# Cont i nuo u s Re lease Repo r ti n g For m F o m1 App r ove d OMB N o. 2050
-0086 E

xp iratio n D a te : XX - XX - X X XX 

# SECTION I: GENERAL INFORMATION CR
- ERNS Number: 

# I 

# I I Date of Initia l Ca ll to NRC: 

# I**~-------------- ~==========** **~** 

# Date oflniti al Release: Type of Report: Se l ect tfom 

# th e dr op-dow n 

# li st, 

# I th e type of repo rt that you are submi ttin g 

# Signed Statement: I ce rtif y that th e hazard o us subs tance re le ases des crib e d h e re in ar e co ntinu o us and s tabl e in quantit y a nd rat e und e r th e de finitions in 40 C FR 30 2 . 8( a) or 355.32 and that all s ubmitt e d informatio n i s a cc urat e and c urr e nt t o th e best of m

y kn o wl e d

ge.
Da r e Na me a nd Position


# Part A. Facility or Vesse l Information N ame of Fac il ity or Ves se l Person i n Charge of Facility or Ve sse l Name Phon e N umber Street S i g na tur e



## Position Alt 

## Phone No. County 

# Facility Address or Ve sse l Port of R eg istration C it y ...__ _____ _, State 

# D ZipCodc'- l
____ _,l 

# Dun and Bradstre et Number fo r Fac i lity 

# I Faci li tyNesse l Location Latitude D cg 

# 0 M in 

# O see 

# 0 Ve sse l LORA N Coordinates Long itud e Dcg 

# 0 M in 

# O s e e 

# 0 NOTE: L a rirude! Longi w de i n fo rmation can be ob t ai

n ed a r tlt e fo llowin g webs ir es : ltup :ll www. s ms i g . net/ mops/l at · l on

g-f

mde r . htm.**hu p:** **l/ ea** **rth. goog** **co l.**  

### a n

d ltu p :!il l'l l'll '. ce n srrs. go l·l geol lan d,· ie w l. Do not use P . O. Bo x. R u ra l R o w e o r M aili ng Ad d

ress. Use ph ys ica l/ oca r ion onl y. 

# Part B Popu l at ion Information

Population Dens i ty Se l e ct from the drop-down l i st , th e range that 

# I desc ri bes th e popu l at ion density wit hin a one mile radius of yo ur facility o r vessel. 

# Sensitive Population s and Eco syst ems wit h in On e -M il e Radius Sens iti ve P opulations or Ecosyste m s Est im ated Distance and Directio n from ( e .g .. e l e m e ntary sc h oo ls. h os pit als, r e tire m e nt c o mmunitie s, 

## Fac ilit y, if Kn o wn or 

## w etl a nd s ) 

# I I

EPA F o nn 6100 -1 0 , Continu o u s Releas e Re p o rting Form P age I o f

# IN ST RUCT IONS SECT l ON 1: GENERAL INFORMATION
C ll -F: R NS Nu mbrr: 

### If

yo u art! rt! poru ng a reletl.<<' of a C£RCL, I ho:ard o u

.< s ub.<tanu{s). )'OIIIItll be nsstgned o CR-ERNS num ber uh e n you mnlce tlu s mil tal t elephone call t o the 1\'RC 0-811n -.fl-l- cY80l) 71us CR-ERNS num ber 1111/ becam e the tdentifier far your fnctllly Your Cll
- ERNS 1111111h er ll 'tllne•·er change : 11 t . f th e number that tdentifie.< )'OIIIfl the CR-£RNS databnu . The mformation reqwred 111 Sectio n I of th e illltWIII ' rtllen repor1 and follvw-up reports includes genera/mformation idemifying yo ur faCility. as well as mf orma llon rl!g arding thl! ar e11 m whic h

**yn ur**  **ft~cili ly**  t.r lo ca 1 ed. 77u.r generalmformall o u is tmportant because i f provide.< a be tier wt derslanding of th e poten ll al nslcs resulting /rom exposure from thefacillly'.r release . A signed . flat e me/11 assertmg lhalth e contmuous release t.r co niiiiiiOllS and s1able in quanllty and rtlle. and thai th e mformnno n s upplu : d IS accur(l(e and currelllto th e hest of yo ur lcnowh:dge. IS also reqwred in Secuon I . In add111on. SecuonlniiJSI clearly tdentify th e t;pe ofw rm e n report/hat you are .rub m i llmg (i . e .. an 11111/a/wmlm repon. a first amu•·ersaryfollow -u p reporl. or a 11 rllten repo rt of th e c han ge m source or com pos111 o n of a prel'lor;s/y reported release) . Yo u must also m e/ rul

e m/ o mratio n 0 11 tir e mil tal n o tification of tir

e rel etue .

. weir as tire date of tire relea.re and tir e dal e of tir e 1111110/ c all . For ('1-."RCI . A lra:nrd o us suh.<tancn tire C R -ERNS munher ass1g11ed t o you by tire N R C wtll also be reqr11red . T y p e of Report
- Selec t from drop-dow111ist
. Initial Wrillrn No t ilicnti o n • Witlun 30 days of th e mllwlteleplro11e 11ottj ica llo 11. yo u are reqwr ed t o s ubmll an uuualwr111e11 report t o tir e appropriate EPA Regtmwl Office. SERC. a11d LEPC {fo r releas es o/CERCLA lra=ardou.t sub.rtances) omlto o nl y tire appmprwte S£RC mrd 1 .1-."I'C (for releases of IIOII· C ERCI.A £1/Ss) 71re pur pose of /Ius rep o rt I.< ta co nfirm yo ur mtemt o repo rt yo ur r e le ase as a ca llllllli O IIS release under Sec/1011 103(/) (2) . a11d to prowd e go,·erm11e nt respo11se officials witlr .wfficielltmformollnn about your releas e to cmablf! tlre m t o de termm e if th e release qualifies os a cammuou s r clea.H!. Firs t

**Annivrr**

**~a y**  Follow-up Report · For rep o rts of releases ofC£RCLil lra

:a

rd

o us subsumcl.'s
. w1tlrin 30 day s of tire

first t mn11 •e r.mry of yo ur 1111/lalll ·rme11 repor t . you are r eq wr e d to reassess your milia/ conti11uous release repo rt nntl ga th e r tire mf o rmau o n o n all of tire repo r1 cd sub . flnn ces bemg r e leas ed Afte r domg tlus . you niiLII s uhm11 a o ne-time wnl/en first amlll'ersary• follow-up r epor t t

o the appropnate El' A Regw11al Office. !'lease n o te tlrattlre first amuversary reporl 11111.</ be semto tire appropriate EI'A Regmnal Office for all reports ofC/iRCIA /w:ardous
.wb . <tan ces. b ill is not required for r e port.< ofnon- C£/?CLA EllS . < . Written No tili c ation of 11 C hange to l nitinl No tilication and/or Writt e n No tilir:lli o n of a Change to Follow-upllcport

## INOTE: For the se re ports. selec t the report t ype that reflects the notrlicatron or r eport lor which you arc rcportrn g a change] Notifica t wn of a cham:e msvum· or COIIIf]lUil.IJI.IJ.. uluch t.f treated as tj1111ere a11e11 release {t. l.' .. u-uh a telephone call t o the NRC. SERC . and LEPC.followed by a llrtl/en report and afirs t amri•·ersary • folluu -up report ). 

