EPA Form 1265-07 (Revised 04/2011)

Previous editions are obsolete 1 United States 

## ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460 AGENCY USE ONLY

OMB Control No.: 2060-0226

Expires: 06/30/2014



# TSCA/SNAP ADDENDUM for Significant New Alternatives Date of Receipt:

When completed send this form via U.S. mail to: Or via overnight delivery to:



## SNAP Document Control Officer SNAP Document Control Officer Office of Air and Radiation, 6205 J U.S. EPA U.S. EPA 1310 L St, NW 1200 Pennsylvania Ave, NW 10 th 

## Floor (MC 6205J) Washington, DC 20460 Washington, DC 20005 Date 90 Day Review Begins:

Date Review Completed:

PMN Document Control Number

Enter the total number of pages in your SNAP information Notice: SNAP Document Control No.



# INTRODUCTION

GENERAL INSTRUCTIONS

This form may be used in conjunction wi th the Premanufacture Notice (PMN) for new chemical substances (EPA Form 7710-25 (Rev. 1-19)) to submit chemicals for review under the Significant New Alternatives Po licy program as alternatives to Class I an d II ozone-depleting substances. In addition to the information provided in the Pr emanufacture Notice, the Agency is requesting submitters provide information on the followi ng topics. This information will assist EPA in assessing the acceptability of the

chemical as an alternative to ozone-depleting substances as required by Section 612 of the Clean Air Act. Please see the

Instructions for the SNAP Information Notice and TSCA/SN AP Addendum (“Instructions”) for additional information on the relationship between the SNAP and TSCA PMN progr ams and for guidance on completing this form.

To facilitate Agency review of alternativ es, both this form and the complete PMN fo rm (including the physical and chemical properties worksheet) must be filled out as co mpletely as possible. Please provide all information requested to the extent tha t it is known or reasonably ascertainable. Make r easonable estimates if act ual data are unavailable.

PAPER SUBMISSIONS: All paper submissions must be provided in th ree complete copies. If information is to be claimed as confidential, all confidential information must be excised from one of the copies which will be placed in the public file; the other two copies must include the confidential ma terial. If no claims of confidentiality ar e made for the submission, all copies mus t be

identical.

CD-ROM SUBMISSIONS: The SNAP program also accepts submi ssions via CD-ROM. If inform ation is to be claimed as confidential, all confidential information must be excised from one of the files on the CD-ROM, which will be placed in the pub lic docket; the other file must include the confidential material. T he file with the confidential material must include “contains CBI” in the file name. Please provide a CD-ROM copy of your PMN submission along with your SNAP submission.

CONFIDENTIALITY CLAIMS: Anyone submitting information must asse rt a claim of confidentiality at the time of submission for any data which is to be treated as Confidential Business Informati on (CBI). Substantiation of th is claim must also be provided at
this time. All information claimed as CBI will be treated in a m anner consistent with 40 CFR Part 2, Subpart B. Failure to as sert a claim of confidentiality at the time of submission may result in disclosure of the information by the Agency without further no tice.

Information submitted as CBI may be accessed by companies des ignated as Authorized Representatives of the United States Environmental Protection Agency (EPA) under an EPA contract for the purpose of assisting EPA in the development and implementation of national regulat ions for the protection of stratospheric ozone, including the development of the SNAP program

. These Authorized Representatives may have access to any inform ation received by the Stratosphe ric Protection Division within the EPA Office of Atmospheric Programs for use in reviewing the need for possible control of any substance, practice, process o r activity that may reasonably be anticipated to affect stratospher ic ozone. In general, this information will pertain to the fe asibility, costs, and environmental and health impacts of using substitutes for Class I and Class II substances. Access to such informati on is necessary to ensure that these companies c an complete the work required by the contract.

