, subsection la ofthis notice form intends to 

### manufactureorimport 

### for a commercial purpose,other thanin small quantities solely for research and development,the substance identified in Part (, Section

## B. 2. All information provided in this n9lice is completeand truthful asofthe date of submission. 

## 3. I am submittingwith this notice all test datain my possesSion orcontrol and a description of

### all other data 

### known

### to orreasonably ascertainable byme 

### as required by 

### §720.50 ofthe PremanufactureNotification Rule. 

## Additional Certification Statements: Ifyou are submitting a 

### PMN, Intermediate PMN, Consolidated PMN, or 

### SNUN, checkthe following userfee certification statement that applies: 

# o TheCompany named in Part 

### I, Section 

### A has remitted the 

### fee of

### $2500 specified in 40 

### CPR 700.45 (b), 

### or 

# o TheCompanynamed in Part 

### I, Section 

### A has remitted the

### fee of

### $1000 for an IntermediatePMN (defined @ 

### 40

# CFR 700.4: ) in accordance with

### 40 CPR 

### 7OO.45(b), or 

# o TheCompany named 

### in Part

### I, Section 

### A is a smaD businessconcern under

### 40 CFR 700.43 and has remitted 

### a fee of

### $100 inaccordance with

### 40 CPR. 

### 700.45 (b). Ifyou are submitting a low volume exemption (LVE) 

### application in accordance with 40 CFR723.50 (c) (1) 

### ora Low 

### release and low exposure exemption (loREX) application in accordance with 40 CFR 723.50 (c) 

### (2), checkthe following certification statements: 

# D The manufacturer submittingthis notice intends

### to manufactureorimport

### the newchemical substancefor commercial purposes, otherthan in small quantities solelyfor research anddevelopment, underthe terms of

### 40 CFR723.50. 

# o The

### manufacturer is 

### familiar with the 

### terms of this section 

### and will comply with those 

### tennsi and 

# o The new chemical substancefor which 

### thenotice 

### is submitted meets aU applicableexemption conditions. 

# o Ifthis application isfor an

### L VE inaccordancewith 40 

### CPR 723.50 (c)(l), the manufacturerintends to 

### commence manufactureoftheexempted substancefor commercial purposes within 

### 1 year ofthe date oftheexpiration ofthe 30 dayreview period.



### The accuracy

### ofthe statementsyou makein this notice should reflect

### yourbest

### prediction ofthe anticipated facts 

### regarding thechemical

substance described herein. 

### Ally knowing and willful

### misinterpretation 

### is subject 10 aiminal 

### penalty

## pursuant 10 18 USC 1001. 

### r--

# - -. d-en-ti-i.

### I-l-t 

# eonfi Sign,ature 

### and titleof Authorized 

### Offidal (Origin.al SignatureR.equired) Date
Signature of agent- (if 

### appUcable) Date
FORM EPA 7710-25 (Rev. 

### 5-95) 

### Page 2

## PartI - GENERAL INFORMATION SectionA - SUBMI'IIER IDENnFICATION 

## 1.. Person Submitting Notice (in US.)
Qty, 

### State, 

### ZIP Code


### b. AgentOf Name of

### authorized offtdal applicable) 

### MailiI'Ig address (number 

### and street) Qty, 

### State, 

### ZIP Code Telephone



### c. If 

### you 

### aresubmitting this

### nol:l.ce as part 

### of• joint 

### submlssion, mark 00 this

### box. 

# ---------------1 .... Joint Name 01 authorizedoffidal Position 

### Submitter

# ruappllcab~**-C~;;----------------------~-----------------------------** Mailing 

### address (number and street) 

### City, 

### State, ZIP Code Telephone 

### 2. Teclmical Contact (in US.) 

### Name Company Position


### Mailing address (number and street) City, 

### State, ZIP Code Telephone I I If

### you have

### had a prenot1ce communication (PC) conoeming 

### this notice and EPA 

### assigned. • PCNumber 

### to the notice, enter thenumber. Mark (X) 

### ------:)10 

# D

.... 

### ifnooe If

### you previously !lUbmitted

### an exemption applicatiQl\ fO£ thechemical substance covered.

### by this notice, enter theexemption number 

### assigned. 

### by EPA. If

### you previously 8Ubm1tted. a PMNfor this substanceenterthe Mark 00 

### --)10" 

# D lfnone PMNnumber

### assigned. 

### by EPA (i.e. 

### withdrawn orincomplete). --oJI)Io
... 

### If

### youhave

### submitted. • notice 01 Bona fide intent 

### to

### manufacture or Mark

### 00 

# ------:,.. ... D import for thechemical !lUbstancecovered. 

### by thisnotice, enter the 

### lfnone notice number assigned

### by EPA )10 

### Manufacture 2. Import Type ofNotice
- 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 ofthe 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. Ifanother 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 ofthat in a continuation sheet. 

### I. Class 

### 1 or 

### 2 chemical substanees (for definitions ofclass 

### 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 ofthe 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 (ifa 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 ofpolymer, see the Instructions Manual.)

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

Indicate maximum weight percent oflow molecular weight species (not including residual monomers, reactants, or solvents) below 500 and below 1000 absolute molecular weight ofthat composition. Describe the methods ofmeasurement 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 ifyou 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 (9fa number exists) ofeach monomer or other reactant used in the manufacture ofthe polymer. (2)
- Mark (X) this column ifentry in column (1) is confidential. (3)
­ 

### Indicate the typical weight percent ofeach monomer or other reactant in the polymer. (4) Mark (X) the identity column ifyou want a monomer or other reactant used at two weight percent or less to be listed as part 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 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. 

### IConfidential

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 ofthe 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, ifone can be reasonably

ascertained.