# = N01tjic atio n of a cham:c 111 tb e n o nna/ range 

## if th ue 1.r a c hang e 111 th e relea . re . filch 1/rar the quail///)' of th e re l eau exceeds th e u ppu bou11d of tire report ed n o rmal rang e. th e releas e 1111/.JI he reported a.t a stat!.<IC(IIIv s tgnifictmt incr e a .

<e.

- For rERCLA subslcmces only. 1/0tijication of (Ill)' a!lu:r..a:po rted jnjOI"IIlCJl.JJJJJ

**r~ g** 

# .. a cha nge infa c tllly OW II I!I"Slrip) in (I wnllen f e lle r to only lire EI'A Region. t '11r1 A. F:tcitit y or

**Vr~srl lnf**  **rrnnlion** I. Tire complet e n11111 e tifyo ur facility (and com pany ulentifier wlra e appmprmte). lfmultiplefacilities arc mcluded 111 your Written report. provul e tir e plant.<tte name ll 'ith th e nam e of tlr ef aciluy . 2. Tire full address of you r fact lily. m c/ udmJ( tire .<tree/ address or lugl111 ' a)' marker . city . count y . Stille . a nd :tp cad.: . A pn<l office box number slw ulcln o t be u. retl as th efactllly address. 77re addr essprnwded .<hou ld be tir e location of the fa c i/lly where tire lm:ardous s ubstance release occ ur s 3 . T ir e locatton of your faeth ty by II.< lallttule a nd /ong uud e in rmm nf dej:reer. minutes. and second< Su below fo r h e lp fu llunt r o n/r ow to obwmthe lalllltde a11d longitude cuord mat e.r of your factilly. -1
. The m11 e dig1111111nb c r as.<tgned b y Du11 a11d

**!Jrt~d tre** 
**t** (D& B) t o yourjircthty
. Tlus nwnb er c an bf! obtomf!d via telepho n e by 011 officer of your co mpany fi"omthe nallonal office o/D rm a11d /Jrad.rtree t (a t/ -800-23-1-3867) 

### If your facili ly lras nlll been assigned a D&/1 numb e r. ple as e .rpecify 1lw11h e mformallon is n o l appltcable. illtf• " " " ".clnh c om / . \ """' "''"""' 5 . For reports ofCERCI.il ha:ardous substance.r. th e C ll-ERNS mJmhe r a .mgned by thl! NHC uhe n you mad e th e milia/tel eph o n e report . Be cerwinto 111 c lude the C R-ERN S number o n fJK.hpage of your report 6 Tire name . telephone 1111111ber {mcludm g area code). and an alternate telepho11e number for the pe rson m cha rge of your faCIIIIy. 

### SO H CES OF

**~FO R~**  **A** 

### TIO N FOR ID E ' T IFYI NG TilE LO CA TIO N Of YO U R FAC I LITY So ur ce.r of daw o n lat llud e amllnng11ude coordmate.r of yo ur faet!t ty m clude £/'A permll.r (e. g .. NI'DES permnr). couatyprop e rt y r ecords. factltty blueprmts
. aml.we plan .r In addiuon. 'u rfo muwn n 0 11 1he latllud e a11d lo 11 g lllul e of yo ur faCility may he obtmn ed from a U mt

c d S lates Geo logiCal Sun•ey (USGS) t opograplucalmap 71tc.<e maps arc arm/able 111 hoth the 7.5 nunule and 15 111111111 1.' scncs. 71w se maps may be obtained ji·om th e USGS distribwion cent er at yo ur local public ltbrar y . 

### If )'O UIIOuld like t o order a mapfi" o m USGS. conto c r U.S . Geological Swwy
- l•rf or

mation Services. Box 25286. Dem·er . CO 80225. c a/11-888-ASK-USGS ( 1 -888-27 5-8747 }/llltJ• It/nan 

## '".1:'

**.\:" ~"**  

# "'''' ' ''"!.' luml 

### If

yo u are not certain onwluch map your stte '-' lo c at e d. consult the md ex Jtj t opograp hic maps for yo ur . rtate. wlu c h may b e obtamed from USGS free of c har ge . 

## usc;s map s are also al"lulable at commercial dealers s uclr as .t un •eyo rs or owdoor rureatwn eqwpmem dealers 

### I t ll tlltrll' 

### I tmgllutl ...· tn{fi iii iU/ Icm 

### om lw ohr a t n

ct l til 

### tlu {ollouun: uc:hHh'\ 

### hllp \11111 ft/1\(l: ll f i iiM/t\ 

### ln t -ltm g -

fi udt·r_/ llm . h11p. c'tllllt 

### _'.!t'n•,• /,• t·om. 

### uud hiiJI u u '• < , -fl\11' gc• t

**\!'~·n** ffiUtf\ h'U 

### l' art II . Populati o n Inf o rmati o n · I Choose th e range fi"o m I h e drop down list . th e nmge thm mo. fl a cn tratcly d escnbl's the p o pultllton denslly willrin o one-11ule radius of your fa c t!tly. l . ldemify and dc.<erihe the local/on of a11y sen sitiv e populmions or c:cosy.<te m . < withi11 a o ne · mtle radmr ofyo ur facil it y . lfp o.r. <iblc. describe th e lo c otwn 

## tr/the populanons or et:osys tems 111 term s af ths tmr ce and direction from your faetlity (e . g .. located !/ , mtle n ortlrwes l of tire factllly) . 

### £.tact addresses are not reqwred. Snrsith·t' popul11tionr • pop u lnuon.r hlcely to b., m orc: su..teep u hle than lll " c:rage lltthl"llluals t o th e effects of I!XfJO. wr e 

### w a lta:artl o a

s s u b.< tnn ce . Examples of St.'

II SI

III "

e populauons are dcmentar)' school c/11/dren . rctm:melll conunulllll t'.<. or hospttals

**s~ <i**  **ti• ~**  **~cosys**

**s** - cm • tronmcms ltkl.'iy t ube m nrc s llscep llblc: than u• · em,11e

**cm ~ronmems**  10 th e effe c t s of expos ure t o alw:artl ai/S s ubstance. ar ecosystems that haw : heen destgnat.:d fnr . rpecml protection hy Federal or state gm·e rnm c m .• Example of.<e iiS tii i 'C eco.<ys lc m .< In c ludes wetlands

# Co ntinuou s R el ease Reporting Form Fonn Approved OMB 

## No. 2050
- 0086 Expiration Date : XX-XX-XXXX 

# SEC T I ON II : SOURCE 

# I I I NF ORMATIO N CR-ERNS N umb e r: Part A: Basis for Asserti ng th e Re l ease i s C ontinuous a nd Sta bl e in Quantitx and Rate. 