Authorized Representatives of the Administ rator are subject to the provision of 42 U.S.C. 7414(c) regarding confidential busine ss information as implemented by 40 CFR 2.301(h)EPA Form 1265-07 (Revised 04/2011)

Previous editions are obsolete 2 

## Part I - GENERAL INFORMATION

Section A - SUBMITTER IDENTIFICATION

1. (a) Person Submitting Notice (in U.S.)

_____________________________________________________________________________________________________ Name of Authorized Official Title

______________________________________________________________________________________________________ Company/Organization

______________________________________________________________________________________________________ Mailing Address Telephone & Fax Numbers

______________________________________________________________________________________________________ Email Address

(b) Agent (if applicable)

______________________________________________________________________________________________________ Name of Authorized Official Title

______________________________________________________________________________________________________ Company/Organization

______________________________________________________________________________________________________ Mailing Address Telephone & Fax Numbers

______________________________________________________________________________________________________ Email Address

(c) Joint Submitter (if applicable)

______________________________________________________________________________________________________ Name of Authorized Official Title

______________________________________________________________________________________________________ Company/Organization

______________________________________________________________________________________________________ Mailing Address Telephone & Fax Numbers

______________________________________________________________________________________________________ Email Address

2. Technical Contact (in U.S.)

______________________________________________________________________________________________________ Name of Authorized Official Title

______________________________________________________________________________________________________ Company/Organization

______________________________________________________________________________________________________ Mailing Address Telephone & Fax Numbers

______________________________________________________________________________________________________ Email Address

3. If you have had a prior communication with EPA concerning this notice, note the date and type of communication (letter, phone, etc.) and the EPA staff person’s name:

Mark (X) if None ________________ 

# 

Mark (X) this box if this page contains CBI __________ 

# EPA Form 1265-07 (Revised 04/2011)

Previous editions are obsolete 3 

## Part II - ALTERNATIVE- SPECIFIC INFORMATION

1. Name of chemical (preferably IUPAC nomenclature) and molecular formula.

2. Generic name (if chemical nam e of substitute is declared Conf idential Business Information)

3. End-uses and ozone-depleting s ubstances (ODSs) being replaced: (a) Describe each industrial sector and end-use that ma y be reasonably anticipated for the alternative. For a list of end uses, see Appendix A to the Instructions, beginning on p. 23. If the alternative is a refri gerant, indicate whether it is a candidat e for use in retrofits of existing equipment, for use in new equipment only, or both. (b) Identify the ODS and the quantity of substitute needed to replace it for each end-use (i.e., the replacement ratio).

4. Ozone-depletion Potential (ODP):

(a) Provide the alternative’s 100-year ODP of the alternativ e relative to CFC-11, if known. Reference the source of the O DP. (b) Provide any additional data on the ODP of the alter native (e.g., atmospheric lifetim e, chlorine or bromine loading potentials). Reference the source of this in formation and attach any supporting documentation.

Mark (X) this box if this page contains CBI __________ 

# EPA Form 1265-07 (Revised 04/2011)

Previous editions are obsolete 4 

## Part II - ALTERNATIVE-SPECIF IC INFORMATION (Continued)

5. Global-warming Characteristics (a) Provide the alternative’s atmos pheric lifetime and global warming potential (GWP ) relative to carbon dioxide over 100-ye ar time horizon, and 20-year or 500-year time horizon, if know n. Reference the most recent assessment report of the Intergovernmental Panel on Climate Change (IPCC AR4). Al ternate sources may include the 2010 World Meteorological Organization (WMO) Scientific Assessment of Ozone Depletion or the peer-reviewed liter ature. If the substitute is a blend, provide the GWPs of the individual constituents and an estimate of the blend at its nominal composition. (b) If known, provide the alternativ e’s expected impact on energy efficiency relative to the substance it is replacing (e.g . +/- X%) and results of any testing or modeling done (both theoretic al and actual testing). Ener gy efficiency information is particularly useful for refrigerants and foams. (c) For GWP values that do not come from AR4 or WM O 2010, provide any available additional data on the atmospheric lifetime and GWP of the alternative, including infrared absorpti on spectrum and infrared absorption capacity. Reference the

source of this information.

