SECTION II: SOURCE INFORMATION

 (continued) CR-ERNS Number:

Name of Source:

Part C: Identity and Quantity of Each Hazardous Substance or Mixture Released From Each Source

Please provide a SEPARATE sheet for EACH source.

List each hazardous substance released from the source identified above and provide the following information.

List each mixture released from the source identified above and provide the following information.

Name of Hazardous Substance

Names of

Months of the

CASRN # Release

Normal Range

(in lbs., kg, or Ci per day)

Upper Bound Lower Bound

Number of Days

Release Occurs

(per year)

Total Quantity

Released in Previous Year

(in lbs., kg, or Ci)

Name of Mixture

Name of Hazardous

Substance

Components CASRN #

Weight

Percentage

Normal Range of

Components

(in lbs., kg, or Ci per day)

Upper Lower

Bound Bound

Normal Range of

Mixture

(in lbs., kg, or Ci per day)

Upper Lower

Bound Bound

Number of Days

Release Occurs

(per year)

Total Quantity of

Mixture Released

in Previous Year

(in lbs., kg or Ci)

Names of

Months of

the

Release

Include units where appropriate. Radionuclides in curies (Ci).

Include units where appropriate. Radionuclides in curies (Ci).

Continuous Release Reporting Form Form Approved OMB No. 2050-0086; Expires 12/31/2011

EPA Form 6100-10, Continuous Release Reporting Form Page of
Name of Hazardous Substance

Hydrogen Chloride (HCl)

Hydrogen Flouride (HFl)

CASRN #

Normal Range

(in lbs., kg or Ci per day)

Upper Bound Lower Bound

Number of Days

Release Occurs

(per year)

Total Quantity

Released in Previous Year

(in lbs., kg or Ci)

Names of

Months of the

Release

7664393

7647010

 6,000 lbs 1 lb

 9,950 lbs 0 lbs

120

8

13,800

11,500 lbs.

All 12 months

February; June

Name of Mixture

Name of Hazardous

Substance

Components CASRN #

Weight

Percentage

Normal Range of

Components

(in lbs., kg or Ci per day)

Upper Lower

Bound Bound

Normal Range of

Mixture

(in lbs., kg or Ci per day)

Upper Lower

Bound Bound

Number of Days

Release Occurs

(per year)

Total Quantity of

Mixture Released

in Previous Year

(in lbs., kg or Ci)

Names of

Months of

the

Release

Z

Z Ethylene oxide

(components listed

below)

75218 10% 10 lbs 0 lbs

 100 lbs 0 lbs 365 79,500 lbs All 12

Months

EXAMPLES OF REPORTING SINGLE HAZARDOUS SUBSTANCES

In this example, your facility has a release which may qualify for reduced reporting as a continuous release. The hazardous substances released from the identified source

(Stack A) are hydrogen chloride (7647010) and hydrogen flouride (7664393).

The volume of hydrogen chloride (HCl) released in 24-hour period is between 0 and 9,950 lbs. During the previoius year, 11,500 lbs of HCl was released. The release occurs

once per week in February and June for a total of 8 days per year. The amount of hydrogen flouride (HFl) released is between 1 and 6,000 lbs. The release of HFl occurs

approximately 120 days each year. A total amount released last year was 13,800 lbs.

For these releases from the specific source, you must provide the information outlined below.

EXAMPLE OF REPORTING A MIXTURE

In this example, if your facility wants to report the release of a mixture of hazardous substances, you must list each component of the mixture by hazardous substance and

include its percentage by weight. For example, for the release of mixture Z, you must provide the following information about its components, ethylene oxide, acrolein, and

2,3,5-tri-chlorophenol:

Z

Z 2,3,5-trichlorophenol

Acrolein

933788

107028

20%

15%

 20 lbs 0 lbs

 15 lbs 0 lbs
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 CRERNS database.

INSTRUCTIONS

SECTION II: SOURCE INFORMATION

(Part C)

Part C - Identity and Quantity of Each Hazardous Substance or Mixture Released:

For each source, you must report information about the identity and quantity of the hazardous substances released from the source. In particular, you must identify the normal

range of each release and the total annual quantity released during the previous year from each source.

You are not necessarily required to monitor releases to determine the normal range of the release. You may establish the normal range by using engineering estimates of releases

under various operating conditions, knowledge of the operating history of the facility, experience with operating processes, professional judgment, or any other method that has a

sound technical basis. EPA will use the upper bound of the normal range to estimate the risks to human health and the environment posed by the hazardous substance release.

To provide the required information regarding the quantity of the hazardous substance released from each identified source, you should begin by determining whether the release

is a single hazardous substance or a mixture of hazardous substances.

Normal Range

The normal range of a continuous release includes all releases of a hazardous substance (in pounds, kilograms, or curies) reported or occurring during any 24-hour period under

normal operating conditions during the previous year. Only releases that are both continuous and stable in quantity and rate may be included in the normal range.

Reporting Single Hazardous Substances - For each source, follow the directions below to report each hazardous substance released from the source that is a single hazardous substance or a component of a mixture that you

wish to report separately.

1. Identify the hazardous substance released by name and by Chemical Abstracts Service Registry Number (CASRN). The CASRN for a hazardous substance can be located in any material safety data sheet or in

 most chemical supplier company catalogues.

2. Provide the upper and lower bounds of the normal range of the release from the identified source (i.e., quantity in pounds, kilograms, or curies) during the previous year.

3. Estimate the total annual amount (in pounds, kilograms, or curies) of the hazardous substance released from the identified source during the previous year.

4. Specify the frequency of the release by indicating the number of days the release occurs per year from the identified source. Stating “continuous” is not sufficient, as one source may be continuously operating 365

 days a year, while another source may be continuously operating on weekdays, 261 days a year.

5. Indicate the actual months the release occurs.

Reporting a Mixture - For each source, follow the directions below to report each mixture released from the source.

 1. Identify the mixture by name (e.g., Blue Pigment #25).

2. Identify each hazardous substance component of the mixture by name and CASRN.

3. Estimate the percentage by weight of each hazardous substance component of the mixture.

4. Provide the upper and lower bounds (i.e., quantity in pounds, kilograms, or curies) of the normal range of each hazardous substance component of the mixture that was released from this source. To calculate the

 upper bound of the normal range of each hazardous substance component, multiply the weight percentage of each component by the upper bound quantity of the mixture.

5. Provide the upper and lower bounds (i.e., quantity in pounds, kilograms, or curies) of the normal range of the mixture that was released from the identified source during the previous year.

6. Specify the frequency of the release by indicating the number of days the release occurs per year from the identified source. Stating “continuous” is not sufficient, as one source may be continuously operating 365

 days a year, while another source may be continuously operating on weekdays, 261 days a year.

7. Estimate the total annual quantity (in pounds, kilograms, or curies) of the mixture that was released from the identified source during the previous year.

8. Indicate the actual months the release occurs.