# For EACH so urce of a re l ease of a ha z ardous s ub s tan ce o r mi x tur e

from your facility or vesse l , provid e th e follow ing inf or mati o n o n a SEP A R A TE s h ee t . 

# I Na m e of So ur ce: 

# I

I. 

## In dica t e whether th e release from thi s so urce is ei th er: 

# 0 Con tinuou s without int crn 1pti o n 

## OR 

# O routine, anticipated. intennittcnt 

## & incid en t a l to 

# No t e that unanticipated eve nts , s u ch as sp ill s, pipe ruptur es, eq uipm e nt failures, e merg e n cy shutdowns, o r accidents, do not qualify .for redu ced r e portin g und e r CERCLA sec tion I 03(/)(2). Unan tic ipated events a r e not incid en t al to normal ope ration s and, by definition, are not con tinuou s or anticipated, and are not sufficiently predictable or regular to be co nsider ed stable in quantity and rat e. 2. 

## Provide a brief s t a t

ement descr ibing the basis for s tatin g that th e r e l

ease i s continuous and stab l e in qu antity and rat e. I f malfunction , describe the malfunction and exp la in why th e re l ease from the malfunction sho uld be considered continuous and stable in quanti ty and rate given the no te above.



## 3. Iden ti fy below how you established the pattem or release and calcu l a t

ed release es tim a t es. O Release data OKnow l edge of Operating Procedures 

# 0 Engineering es tim at e O Best Professiona l j ud gment

OtherEPA 

## Fom1 6 

## I 00- I0, Contmuous R e lease Reportmg Fom1 Page 

# or 

# II

I

# INSTRUCTIONS SECTION II: SOURCE INFORMATION ( Part A) 

## C R -E R NS N umb e r : {(

y ou are reporting a release of a CE R CLA hazardous sulwam :c{.1), yo u will be assign e d a CR
- ERNS mtmbe r when yo u mak e thi s initial t e lep hon e call t o th e NRC (1-800 - 424-8802). 

## This C R -E RNS munh e r will beco m e th e ident(/ie r fo r yo ur.facilit y. Your CRE

RNS numbe r will n e ve r change: it is th e numbe r thai id e nli[i cs yo u in the CR -£ RNS dalahase. Ge n era / ove r view
- Wh e n co mpleting your wri lle n report .s. yo u must toke imo con .<idcro tio n 

## all source.,· oj th e re lease from yoru)ut·ilit y . Pro, , iding thu· informn/1011 liCLIIralefy in the lltillnl "t'tllrn tmdfirs t anui, • er

.,a n • falfaw- up repnrt .,;(( m inimi:e f utur e request< b• • EPA far additional mformat wn or clarificat ion . /11 th i.< scc tion of the wrillen report. yo u should ulentify and tlescrihc ,,·epora tcly 

### flJ£h m minuous rc lcasc 

## If th e con tinuou s release of th c same ha: arclo w · s u bs tan ce co me.< fro m two or more .murces (e. g .. tu·o s ta cks). th en informutiou
. <lwuld be reported seportllcfy for 

### J:tJ&h. of th e so ur ces. Fnr example. if a swck 

### i.,. one of ,\ ' I'VI:rol so ur ces of a Jwwrtlou.< sub.<tance release at yo urfacilit y . yo u must provid e il!formmion o n that s ta c k including: the stack h eig ht : th e identit y of th e lwwrdou, , ·

.wb s ttm cc(s) being rel e a. w d from th e stack: th e qua11tit y released: and th e ji-eq u c n q of the release fro m th e s tu ck . 

## If yo u hove a ref l!t

J.< I! of a particular hawrd u us s ubstan ce from thr ee s ta ck.<, yo u sho uld report 

### mdJ_

**.~ ta**  **ck .repa**  **rote~v** ond pro••ide the req uir ed inf or

matio n specf/ied for each s to c k .

**Afthou~:h** the contimtoU> relcM e reporting regulation alfows multiple con c mr e nt

**ll!<~•**

**·. <**  aft he som e CI!RCL ; f lw:ardous substun ce t o be cons id ered as if th ey were o11c c ominuous releare. aggregate reporti11g of.mch releases from different
.wun· c.t c nmplico tcs r i . <k a11aly.re.< . Area so ur ces ore most readily aggregated jarpurposes of

r u 11t inuo u.< release reporting mrd risk ei'Oiuo t iofl whe11 th ejre quc 11 cy of the release fro m each source 

### is th e .w m e . Similarl y, aggregated s tock releas es are m ost readily ev aluated if th ef req u e n 'y of th e re lea se.from each s ta ck i.r th e some and rh e ,, · ta ck co11jigurationv (e.g .. stack height, diam e te r , throughput) are th l! s ame . {{you elect to aggregate releases ocro.u.facilities , b e ce rtointo identify injarmotiofl about 

### mdJ_ so ur ce of th e re le ase .fro m olf of yo ur.fad liti es. Also . note that if y ou oggr eg ot e yo ur releas e.<. Bf' 1 f may request clarifying it!formotion about th e rclca .ws fmm each of t h e individual murccs. Id

e ntification ofsmtrccs- In Section II . yo u must itlemify (i . e .. 11ame) o11d dl!.> c rihe each co ntimwus releu . <e . < or trcc. Ther e are several woys 10 name relea:,e .w ur ce.r . It it import ant t o (I) provtde o nome rhat dearly idemijie . <

th e source (e . g. ccmrifit gal

**proce.~ <or**  A. mther than Uni t A): and (Z) avoid g i ving 11\' o or m ore so ur c es the

. \time flame. It 

### is also tmporltmtlo reme m ber when naming your sourw . <

that I:.' I' A . nt any t ime . may comaa J'fm with questions regarding releases from one of your aom c d source . < . It woutd be pmdcnl , therefore. to ntmre the .murces at y our(tu · ctit) ' in a manner that will be ea.<y fnr yo u and a th er e mpl oyees t a identifY th e m For cwmple, ifyourplam ha<four
. <tack.< . rwo wastepile
. <, and twenty-four vol • ·cs. I'OU ma y name th e source.< a.< {olfows : Sta c k # I : Swl'k #Z; Swck 113: Sta ck 114. Wa.r tepile Ill , Wastepile #1 : wrtl V alves i n OuildinJ< #1
. No te thottlw .. Valves in

**lluiltfm**
**~:** Ill" ar e aggr eg ated in thi.< ewmpl e o11d reporte d as o .< in}(le source . llriJIIlrrtl ; , p,rlltnlinn .. St •clion/1, Sour re '' !for mulum . ( fiii/Uin.\ ' th l'(.'t! I'm ' / ,\ (l'f. 