6. Flammability Concerns: (a) Provide the alternative’s flash point, the upper and lo wer flammability limits (UFL & LFL) in percent by volume, the h eat of combustion (kJ/kg), maximum pressure (PSI), and maximum rate of pressure rise. (b) Provide any additional informati on on flammability concerns. For example, if any abatement techniques are being used to
minimize the risks associated with flammable subs tances or mixtures, deta il those techniques below. (c) For flammable refrigerants, pr ovide a fault tree analysis for each end use. For flammable foam blowing agents used in spray foam, provide a training program that addresses flammability concerns specif ic to this substitute.

7. Cost and Availability of Alternative: (a) Estimate the cost per pound for the alternative chemic al. Please describe the informat ion used as the basis for this cost

estimate. (b) Describe any new equipment and use profiles that will be necessary in order to use the substitute. If retrofitting of existing equipment is required, detail changes in technologies needed to use the alternative and address any materials compatibility issues. Provide information on any new materials, equipment lifetime, changes in labor, and energy costs. (c) Provide information on when the subs titute is expected to be available, including:

- Year substitute is ex pected to be available - Years to maximum market penetration - Maximum total production per year at maximum market pe netration, providing units of measure and estimated percentage of market.

Mark (X) this box if this page contains CBI __________ 

# EPA Form 1265-07 (Revised 04/2011)

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## Part IV - LIST OF ATTACHMENTS

List below any attachments that complete the responses to the questions on this form or that provide additional information tha t may assist EPA’s review of the alternative under Section 612 of the Clean Air Act. Also, provide citations for information alr eady submitted to EPA as part of past regulatory and information activiti es, as well as for other information that could not be incl uded with this submission. If you have atta ched continuation pages, describe the Part, Section and question number being continued. Attach additional pages if necessary. Mark (X ) in the CBI box next to any attachment that contains information you claim as

confidential.

Attachment Name Question # Number of Pages CBI

Mark (X) this box if this page contains CBI __________ 

# EPA Form 1265-07 (Revised 04/2011)

Previous editions are obsolete 6 

## Part V - CERTIFICATION

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

1. All information provided in this notice is comple te and truthful as of th e date of the submission.

2. 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.

3. If this is a submission of a new alternative, t he company named in Part I, Question 1a of this notice: (a) intends to manufacture, fo rmulate, import, market, or use a new alternative to a Class I or Class II ozonedepleting substance which is identified in Part I, Section B, Question 2. (b) seeks an acceptability determination on a new alternative(s) to a Class I or Class II ozone-depleting substance, which is identified in Part I, Section B, Question 2.

4. The accuracy of the statements m ade in this notice reflects my best predi ction of the antici pated facts regarding the alternative described herein. Any knowing and willful misint erpretation is subject to criminal penalty pursuant to section 113(c) of the Clean Air Act and 18 U.S.C.§1001.



## Signature and Title of Authorized Official (Ori ginal Signature Required): Date

Signature of Agent (Where Applicable): D ate

For persons filing a SNAP Information Notice, the re porting burden is estimated to average 171 hours per year. For persons filing a TSCA/SNAP Addendum, the reporting burden is estimated to average 36 hours her year. Burden means that total time, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instruction; develop, acquire, in stall, and utilize technology and systems for the purposes of collecting, validating, and verifying inform ation; adjust the existing ways to comply with any previously applicable instructions and requirem ents; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and

transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of informati on unless it displays a currently valid OMB control

number.

Send comments on the Agency’s need for this inform ation, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the U.S. Environm ental Protection Agency, Attn: Director, Collection Strategies Division, Office of Information Collection, 1200 Pennsylvania Avenue, NW, Mail Code 2822T, Washington DC, 20460. Pl ease include the EPA Docket ID Number OAR-2004-0077 and OMB Control Number 2060-0226 in any correspondence. Do not send the completed form to this address.