RECEIVED 

OPPT CBIC 

2015NOV -2 PM 4: 15 

OPPT ·2006·0621 

Does not contain Confidential Business 

Information (CBI) 

AppendixC 

r ReCEIVED 

NOV 13 2015 

EPA DOCKET CENTER 

Draft Facility Report on Emissions 

CBIC Control Number 

366802-S 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

IdentifY the chemical for which you are submitting information: 

Chemical name: Ammonium perfluorooctanoate 

CAS number:__,3~8~2ci!5-~2~6c:J-lL_ ____ _ 

II. COMPANYIDENTIFICATION 

IdentifY the company and location of the facility submitting information: 

Company name: AGC Chemicals Americas Inc. 

Site location: Bayonne. New Jersey 

IdentifY a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Jonathan Clapp 

Phone: (201) 805-0989 

Address: 55 East Uwchlan Avenue, Exton, PA 19341 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31,2014 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) _ _,o,__~kgs/yr 

Imported (externally recycled) _;,<._O __ kgs/yr 

Manufactured _.,0'--~kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

0 kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release ofthe subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 

Because of the plant shutdown at the end of2007, there was no production since 2008. 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or auy other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

au estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of2 significaut figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases ofless than 0.5 kgs per year. 

For all releases, the source of data aud/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

1. If the source/basis is au aualytical measurement, then 

• Describe the method (including aualytical staudards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level ofQuautification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balauce calculation. 

• Show that the mass balauce closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for aud the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other thau measurement or mass balauce, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tauk 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Estimated Total Estimated% #Days/year 

Annual Releases Accuracy Release Occurs 

(kgs) (Optional) 

Fugitive (non-point) _o_ 100 _Q 

Stack (point) _0_ 100 ___Q 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarity your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no air releases after 2008. 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): na 

NPDES number(s): na 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no water releases after 2008. 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Estimated Total 

Annual Releases 

(kgs) 

Landfill na 

Land Treatment/Land Amendment na 

Surface Impoundments __!ll! 

Underground Injection __!ll! 

Other (specifY): _lli! 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarity your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no on-site land releases 

after 2008. 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _0_ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs): __Q_ 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWName: N/A 

Street Address:---------~--:-- City:___ County: __ _ 

State: Zip Code: _ 

NPDES number: ____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarizy your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no transfers to POTW after 2008. 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy ofthe estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there was no incineration 

and no landfill after 2008. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identity the product (e.g fluoropolymer dispersion) for which you are submitting information: 

Product name: Fluoropolymers 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

II. COMPANY IDENTIFICATION 

IdentifY the company and location of the facility submitting information: 

Company name: AGC Chemicals Americas Inc. 

Site location: Bayonne. New Jersey 

IdentifY a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Jonathan Clapp 

Phone: (201) 805-0989 

Address: 55 East Uwchlan Avenue, Exton, PA 19341 

III. PRODUCTION 

Calendar year for which you are reporting: Jan I, 2011 to Dec 31, 2014 

Provide the amount of the product for the reporting year at each specific site: 

GRANULAR PRODUCTS 

AD PRODUCTS (ED and non ED) 

CD PRODUCTS 

Manufactured _O_kgs/yr 

Manufactured_O_kgs/yr 

Manufactured __!!_ kgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your product. For 

chemicals for which you do not have actual data, please provide range estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

P FOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) 

P FOA precursors 

• Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

27905-45-9) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl 

ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-hexadecafluoro- (CAS 70887-84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 27854-31-5) 

Higher homologues 

• Dodecane, 1,1 ,1 ,2,2,3,3,4,4,5,5,6,6, 7,7 ,8,8,9,9,1 0, I 0,11,11 ,12, 12-pentacosafluoro-12-iodo-

(CAS 307-60-8) 

• Decane, 1,1, 1,2,2,3,3,4,4,5,5,6,6,7, 7 ,8,8,9,9, 10, I 0-heneicosafluoro-1 0-iodo- (CAS 423-62-

1) 

• Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-53-0) 

• Dodecane, 1, I, 1 ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9,10,1 0-heneicosafluoro-12-iodo- (CAS 

2043-54-1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

4980-53-4) 

• 2-Propenoic acid, 2-methy1-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 
Part IV (cont.) 