### n. mul C) . Youmtt , \'l jJI ' ()V/

tic th e: injur mutioll r c qutt'Ctlllll!U( .' It of the se I"uriS jorl:.aJ:h c · a ntimmus releas e

**.~o**

**.** /Je sure 10 place th e nom e o{the source on all puge.< o.<.<ncioted with thm spec:i/ic .wur ce . Th e re i s one ercc ption t n this rule . lj th c reletw: fro m any indcvidtmf .w

mr

c e wtlf u(fe c t m ore than tml.! e n vtrm un c ntal m l!dium (e . g, o wastepile relea.<ing t o oir and gro und water) it mu.lf he m o del e d separat ely. Thcnfore. any source that affe c ts two differcm medm . <hrmld he treated a.< two .n:parate so ur ce.<

fur purpo .•es of repor tin

g . 71ci s 

### iJ desirable bt:cu u sc EPA must

**tma~v::e** each relewe pathway separat ely to properly e •• aluate the risks posed by the nmtinuous release: . In addition. because th e hawrdous substance releose .< ta each m c dwm

**mt~\**

**'** differ in[rl!tfllency and quantity. it is we{ul 

### w distinguL<h th e rdea .H: .

<.for purposes of ri

. <k el'(1/uation
. 

### flrw A
- Ba s is ((lr A sscai!IC! 

### th e llcka. • -r is Cawitlll!flts ami Stable i n Ouallfi(J • _tl.11.!l../1Jm:.: You mu.vt }irs/ id entify th e .<m t rce of th e r e lea.<e (im: ftule th e twm e of th e source in olf .whscquent part s) . th e n brief ly describe th e basis far .< f ating that th e rele as e i s 1 ll11ti11uous and .<whlc in quantity and rare . )' o ur d escri (Jfino of the ba.<is/or
. Hating thuttlte hawrdous sulwmtce release is c olllinmJ/IJ a nd stable in quantity and rote , ,lwuld tn cl ud

c whether the rt.:kuse i.f continuuu .\ ' wttlumt int err uption . or/ , '( a rvuti11c . ant icipat e d . intcrnullent r eleas e . It s hould al .fn 

### inc ·lude information u n when th e rt•f

c me is <'xpected Ill 01 c ur (i . e . . e• • iden cc ojpredl( wbilcty of rhc release) One ewmph• of a ref ell.< I.! that moy be predictable and regular is fugiti • ' e e m1 sston.•jmm wtlw:s that occur at tltjferc • m mte.< ow: r the cour . <e ofo produc tion cyde tt< the pre . < . <urc inside the system ( lwngcs Although the rate of such jugiti•·c

**~<sion.<** m ay not be . r:tri

c t(

v uniform. II m n• • he predictable 111 the
. 'ft!llfl" that/he rate and amount nf the relt"tttc WU) ' in u , ,· jmi/nr mann er each t ime tir e prncc.r: . r: is opercuet. l or dl't ' nmpressiflll occ ur . f . Your de.fcriptionsho uld al . so id e ntify the

**a~ tivit**  **y** thot re.wfls in the releas e

**(e ~:**  .. hmc h process. operating pro ce dure.

**adin glcm**  **lood ~:.**  maint e nance a c tivit y. jilfing of .< t orogc tanks) . 

## If th e r e le a.w : o cc urs hecatJSC ofamol(tmction. this should he C Xfllain ed.fully . Note that o11fy cc rrnin rel e ases du e r o mafjimc rirms can '1 ""/i /j• a.< a r · n nr imuw s refeose . Plea. <e rt'{er t o th e dis c· 11.ui o n in th e prcnmhte ojtht• ccmti11uous release .filial rule ot 

### .5.5 FR .10171, Jul. 14. 1990 . Fmoll y, yo ur description shnrcld include it!formatirm tm /w1 1' you establish!'d the pal/em ajth e release ami c alculated relc:ose es timat es (e . g .. e ngin eering cs t immc .,, 1'111/r bes 1 projessiotwf judgment. past r elease data} . For each .<ourcc iden t ified. provide th c.followinR in(tcr maliOtr: (I) Indicate whether th e rl!lea . re is c ontinu o us without intcrruplion or alwt c lll ('lll or routine. antidpot cd

, und int er miu e nt . (Z) ld c nt{fy th e a c tivit y or a c tivities thot c mtsc th e n:leo.\'c.fr(Jm th e so u rw . (.1) 

## If th e release re s ults fro m n ma!fimc tion . describ e th e malfimc tion and explain wh y ,;,,. re lease should Ire ,-n n.<id e rcd co ntinuous and s ta ble in IJIItmtity and rat e. (</) ld elll{fy how you es tabl ished rh e pau c m ol th e rdea.<c and calculatecl rt:lease e.ffimmc.< .

# INSTRUCTIONS SECTION II: SOURCE INFORMATION ( P a rt B ) C R -E R NS N um be r : 

# If

yo u a r e repo rt ing a relea:;e of a Ct;; I? CLA hazardo us substa nce(\), yo u will be assign ed a C R-D?NS numbe r w h e n yo u m ake th is i nitia l t e leph o n e ca ll t o th e N RC (1
- 800- -1 2-1
- 8802). 

## 'l11i s C R -D?N S 

## numbe r w ill beco m e th e id e ntifie r fo r yo ur fac ilit y. Yo ur C R
F. I? NS num be r w ill n eve r c hang e: it i s th e num be r that id e nt ifies yo u in th e C R -E I?NS da tabas e. Part 8- 

## S.p.J: s:

.i./k.J.J.Jfomwtion o n th e So u rc e : Yo u mus t ide nt ify th e e n vir o nm e ntal m e dium (i . e .. air . sw f a ce wa t e r, s o il , o r g r o und wa t e !

J a

ffec t ed by th e h aza rd o us s u bsta n ce release f ro m 

# 5W.f.h so u rce ide nt ified in Sec t io n 

## II , Part 

## A . I n add it io n . yo u mus t provide specific i n for m a t io n o n th e so ur ce a n d i t s affec t ed e n v iro nme 111 . It is i m po rt a nt t o re m e m be r tha t if you h ave a r elea se fro m a s in g le so urce th a t affect s two 

## d iffe re nt m edia (e . g . , gyps um s t ack re leas in g rad on t o ai r a n d radionuclides t o g ro und wat e !

J. yo u s h o uld tr e at th e re lease t o ea c h m e dium as a se

p a ra t e so ur ce

fo r p urp os es of re

p o rtin g . A n o th e r im po rtant p o i111 t o re m e mbe r whe n co mpl e tin g all sec tio n s o f th e wrille n re p o rt is t o includ e th e appr o priat e units , s uc h as kil og rams . m e t e rs. o r c urie s . Env ir o n men tal m edi um -Id e nt ify th e e n vir o nme ntal m ed ium (i . e . . a ir . s w f

a ce wat e r. so il . o r g r o und wa t e r ) tha t is a ffec t ed by th e

**relea~**
**e**

## fro m t he ide/1/ified so ur ce . I Air -((the m edi um affect ed is ai r . provide the followi ng in fo rma t ion . a . In dica t e w h e th e r th e so urce is a 

## s t ack or g ro und-base d ar ea so ur ce . b . ( f th e so ur ce i s a s t ack. pr ov id e th e s t ack h e i g ht infee l o r m e t e r

s. T h e stac k h e ight i s th e d i s tan c e fr o m th e g r o und tv th e t o p of th e stac k. c. 