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



# 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,
, h C S 

### 1" bfl ble, If h 'd 'fied' 'd 'fied " ProVlde t e A Registry urn er laval a t 

### ey are um entl I Impuntles, enter "um enlJ 1 (b)-- Estimate the maximum weight % ofeach impurity. If there are unidentified impurities, estimate their total weight %, 

### I ' Impurity and CAS Registry Number (a)

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

## 4. 

## Synonyms -- Ente ! 

# o Mark (X) this box 

### ifyou attach a continuation sheet

5, Trade identification
-­ 

# o Mark (X) this box ifyou 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 ofthe 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

IContidential



## X



# o Mark (X) thiS box Ifyou attach a continuation sheet 7, Byproducts
-- Describe any byproducts from the manufacture, processing, use, or disposal ofthe 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 ofproduction. Also estimate the maximum production volume for any consecutive 

### 12 month period during the first three years ofproduction. Estimates should be on 

### 100% new chemical substances basIs. For Low Volume Exemption application, ifyou 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 ofthe category of use, the percent ofproduction volume

devoted to each category, the formulation ofthe 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 ofuse ofthe new chemical substance by function and application. (2) --Mark (X) this column ifentry 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 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 (CEI). (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 if entry 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 eX) this column ifentry(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 

## * Ifyou have Identified a "consumer" use, please proVide on a contmuatIOn sheet a detailed descnptlOn ofthe 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,,"" ;. ,"."mcrpcod,,,,**~d d~cr;b,** 

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

# D "vI ark (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 use category. Read the Instructions Manual for examples ofgeneric use descriptions. description 

### Additive for coatin2s, inks, adhesives and composites. 

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

3. Hazard rnfonnation Include in the notice a copy ofthe reasonable facsimile ofany 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 ofthe new substance. List in part III hazard infonnation you include. Mark (X) Mark (x) this box ifyou 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 

### Ifthe same operation will occur at more than one site, enter the number ofsites. Identity the 

### # 

### of sites

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. industrial' after I. 

### ofthe site at which the

Mark (X) 

### this box ifyou attach a continuation sheet. b. 

### Type-­ Mark (X) 

### Use c. Amount and Duration
-- Complete 1 

### or 2 

### as appropriate Hours/batch Batches/year Maximum kg/batch (100% new chemical 

# 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 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 or per batch). (3) 

### Identity by number the points ofrelease, 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 ofworker activity, physical form ofthe new chemical substance, number ofworkers exposed, and duration ofacti'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 ifentry 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 (ifin mixture) ofthe new chemical substance at the time ofexposure (i.e" solid: crystal, granule, powder, or dust) and % new chemical substance (ifin mixture). (7)--Mark (X) this colunm ifentry in column (5) is confidential business infonnation (CBl). (8)--Estimate the maximum number ofworkers involved in each activity for all sites combined. (9)--Mark (X) this colunm ifentry in colunm (8) is confidential business infonnation (CBI). (10) and (11 )--Estimate the maximum duration ofthe activity for any worker in hours per day and days per year. (12)--Mark (X) this column ifentry 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 ifyou attach a continuation sheet. 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 information. Mark (x) the "Confidential" box next to each item you claim as confidential. (I)
-­ 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 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, ifany, and control efficiency that will be used to limit the release ofthe new substance to the environment. For releases disposed on 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 after control technology (in kg/day). (6)--Mark (X) this column ifentries in columns (4) and (5) are confidential business information (CBI). (7)--tdentify the destination(s) ofreleases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct dischargers or NPDES numbers ofthe POTW (Publicly Owned Water Treatment Works). Mark (X) ifthe 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 ifyou 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 ofprocessing, or use 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. 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 ofall feedstocks (including reactants solvents and catalysts, etc.) and ofall 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 ofthe new chemical substance. (4) Please enter the # 

### of sites (remember to identify the location ofthese on a continuation sheet. Enter # 

### of sites 

## ­

Mark (X) this box ifyou 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 ofworkers exposed for all sites combined. (4) Estimate the typical duration ofexposure per worker in (a) hours per day and (b) days per year. (6) 

### Describe physical form ofexposure and % new chemical substance (ifin mixture), and any protective equipment and engineering controls, if any 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, enter the number ofeach 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 ofrelease {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), (II ,(13) and (15)
-- Mark (X) this column ifany ofthe 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) % 

### inFormulation

(7)



### Mark (X) this box ifyou 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 ofthe 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 ofchemical wastes by technological modification, process and procedure modification, product reformulation, raw materials substitutions, and/or inventory control. Recycling refers to the reclamation ofuseful chemical discharges, or land disposal. Descriptions ofpollution 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 ofrisks 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 ofwaste 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 ofthe 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 ifyou attach a continuation sheet.

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

## Part III -- LIST OF ATTACHMENTS Attach continuation sheets for sections ofthe 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 ofthe form towhich it relates, ifappropriate. Number consecutively the pages ofthe attachments. In the column below, enter the inclusive pagenumbers of each attachment. k ( ) th C tid 1 b hm 1 . fid' I d the InstructlOns Manua forguidance on Mar X e" on 1 

### entia" ox next to any attac ent name you c aIm as con I entIa . Rea how to claim any information in an attachment as confidential. You must include with the sanitized copy ofthe noticeform a sanitized copy ofany 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 ifyou 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 ofphysical 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 ofthe noticc 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. The physical state ofthe 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 oftest data. This worksheet is not a substitute for submission oftest 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 ofneat substance i- (s)_(l)

__ (g) 

## X
i Vapor pressure @ Temperature °C torr ! •Density I relative density glcm3 

### I Solubility 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 ammabi

### lilY
•Explodability
! Adsorption! coefficient Other specify 

## X I

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

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