B. ANALYTICALMETHODS 

Analyses should be conducted using the most accurate instrumentation and procedures available as 

of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties 

and detection limits (LOD, LOQ) for the data provided. 
AppendixF 

Draft Company Annual Report: Summary of 

Reductions in Emissions and Product Content 
2010/15 PFOA Global Stewardship Program 

Draft Company Report: Summary of Reductions in Emissions and Product Content 

I SECTION 1: REPORT DATE I October 2014 I 

SECTION 2: COMPANY IDENTIFICATION 

Company Name 

Asahi Glass Co., Ltd., AGC Chemicals Americas Inc., AGC Chemicals Europe Ltd., Seimi Chemical Co., Ltd. 

2a Street Address 

SECTION 3: SUMMARY OF EMISSIONS 

Reporting Period (use calendar year- e.g. Jan I, 2005 to Dec 31, 2005) I Jan. I, 2014 to Dec. 31, 2014 (Year End Run Rate) 

Releases to all environmental media from 

fluoropolymer and telomer manufacture % Reduction of 

Operations Chemical category kgs of category kgs of category total kgs released 

3a kgs kgs of fluoropolymers 1 kgs of telomers 

from baseline year 

PFOA, PFOA salts and 0 na na 100% 

U.S. facilities higher homologues 

Precursors na na na na 

PFOA, PFOA salts and 0 0 0 100% 

3b Non-U.S. facilities higher homologues 

Precursors 0 na na 100% 

Please provide information on the methods, assumptions, uncertainties and detection limits for the data provided above. 

Release to the environment were based on actual measurement or mass balance. Analysis of representative samples were 

assumed to reflect average values. 

3c 

- ------
SECTION 4: SUMMARY OF PRODUCT CONTENT 

Reporting Period (use calendar year- e.g. Jan 1, 2005 to Dec 31, 2005) Jan. 1, 2014 to Dec. 31, 2014(Year End Run Rate) 

4a Product type Fluoropolymer dispersions Other fluoropolymers 1 Telomer based products 

Production volume (kgs/year)" (1) (1) (5) 

Concentration3 %Reduction 

from baseline year 

Operations Chemical Other 

category Fluoropolymer fluoropolymers Telomer based 

dispersions4 l,S products6 Fluoropolymer Other Telomer based 

4b (ppm wet- (ppbdry (ppb dry weight) dispersions fluoropolymers 1 products 

weight) weight) 

PFOA,PFOA 0 0 na 100% 100% na 

u.s. salts and higher 

facilities homologues 

Precursors na na na na na na 

PFOA,PFOA 0 0 0 100% 100% 100% 

4c Non-U.S. salts and higher 

facilities homologues 

Precursors na na 1,000 na na 100% 

4d Please provide information on the methods, assumptions, uncertainties and detection limits for the data provided above. 

1 Fluoropolymers manufactured with PFOA or related chemicals. 2 Use the following ranges: (!)Zero (2) > 0-10 kgs; (3) > 10 kgs -100 kgs; (4) > 100 kgs -1,000 kgs; (5) > 1,000 kgs -10,000 kgs; (6) > 10,000 kgs -100,000 

kgs; (7) > 100,000 kgs- 1,000,000 kgs; (8) Over 1,000,000 kgs. 3 Concentration should reflect the concentration of chemical in the product as sold by the reporting company. If the reporting company has information concerning the 

concentration of chemical in the product as used by others -for example, as incorporated by dilution into a formulation- that additional information would also be 

helpful. 

4 This value should be expressed as a weighted average concentration and range. 5 This value should be expressed as a maximum concentration. 6 This value should be expressed as a simple (not weighted) average and range. 
Analytical methods were described in Appendix D when data were based on measured data. Some data were based on mass 

balance. With regard to Telomer based products, non-polymeric low molecular weight chemicals were regarded as precursors. 
Reported Emissions and Product Content 

Table 1. Reported Emissions and Product Content of PFOA, Precursors, and Higher Homologues from U.S. Operations 

Company Ninth Chemical Emissions Product Content 

Reporting Category Releases to all Telomers 

Year media from FP kg of Other (ppm dryand Telomer release I kg Dispersions Fluoropolymers weight basis, 