# If th e s o ur ce is an ar e a so ur ce (e. g.. a was t e p il e . s ur f

a c e imp o undme nt. landfill , valve . pump s e al. or s t o ra ge tank ve m). p ro vid e an es tima t e of th e s w face a r ea o r a rea of th e rel e a se so ur ce in c lud in g th e app ro priat e un i t s uc h as sq uare fee t, s qu a r e m e t e r

s. or ac res . 

## 2
. S urface W a t e r - 

# If th e m edium affected is s ur face wa t er. provide th e fo llowing i n fo rmatio n : a 

# If th e re le a se affec t s any s w face wa t e r body.

**ve** 

## t he name of th e wa t e r bod y. 

## b

. 

# If th e re le as e aff ect s a str eam. g iv e th e ''s tream o r de r .. or th e a re r age .fl ow rate ( in c u b ic fee t p e r s econd) . This iJ?f

o rmation c an b e obtaine d/rom y our slat e wat e r r es o ur ce divisi o n ofU SGS . 

# If y o u cann o t/o c ate this in

fo rmatio n. use th e c h a rt be l o w to es timate th e fl o w rate a cco rdin g t o th e ve lo c ity of th e s tre am . 

# If th e ve locit y of th e s tream flu c tua t es durin g th e year . use th e ave ra ge ve l oc it y whe n ca lc ul a tin g av e ra ge

flow ra t e. c . 

# If th e rele ase a ffects a lake. or o th e r large s u rface wa t er body (e 

## g . a bay ) g i ve th e s w face a rea of t h e lake (in acre:.) and th e average dep t h (i n fee t or me t ers) . Below are so urces of info rma t ion fo r es t ima t ing the ave rage lake dep th. 3 . 

## So il o r G ro und Wat e r 

# -If th e m edium a.ffect ed i s soil o r [!. ro und wat e r

. pr o vid e th e.fo llowin g in fo rma tio n : a . 

# If th e re l eas e is on o r und e r g ro und . indica t e th e distan ce t o th e c:los est public wat e r s uppl y w e ll within a tw o- mile radius q f th e sit e . Inf o rm a tion reg ardin g th e l ocatio n of p ublic: w c 11 e r s uppl y w e lls ma y be availabl e thr o u

g h th e co unt y office that iss ues pe rmit s fo r w e ll s . Est im ated Ave r age S trea m F low Rate s Str

e am 

### M e nn Flow Order 

# LCESJ

I 

### 0 . 65 2 3. 10 

### 3 1 5.00 

### 4 7 1 .00 

### 5 3 4 0.00 

## 6 1 . 6 0 0 . 0 0 7 7. 600 .00 

### 8 5 6 , 000 . 00 9 1 7 1,0 00 . 0 0 10 81 0.000 . 00 

## M ea n Ve loc it y

**(11:~** 

### 1. 0 

### 1.3 1.5 1. 8 2.3 2.7 

## 3.3 3 . 9 5.6 5 .9 

### So ur ces o f In formation for Est im at in g Average Lak e D e pth 

# If

th e lake is lar ge e noug h to b e navi g able, y our lo c al Coast G ua rd o ffi ce will h ave a nav i g atio n c hart tha t will pr o vid e th e ave ra ge d ep th of th e l a ke . Fo r smalle r l a kes. yo u may es tima t e th e a 1 ·e rage dep th of th e l ake b y re l y in g on yo ur k n owl edge of t he use of th e lake and th e s urr o und ing a r ea. a nd yo ur best p rofessional j udg m e nt .

Q

pt

iOIII!l jn(ommtion
- 1'111: foltowmg mformalwn It UIU 

### reqmred 10

**COIIIfl~l**
**"** 

### 11h

**1h~ re~:ulolmll.**  

### ltoll'tl'tr . .r11ch mformolloll "1/t oss1st EPA 

### 111 Holuo l mg

**1h~** 

### nslc.r atta c tatl!d wult a COII/1111/0IIt release . 

## If I 

### he mform0/1()11 below IS 

### no/ pro• · tdetl . c nnsen · n11w mlue.t witl be usetl 1 o e• · oluo l e 1he rt.tks a .uo cwted wuh I 

### he conlmttO i l.t rrh•an• I
. 

## If t h e sa 11 rce is a s ta ck r e l ease to w r . pro \'Ide 

### th e: (n ) w s1de dw m e l er of th e s la ck : (b) 

### gas ex11 •· e t

nc u y: a11d {c) gas 1 e m

pe rat11r e. 2
. 

## If th e r e l

eo.se ojJec1 s s wfo ce wat e r

. fl l'lll'ide I 

### h e m •e ra ge wloc11 y of 1he s ur face wole r .

# Co ntinuous Relea se Reporting Form 

# SECT IO N H: SOURCE I NFORMAT IO N (continued) 

# I Na m e of So urce: Part B: Spec ific Inf ormatio n on th e So urce Form Approved OMB No 2050 · 0086 Exp irat1on 

### Dntc · XX-X X-X XX X 

# CR-ERNS N umb e r: 

# II

For th e so urce id en tified above, pro v id

e th e follmving information
. EAC H source. Please pro vide a SEPARATE sheet for AFFECTED MEDI UM. Identi fy th e environmental medium ( i .e .. air. s urface water. soi l. o r ground wate r) that i s affec t ed by the r e l ease from thi s sou rce. If yo ur source releases ha zardous substances to more than o ne m edium (e.g., a wastepile releas ing to air a nd g ro und water) , trea t th e release to EAC H m edium as a separa t e so urce and co mpl e t e Sec ti o n II , Pa rt s A , B , and C, o f thi s fo rmat f o r E A C II medium affec ted . 

# 0 AIR I f th e medium affec ted i s air, please also specify whether the so urce is a s t ack o r a ground-based area so ur ce . 

# O ta cl< In dicate s tack heig ht in fee t or meters 

# 0 SU RFA CE WATER If th e re lease affects a ny s urf ace wa t er 

### bo d y, give th e na m e of th e water body. S urf ace 

# D Wat er B o d y 

# O S tr ea m I f th e rel ease affec ts 

## a s tream , g i ve th e st ream o rd e r o r average n o w rate, in c ubi c feet per seco nd . S trea m Order 

# I O R Average Flow Ra te (c ubi c feet/seco nd )' 

# O L ake S ur face area o f lak e ( in ac res)L'--

- ---' Average d ep th of l a k

e ( in



# meter **s)~..I**_ ____ _J 

### I fthe re l ease affect s a lak e , g iv e th e s urfa ce area o f th e l ake in acre s and the avera ge d e pth in m e ter s. 

# 0 SOIL OR GROUND WAT E R l f 

### th e re lease i s on o r und e r ground, th e l oc ation of publi c water s upply w e ll s wi thi n tw o mil es. 

# I Op ti o n a l Inf or

m at i on _ ' l1 te lollowmg inlo rma ll on is not required to comp ly wi t h the regulat1on : however , such mformauon w1ll nss 1 st l o P A m cvaluaung the nsks assocaatcd 

### wnh the con ti nuous rclcnsc If I hi s inf ormatio n 

### is not pr n , •

idrd . 

