SECTION III: SUBSTANCE

 INFORMATION CR-ERNS Number:

Calculation of the SSI Trigger

For EACH hazardous substance component of a mixture indicated in Section II, Part C, list the names of

the releasing sources and their upper bounds. Please use a SEPARATE sheet for EACH hazardous

substance.

Name of Hazardous Substance:

To calculate the SSI trigger (i.e., the upper bound of the normal range of a release) for the hazardous substance identified

above, aggregate the upper bounds of the normal range of the identified hazardous substance across all sources identified in

Section II, Part C. If the hazardous substance is also a component of a mixture, be certain to include the upper bound of the

component as calculated in Section II, Part C, in your calculation of the SSI trigger.

* This method for calculating the SSI trigger for the hazardous substance assumes that all releases of the

same hazardous substance or mixture occur simultaneously. To the extent that a hazardous substance is

released from your facility from different sources and at different frequencies, you may adjust the SSI trigger

as appropriate so that it more accurately reflects the frequency and quantity of the release. The SSI trigger

in the final analysis must reflect the upper bound of the normal range of the release, taking into

consideration all sources of the release at the facility or vessel. The normal range of the release includes all

releases previously reported or occurring over a 24-hour period during the previous year.

TOTAL - SSI trigger for this hazardous substance release*:

Name of Source(s)

Upper Bound of the Normal Range of

the Release (specify lbs., kg., or Ci)

Continuous Release Reporting Form Form Approved OMB No. 2050-0086

Expiration Date: XX-XX-XXXX

EPA Form 6100-10, Continuous Release Reporting Form Page of
INSTRUCTIONS

SECTION III: SUBSTANCE INFORMATION

CR-ERNS Number:

 If you are reporting a release of a CERCLA hazardous substance(s), you will be assigned a CR-ERNS number when you make

this initial telephone call to the NRC (1-800-424-8802). This CR-ERNS number will become the identifier for your facility. Your

CR-ERNS number will never change; it is the number that identifies you in the CR-ERNS database.

After you provide the required information for all sources of continuous releases from your facility, you must aggregate

information of a hazardous substance release from all sources to determine the SSI trigger (upper bound of the normal range)

for each hazardous substance released at your facility.

The SSI trigger of a particular hazardous substance is calculated by aggregating the upper bounds of the hazardous

substance released across all sources at a facility.

If you are aggregating CERCLA hazardous substance releases from separate, contiguous, or adjacent facilities and

reporting them in a single report, aggregate the upper bound of the normal range of the hazardous substance released from all

sources at the site to determine the SSI trigger. If you aggregate your releases across facilities, the SSI trigger must also be sitespecific, not facility-specific. Aggregating releases across facilities at the same site may reduce your reporting burden; however,

EPA will evaluate the risks associated with the releases as if the releases were from one facility.

To calculate the SSI trigger for each hazardous substance you should:

1. List each specific source name and enter the upper bound of the normal range of the release from that source. If the

identified hazardous substance is a component of a mixture, enter the upper bound of the normal range for that

component of the mixture (as determined in Section II, Part C).

2. Aggregate the upper bound quantities from each source of the release. Report these totals as the SSI trigger for the

hazardous substance. The example that is provided below illustrates the calculation of the SSI trigger for a release of

ammonia.

The above method for calculating the SSI trigger of a hazardous substance assumes that all releases of the same

hazardous substance occur simultaneously (i.e., over the same 24-hour period). To the extent that the frequency of the release

differs, you may adjust the SSI trigger so that it more accurately reflects the frequency and quantity of the hazardous substance

released from all sources over a 24-hour period. The SSI trigger in the final analysis must reflect the upper bound of the normal

range of the release, taking into consideration all sources of the release at the facility. The normal range of the release includes

all continuous releases previously reported or occurring over a 24-hour period during the previous year.

Calculation of the SSI Trigger for a

Hazardous Substance

Hazardous Upper

Substance Source Bound

Ammonia Tank Vents 120 lbs.

in Building #1

Valves in 115 lbs.

Building #5

 Upper Bound for Ammonia 235 lbs.

For the purposes of this example, it is assumed

that the only sources of the ammonia release at

the facility are the Tank Vents in Building #1

and the Valves in Building #5.

Paperwork Reduction Act Notice

The public reporting and recordkeeping burden for this collection

of information is estimated to average 10 hours per response.Send

comments on the Agency's need for this information, 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 Director, Collection

Strategies Division, U.S. Environmental Protection Agency

(2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.

Include the OMB control number in any correspondence. Do not

send the completed form to this address.