Manufacturing of product (ppm wet- (ppm dry-weight unless stated 

(kg) produced weight basis) basis) otherwise) 

PFOA,PFOA 

salts and 0 Not 0 0 Not 

As a hi 2014 Higher Applicable Applicable 

Homologues 

Precursors Not Applicable 
T bl 2 R a e eporte dE .. IDISSIODS an dP ro d C uct on tent o fPFOA , P recursors, an dH" 1grer h H omo ogues f rom N on USO Jperatwns 

Company Ninth Chemical Emissions Product Content 

Reporting Category Releases to all Telomers 

Year media from FP kg of Other (ppm dryandTelomer release I kg Dispersions Fluoropolymers weight basis, 

Manufacturing of product (ppm wet- (ppm dry-weight unless stated 

(kg) produced weight basis) basis) otherwise) 

PFOA,PFOA 

salts and 0 0 0 0 0 Higher 

Asahi 2014 Homologues 

Precursors 0 Not Not Not Applicable 1,000 Applicable Applicable 
Reported Percent Reductions in Emissions and Product Content 

Table 3. Reported Percent Reductions in Emissions and Product Content ofPFOA, Precursors, and Higher Homologues from 

U.S. Operations 

% Reduction in Emissions 0/o Reduction in Product Content 

Ninth Chemical Company Reporting o/o Reductions in total 

Category quantity of chemical(s) Fluoropolymer Other Telomer based 

Year Dispersions Fluoropolymers products released from baseline year 

PFOA, 

PFOAsalts 100% 100% 100% Not Applicable 

As a hi 2014 and Higher 

Homologues 

Precursors Not Applicable 
Table 4. Reported Percent Reductions in Emissions and Product Content of PFOA, Precursors, and Higher Homologues from 

Non U s 0 . .. erattons 

o/o Reduction in Emissions o/o Reduction in Product Content 

Ninth Chemical Company Reporting % Reductions in total 

Category quantity of chemical(s) Fluoropolymer Other Telomer based 

Year 

released from baseline year Dispersions Fluoropolymers products 

PFOA, 

PFOA salts 100% 100% 100% 100% 

Asahi 2014 and Higher 

Homologues 

Precursors 100% Not Applicable Not Applicable 100% 
Accomplishment Table 

Company Facilities Reductions 

Emissions Product Content 

us 100% 100% 

Non-US 100% 100% 

Global 100% 100% 
Does not contain Confidential Business 

Information (CBI) 

AppendixC 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Ammonium perfluorooctanoate 

CAS number:---'3"'8"'2"'5-::.2,6::e-1,__ ____ _ 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC Chemicals Americas Inc. 

Site location: Bayonne, New Jersey 

Identify a company techoical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Jonathan Clapp 

Phone: (201) 805-0989 

Address: 55 East Uwchlan Avenue, Exton, PA 19341 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan I, 20H to Dec 31,2014 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) _ _,0'--~kgs/yr 

Imported (externally recycled) _ __,Oc__~kgs/yr 

Manufactured _ _,0'----~'kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

0 kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 

Because ofthe plant shutdown at the end of2007, there was no production since 2008. 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of2 significant fignres. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases of less than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

I. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

coiTect the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Estimated Total Estimated% #Days/year 

Annual Releases Accuracy Release Occurs 

(kgs) (Optional) 

Fugitive (non-point) _0_ 100 _Q 

Stack (point) _0_ 100 _0 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no air releases after 2008. 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water rnnoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): na 

NPDES number(s): na 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no water releases after 2008. 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land olher 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Estimated Total 

Annual Releases 

(kgs) 

Landfill na 

Land Treatment/Land Amendment __lli! 

Surface Impoundments __lli! 

Underground Injection __lli! 

Other (specifY): __lli! 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no on-site land releases 

after 2008. 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar iu accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _o_ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs): _Q_ 

Estimated % Accuracy of Transfer Estimate (optional) __ 

POTWName: N/A 

Street Address:----------=--

City:____ County: __ _ 

State: Zip Code: _ 

NPDES number: ____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007, there were no transfers to POTW after 2008. 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

{This section is available to clarifY your responses. Attach additional pages if desired.) 