### EP , \ "ill rn:1kr ronsrn • : lli vr a ss umption s ab o ut th r appropr i 11tr valur,. Pleas e note that the unit s s pcc1fied hcl o w arc s uggested llltlts You may usc other un1ts. however
. be ecrlllin that the umts are clearly 1dcnut i cd For n stuck

**rclca~c** to mr . prov 1 dc the tollowm g mt'onnauon , 1t'avmlnble h lSidc diameter (fee t or meters ) 

# D Ga s Exu Velocity ( l i or meter s/sec) 

# D Gas Temp ( de grees Fa hrenheit , Kc lvm . o r Ce l si us) 

# D
for 11

**rclca c**  to surlilcc w,ucr , prov1dc the tollo,,mg mlormauon , 1favallable : Averag e velocity of surface watcr(lcetlsccond ) l,... --------,

**I'** 

### A Form 6 l 00- l 0, Co ntinu ous Release Rep orting Fom1 Page ofEXAMPLES OF REP ORTI NG S I NGL E HA Z ARDOUS SUBSTANCES

I n this example

, your facilit y has a release which may qualify for reduced reportin g as a continuous release

. The hazardous substances released from the iden t ified so ur ce

(Stack A) arc hydr oge n chloride (7647010) and hydrogen n o uride (7664393).

The volume of hydr oge n chloride (HCI) rel eas ed in 24

- h our period i s between 0 and 9,950 lbs. During the previoius yea r. 11.500 lbs of H C I was released

. The release occurs

once per week in February and June for a t o tal of 8 days per year. The amount of h y drogen nouridc (HF I ) r eleased is betw ee n I and 6,000 lbs. The release of HFI occurs

approximately 120 days each year . A t o tal amount re l eased last year was 1 3, 800 l b s.

For t h ese re l ease s from the s pecifi c so ur ce, yo u mu s t pr ov id e th e infor m a tion o utlin e d below. Nom1al R a n ge Number of Days Total Quantity

( in lbs

., kg or Ci per day) Release O cc urs Released in Previous Year Period of the

N.am_e

_ of tiazard o u s Substance CASRN # .!.l.P.. I W Bound Lower Bound (per year) (i n lbs., kg or CD **~**

Hydr og en C hloride (HCI) 7647010 9,950 l bs Olbs 8 11.500 lbs. February ; June

Hydrogen Flou rid e ( Hfl) 7664393 6,000 lbs llb 1 20 13,800 All 12 m o n t hs

EXA MPLE OF REPORTING A MIXTURE

In thi s examp l e, if your fac ilit y wants to r epo rt the release of a mixture of hazardou s s ub sta n ces, yo u mu st li s t eac h co mp one nt of the mixtur e by h azardous s ub s tan ce a n d

include itS percenta ge by weight. For example, for the rele ase of mixture Z. you mu s t provide the followin g infonnation about itS componen t s, ethylene oxide, acr o lein, and

2,3,5-trichlorophenol: Name of Mixture z z z z Na m e of Ha zardo u s Subs

ta nce Components (co mp o nents li s t ed below) Ethy lene ox id e Ac rol ein 2,3,5-trichlorop h eno l CASRN # 75218 107028 933788 Weight Pcrcenta!!.e 10 % 1 5% 20% Nonna l Range of I

o !lf

No ml al Ran ge of Components Mix tur e

(in

lb s ., kg o r C i per day) (in lbs., kg or Ci per day)

Upper

Lower Upper Lower
Bound

B ound Bound Bound

1 00 lb s 0 lbs

lOib s 0 lbs 151b s 0 l bs

20 1 b s 0 lbs T otal Quantity of Number

of Day s Mixture R eleased
Relea se Occurs in Pr evio us Y car

(per

year) (in lb s .. kg o r Cil

365 79.500 lb s Period of the Release A ll 1 2 Month sCon tinu o u s Re l ease R e port

i n g Form SECT ION II: SOU R CE lNFORMATION (co nt i nu e d)

F or m App rO\'Cd OMB No 2050-0086 Exp1rauon Date XX-XX

- XXXX I CR-ERNS Number:

I Part C: Identity

a nd Q u a n tity of Eac h H aza rdo u s Substa
n ce or Mixture Re l eased From Eac h Source Pl ease provide

a SE PARATE shee

t for EAC !I sou r ce. I Na m e o f Source:

I List eac h ha za rdou s s ub sta n ce r eleased from the
s ource identified

a bo ve an d provide

t h e followin

g i nf ormatio

n . In clud e umts where appropnate Rad1onuchdes

10 cuncs

( C1) No nnal Ran ge Numbe

r of Da ys

T o tal Quantity (in lb s., k g, or C i per da y) Rel ease O cc ur s R e l eased in Pr evio u s Y ca r

P er i o d of th e Name of H a7.a rdou
:; Subs tan ce CAS R N il **m~er** BQund

l '" owe r Bound (uer vear)

(in
l bs., kg, o r Ci) Releas
e I I

I

I I

I

I I

I

I I

I L ist each mi x ture
r e l eased fr o m t h e so u rce identified above and provide

t h e f o llowin
g i nf ormatio

n . In c lude umts \\here appropriate Radionuchdcs

m cunes (Ci) No rm a l R ange of Ej No m1al Ran ge of Co mponents Mixture

Total Quantity of Na me of Hazard
o us

( in Jbs.

, k g, or Ci per da y) (in lb s . , kg, or Ci per day) Num ber of Day
s Mixture
R eleased Period of Subs

t a n ce

W e i g ht U pp er Lower Upper

L ower
R ele a se Occ ur s in Pr evio u s Y car
th e **~am ~**  Q(Mil!;llt
re CQWI2Qile!lt:i C6S R i'\l # **ers;~ntage** .B.ru!rul. .8ru!!!.Q. .!12.urul. fullirui {uer :ts:l!r) (in lb s .. kg 2 r Cil **~** I I

I

I

I

I

I

I

I

I

I

I I

I

I

I

I

I

I

I

I

I

I : I

I

I

I

I

I

I

I

I

I

I E PA F on n 61 00· 1 0, Continuous

R e lea se Reporting Fom1

·--

- II ICR-ERl"'S Nu mb e r :
INSTR UC TIONS SECT ION II: SOURCE

I NF ORMATION ( Par
t C) If yo u ar e r e p o rting a r e l e as e of a C E RCLA hazardous subst a n ce( s ), y ou will b e assi g ned a C R-ER.. VS num be r wh e n yo u mak e this initial

t e l e ph o n e c all t o th e N R C {/- 800 -424- 880 2) . Th is CR -E R N S num be r II' ill b eco m e th e i de ntifi e r fo r yo u r f a c ilit y . Y o ur C R - ER.. VS num be r will ne v e r c h a n ge: it is th e numb
e r th a t id e nt ifies yo u i n th e C R- ER XS da ta base