Because of the plant shutdown at the end of2007; there was no incineration 

and no landfill after 2008. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

IdentifY the product (e.g fluoropo1ymer dispersion) for which you are submitting information: 

Product name: Fluoropolymers 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

II. COMPANYIDENTIFICATION 

IdentifY the company and location of the facility submitting information: 

Company name: AGC Chemicals Americas Inc. 

Site location: Bayonne, New Jersey 

IdentifY a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Jonathan Clapp 

Phone: (201)805-0989 

Address: 55 East Uwchlan Avenue, Exton, PA 19341 

III. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

Provide the amount of the product for the reporting year at each specific site: 

GRANULAR PRODUCTS 

AD PRODUCTS (ED and non ED) 

CD PRODUCTS 

Manufactured _O_kgs/yr 

Manufactured_O_kgs/yr 

Manufactured __!!_ kgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your product. For 

chemicals for which you do not have actual data, please provide range estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

PFOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) 

PFOA precursors 

• Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,1 0-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

27905-45-9) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl 

ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,10,1 0-hexadecafluoro- (CAS 70887-84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,1 0,10-heptadecafluoro- (CAS 27854-31-5) 

Higher homologues 

• Dodecane, I, I, I ,2,2,3,3 ,4,4,5,5,6,6,7, 7 ,8,8,9,9,1 0,10,11 ,11,12,12-pentacosafluoro-12-iodo-

(CAS 307-60-8) 

• Decane, 1 ,1, I ,2,2,3,3,4,4,5,5,6,6, 7,7 ,8,8,9,9,1 0,1 0-heneicosafluoro-1 0-iodo- (CAS 423-62-

1) 

• Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,1 0,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, I, I, I ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8-heptadecafluoro-1 0-iodo- (CAS 2043-53-0) 

• Dodecane, I ,I, I ,2,2,3,3,4,4,5,5,6,6, 7,7 ,8,8,9,9,1 0, I 0-heneicosafluoro-12-iodo- (CAS 

2043-54-1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

4980-53-4) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 
Part IV (cont.) 

B. ANALYTICAL METIIODS 

Analyses should be conducted using the most accurate instrumentation and procedures available as 

of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptious made, uucertainties 

aud detection limits (LOD, LOQ) for the data provided. 
Company sanitized 

Does not contain Confidential Business Information 

(CBI) 

Appendix C 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name:Ammonium perfluorononanoate 

CAS number: 4149-60-4 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: ASAHI GLASS CO.,LTD 

Site location: Chiba Plant 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Yoshiteru Sumi 

Phone: 81-436-23-3146 

Address: 10, Goikaigan, lchihara-shi, Chiba 290-8566, Japan 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Normalized data based on year end run rate) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) 

Imported (externally recycled) 

Manufactured 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

ZERO kgs/yr 

ZERO kgs/yr 

ZERO kgs/yr 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

ZERO kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 

Narrative Description and Process Flow Schematic: 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases of less than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

I. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

#Days/year 

Release Occurs 

(This section is available to clarify your responses. Attach additional pages if desired.) 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. 
Part IV (cont.) 

B. WATERRELEASESFROMSITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): Tokvo Bay 

NPDES number(s ):.~N'-"'-ot,_,a,.p"'p~li""ca,b"'"le,_ ____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

Accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

No such activity. 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _ZERO_ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs): 

Estimated % Accuracy of Transfer Estimate (optional) __ 

POTWName: Street Address_: __________ _ 

City: _____ _ County: _____ _ 

State: Zip Code: __ 

NPDES number: _________ _ 

Basis for each release estimate: 

(See discussion on source/basis in begioning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

ZERO 

ZERO 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. 
AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting 

information: 

Product name: Carboxylate polymer 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

The manufacturing process was changed to a process that doesn't use emulsifier as 

polymerization aid. Accordingly, the polymer contains no residual emulsifier. 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: ASAHI GLASS Co.,LTD 

Site location: Chiba Plant 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact:_Y:"-:"o"sh'"i"'te"'r-"'u-"S"u"'m"'i, ______ _ 