. Part C- /d e ntit v and Quantity of Ea c h H azardous Substanc

e or Mixture
R e leased: For eac h s o ur ce, yo u mu s t r e p o rt inf o rmation

a b o ut th e id e ntit y and quantit
y of th e ha:ard
o u s s ubswn ce s r e l eased fro m th e so ur ce. In part ic ular
, yo u mu s t i de nt ify th e normal range of e a c h r e l e a se a nd th e t o tal annual qu a ntit y r e l ease d during th e pr e vi o u s ye ar fro m eac h s o ur ce. You ar e not n ece ssaril y r e quir e d to m o nitor
r e l e as e s . t o det e rmin e th e n o rmal ran ge of th e r e l e as e . l' o u may es tabli s h th e n o rmal ran ge b y usin g e n g in ee rin g es timat es of r e l e as e s un der va ri o u s opera tin g co n di t io n s, kn ow l edge of th e ope r a t i n g hi s t o r y of tir e fac

i l ity . expe r ie n ce w i th ope r a t i n g p r ocesses

. p r ofessio
n a l j u dg m e nt , o r a n y other m ethod th a t has a so un d t ec hni cal b a sis . E PA wilt us e th e upp e r bo und of th e n o rmal
r a n ge t o es timat e th e ri sks
t o hum a n h ea lth a nd th e e nvir o nm e nt posed by th e h a:a rd o u s subs

t a n ce release

. To p r ov i de th e r e qu ired

i n fo rm a t io n regardi
n g th e quanti ty of t he haza r do u s s u bs t a n ce r eleased fro m each ide nt ified so u rce
. yo u s h o u ld begi n by de t e rm i nin g w h e t her
t he r elease i s a si n g l e h aza rd o u s s ubstan ce o r a mi x lllr e of hazar do u s s u bs tan ces
. Nor ma l R a n ge Th e n o rmal
r w r gg, of a co minu o u s r e l ease in cl ud e s all re l e a ses of a h a: ard o u s s ub s tan ce (i n po und s, ki l og ram s, o r c uri es) r epo rt e d o r occ urrin g du ri n g an y l.f -h our pe ri o d un de r n o rm a l o p e ratin g co n d iti o ns durin g th e pr e 1·i o u s ye ar Onl y r e l e as es that ar e b o th co ntinu o u s a nd st ab l e in qu a ntit y a nd rat e may b e includ ed in th e n o rm a l r a n ge . **epo rt**  **~:** S in g l e H azar d o u s S ub s t11nce

s - F o r J:ru;h so ur ce, f o ll ow
t he dm :c t 1o n s be l ow
t o r e p ort e ac h h azard o us subs
t a nce re l eas ed from

t h e so ur ce th a t 1 s a s m g lc hazardous

s u bs ta nce or a compone

n t of a m ixtu r e t hm yo u w1sh to report separately I Identify the lurardous subswnce released by name and by Chemtcal Abstracts Se n ·tce Reg/Sir)' N1m1ber (CASR.\') Tl1r CASRN for a ha:ardo

r tS subs

t ance can be located many matenal safety data sheet or m m os t c h e m rca l s u ppfre
r co m pa n y c at a l og u e s . 2 P r O l' ldc tire upp e r and lo w e r bou n ds of t he n o rm al ra n ge of the r elease fro m th e 1 demr[ied so ur ce (1 e. quamrty 111 po11nds. ktlograms

, or cu n es) durmg

t he prei'IOIIS yea r 3 Estimate the
t otal an n ual omo1mt (111 pounds. lulograms. or curtl!s) of the ha:ordous substance released from the 1demrjied soura durmg the pre

\ 'IOitS year

. ./ Specify

t he Jre q11 e n cy of t h e release by m drca 11n g tir e mm1 htr of **dayo~tlre** release occurs per y ear fro m th e 1de m i[ted source. Stau n g "co mmu ous" IS n o t s u j]ic
t e lll , a s o n e source m ay be con11nuoruly ope r aung 365 days a year. wl u l e a n o th er so ur ce m ay be c o llltnU O i tS i y opera

t i n g o n weekifays. 26 1 d ays a y ear
. 5 **lndtcat~** the ac11ml months tht release occurs **R~p rting** 
a ll l ixturt-
F or 00 source

. follow the directions belo" to r e port each mixture released

f r om the source I Ide n tify the m /XIurc by n a m e (e.g .. Bl u e Pig m e n t 11 25)
. 2 . l de nn fy eac h ha : ar do us s u bs t a n ce co m po n e nt of th e m1x111r
e by n a m e a nd CASliN. 3 Esti m ate the percentage by u ·e1gh c of eaclr h a:ardo

1 tS s u bstance co m po n e m of th<' ntt .t t ure -1 . **Pra \'l**  **d~** the u pper and lower bo w 1ds (t e .. q u a n tr r y 111 pow1ds. k1lograms

. or cunes) of the n o r mal range of each lra-qrtfous substance co a monent of the m 1.tt u re that was released fro m t lrrs source To calculate the u ppe r bo un d of th e n o rm a l ran ge o f e a c h lra: a rd o u s **bs c~**  co m pa n <' lll . m1dnpZ

v th e ll' e 1 g lrt perce mag e of eac h co m po n e tll by th e np pa bo und qu a /111/y of th e mtxutr e. 5 Pra \'l de the u pper a n d lower bou nd s (c e., q uanm y Ill pa w1 ds , k ilog r ams. o r c u rces) of t he n o rmal ra n ge of t/11• l1lill1ICt.

t hat was **releas~d** fro m t he tde m ifle d so u rce du rmg

t he pre\'IOUS

y ea 1 · 6 Specify tht frequency of tire release h)

' mdtcamcg

t he number of da)S the release occurs per year fi'onr the tdwtrfied source. Statmg "co n ttmtous

" IS n o t suj}ictelll

. as one source ma) be **contmuortS~'** operatmg 365 days a year

. whrlc ano th er so u rce m a _1 · be co muw o u sly opera trn g o n ll'eekifays. 261 days a year. 7. Es trm a t e th e t o ta l a nnual qu a mu y (i n po unds

, ktl og ram s. o r cr m es) of th e !l.l.l.I.U1!:f. that was rl' l e a sed fro m t ire t de m rjied sou r ce d u r m g th e fl

' 'l! l 'io u s year 8 lndtcate the acwal months the release oc curs

.

# Cont inu o u s Re l ea se Reporting Form 

# SECT I ON ll l: SUBSTANCE I NFORMATION Ca lcu lation of t h e SS I Trigge r 

# I Form Approved OMB No
. 2050-0086 Expiration Date XX-XX-XXXX 

# CR-ERNS 

# N u mber: 

# I For EACH ha z a rdo u s s u bstan ce co mpon e nt of a mixtur e indi c ated in S ec tion II , Part 

# C, list th e n ames of th e r e l easing so u rces and th eir upp e r bounds. Please u se a SEPARATE sheet for EAC H ha za rdou . <o s ubs tan ce. 

# I Na me o f H aza rdo u s S ub s ta n ce '

To ca lculat e the SSI tri gge r (i.e., the upper bound of th e norma l range of a release) for the hazardous subs tance id e ntifi ed above, aggregate th e upper bound s o f the n onna l ran ge of the identified haza rdous substance across al l sources identified in !Section II, Part C. 

## If the hazardous substance is also a component of a mixture, be certain t o include th e upper bound of the c ompo nen t as calculated in Section II , Part C, in your ca l cu l ation of th e SSI trigger. 

# ll w c r BQuod Q( 

## I 

# be

**~ormal** 

## Rang e 

# Qf

**~muc (SQ!m** 

**~( .s**  **)**



### !h~ **~~ l!<ll**  **:!~ (SR~~if~**  

## lb s.. kg
.. 

## Q r Ci) 

# I 

# I I 

# I I 

# I I 

# I I 

# I I I I 

# I I I I 

# I TOTAL- SSI tri gge r for th i s h azardo u s s ub s ta n ce r e lease*: 

# * This method fo r calculating the SS!triggerfor the hazardous substance assumes that all releases of th e same hazardous substance or mixtur e occur simultaneously. To th e extent that a haza rdous s ubstan ce is releasedfrom your.facil ity ji·om d(fl eren t sources and a t d(fferentfrequencies, you may adjust the SS!tri gger as appropriate so that it more accurately reflects the frequency and quantity o.f th e r elease. The SS! tri gger in the .fi nal analys is must r eflec t th e u pper bound o.f the n or mal ran ge of th e release, taking into consideration all sources o.fthe release at th e facility or vesseL. The normal range of the r e lease includ es all releases previo usly reported or

**occurrin~-:** 

# over a 2-1
- hour period dw·ing th e previous year. EPA Form 6100-1 0, Continuous R elease R eporting Form P age of 

# II

II

# INS TRUCTION S SE C TIO N Ill: S U B ST ANCE IN FORMATIO N
C R-E R NS N umber: 

# if

yo u ar e r epo rtin g a rel e as e of a CERCLA hazardous suhstance(s). yo u will be ass i gned a CR
- E RNS numbe r when yo u mak e this initial t e leph on e ca ll to th e N R C {1- 8 00-424-8802). This C N -E

RNS num be r will b ecom e th e id e ntifie r fo r yo ur facility . Your C

R -ERNS numb e r will n e ver chang e: it is th e numb e r that id e ntifies yo u in th e C R
- D? NS da taba se . Afteryo u provide th e requir ed in fo rmation/o r all so ur ces of co ntinu o us re lease sfrom yo ur fac ility . yo u mu s t aggregate infor mat ion of a haz ardo us s u bstance release fro m all so ur ces t o deter mine th e SSt/r igger ( u pper bo und oj1he normal ran ge) fo r e a c h ha::ard o u s s ub s tance re le ased a t yo ur fac ilit y . The SS I tri gge r of a partic ular h azardo us s ubs t ance is c al c ulat ed by ag g r eJ:: at in g th e upp e r b o und s of th e haza rd o us s u bstan ce re l eas ed across all sour ces a t a fac ility. 

# if

you are aggregaling ('t:; N CLA ha:ardous s u bstance re le ases ji'o m sepa rat e. co nli g u o us, or adjacent fac ilities and reporting !he m in a single report . aggregate th e upp er bo und of th e normal ran ge of th e haza rdous s ubstan ce re le as ed fro m all sources at th e sit e t o deter mine th e SSt tri gge r. 

# if yo u aggregate yo ur releases across f a cil ities . th e SS /trigge r mus t also be sitespecific, not facili t y-spec ific. Agg regatin g re le ases acrossfacilities a t th e same sit e m ay red uce yo ur repo rtin g burden : h owe ve r, EPA will eva luate I h e risks ass ociale d with th e re leas es as ((th e re le ases were .fro m o n e.f acility . To c al c ul a t

e th e SSt tri gger fo r e..m;;h. hazard o us s ubs t a n ce yo u should : Ust each specific sour ce name a n d e m e r th e u pper hound of th e n o rmal range of th e relea se fr o m thai source . 

# if th e identified ha;ardous s u bstan ce is a co m ponent of a m L rtur e, e nler th e u ppe r bo und of th e n o rmal ran ge

fo r thai compo n e nt of th e m ixture (as determined in Section II , P art C). 2.

**ARgr e~**  **at e**  

## th e u pper bo und q u a nt itiesji·om each sour ce q( th e re lease . R e port th es e t o t a ls as th e SSt tri gge r /o r th e hazardous suhslance. Th e e xampl e tha i is provid ed 

## be l ow illus tr ates th e ca lc ul a tion of th e SS!Iri ggerfor a re l ease of amm onia. The above m e th od fo r calc ulatin g the SSt tri gger of a ha:ard o u:; s u bstan ce ass umes that all re l eases of the same ha:ard o us substance occ ur simultaneo us l y (i.e .. ove r th e sam e 2 -1-h o ur pe r iod) . To th e ex tent that th e .freq u e ncy of t h e re lease diff e r

s, you ma y adjust th e SSt tri gger so that it m o re a cc urat e l

y reflec ts th ef req u e m . y and quan tit y of I h e hazard o us substance re le ased .fro m a ll so ur ce s o ve r a 24-ho ur pe riod The
. )'Sf 

## tri gge r in th e fina l anal ys is mu s t reflect/h e upp e r bound of th e normal ran ge of th e re le as e . taking int o consid e rati o n all sour ces of lh e re le ase allhefaci lit y. The normal ran ge of th e releas e inc lud es all continu o u s re leases previo u sly repo rt ed o r occ urr ing ove r a 24 -h o ur p e riod d urin g th e previous yea r. Ca lc u l atio n of t h e SS I Tri gger fo r a Ha z ard o u s S u bs t a n ce 

## lla zardou s Upper S ub s tance So urce B o und Ammonia Tank Ve ntS 1 20 lb s. in Building # I 

## V

a lves in 11 5 lb s. Building 

## # 5 Upper B o und f o r Ammo ni a 

## 235 lb s. For the purpose s of th i s exa mple , it is assumed th at the o nl y so urces of the amm o nia r e le ase a t th e fac ility ar c th e Ta nk Ve nts in Buildin g # I a nd the Valves in 13uilding 

## #5. Pap e rwork R ed u ct ion Act Notice The public re p o rtin g and reco rdkee pin g b urd en

fo r thi s collecti o n of information is es timat ed t o average I() h o ur s per response . Se nd co mm en t s on th e A ge n cy's n eed fo r thi s i1!fo rm ation, th e accurac.y 

## <if

th e p rovi de d b ur den es timates . and any s ugf!,e. w e d m ethods fo r minimi :ing r e spond ent burd e n. including thr o ug h th e use of automated co llec t ion t echniques to th e Dir ec t o r, Co ll ec tion S tr a t

ef!,ies Divisio n. U.S . Environm e nlal Pr o t ec tio n Agency (2822 7 ), 1200 

## P e nn\ y lvania Ave . . NIV, Washingto n , D. 

## C. 20-160
. 

## In clud e th e 0/v/B 

## co ntr o l num be r in any co rrespond e n ce . Do !WI s e mi tlt e co mplet e r/form to tlti s addr ess.