Phone: 81-436-23-3146 

Address: 10. Goikaigan, Ichihara-shi, Chiba 290-8566. Japan 

ill. PRODUCTION 

Calendaryearforwhichyouarereporting: Jan 1,2014 to Dec 31,2014 

(Normalized data based on year end run rate) 

Provide the amount of the product for the reporting year at each specific site: 

< Confidential Business Information> 

Imported 

Manufactured 

ZERO kgs/yr 

-~Z""E"'R"'O'---__ kgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your 

product. For chemicals for which you do not have actual data, please provide range 

estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

PFOA and its salts 

o Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

o Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) 

PFOA precursors 

o Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

o 1-Decano1, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

o 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-

4) 

o 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester 

(CAS 27905-45-9) 

o 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-

heptadecafluorodecy1 ester (CAS 1996-88-9) 

o 2-Decenoic acid, 3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0,1 0-hexadecafluoro- (CAS 70887-

84-2) 

o Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 27854-

31-5) 

Higher homologues 

o Dodecane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11, 12,12-

pentacosafluoro-12-iodo- (CAS 307-60-8) 

o Decane, 1,1, 1 ,2,2,3 ,3 ,4,4,5,5,6,6, 7, 7 ,8,8,9 ,9, 10,1 0-heneicosafluoro-1 0-iodo-

(CAS 423-62-1) 

o Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

o Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

o 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

o Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-

53-0) 

o Dodecane, 1,1, 1 ,2,2,3,3 ,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 1 0,1 0-heneicosafluoro-12-iodo-

(CAS 2043-54-1) 

o 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester 

(CAS 4980-53-4) 

o 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 
Part IV (cont.) 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures 

available as of the time of testing. Please provide detailed information on the methods 

used (including analytical standards used, sampling, sample treatment, analysis), 

assumptions made, uncertainties and detection limits (LOD, LOQ) for the data provided. 
Company Sanitized 

Dose not Contains Confidential Business Information 

(CBI) 

Appendix C 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Ammonium Perfluorononanoate 

CAS number: _ __,_4_,_14-'-'9'----6"'0"---_,4 __ 

ll. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co., Ltd. Chemicals Company 

Site location: Chiba, Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Hiroaki Shida 

Phone: 81-436-23-1251 

Address: 10, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide tbe amount of chemical identified above for tbe reporting year at specific site: 

Imported (virgin) _ _,Oc_kgs/yr 

Imported (externally recycled) _O_kgs/yr 

Manufactured _O_kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 %of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

CBI kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of tbe chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In tbe event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 
Narrative Description and Process Flow Schematic: 

CBI 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases of less than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

1. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

CBI 

Comments: 

#Days/year 

Release Occurs 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Estimated Total 

Annual Releases 

(kgs) 

Water releases: CBI 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Narne(s): Tokyo Bay 

NPDES number(s): Not Applicable 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

CBI 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

na 

na 

na 

na 

na 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: __lli!__ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs): 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWName: __________ _ 

Street Address:----------=---------

City: County: _____ _ State:_______ Zip Code: __ 

NPDES number: ________ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 
AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting 

information: 

Product name: PTFE granular grade; suspension polymerisation 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

CBI 

ll. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co., Ltd. Chemicals company 

Site location: Chiba, Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact::----:'H'-'1". r,oak""-'-i_,S,hi". d,a:L_ ____ _ 

Phone: 81-436-23-3326 

Address: I 0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 

III. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2013 to Dec 31, 2013_ 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

Imported _ _.e.o __ .kgs/yr 

Manufactured CBI kgs/yr; 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your 

product. For chemicals for which you do not have actual data, please provide range 

estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

PFOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- armnonium salt (CAS 3825-26-1) 

PFOA precursors 

• Octane, 1,1, 1 ,2,2,3 ,3 ,4,4,5,5,6,6, 7, 7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-

4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9, 10, 10, 10-heptadecafluorodecyl ester 

(CAS 27905-45-9) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-

heptadecafluorodecyl ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-hexadecafluoro- (CAS 70887-

84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 27854-

31-5) 

Higher homologues 

• Dodecane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12-

pentacosafluoro-12-iodo- (CAS 307-60-8) 

• Decane, 1,1, 1 ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0-heneicosafluoro-1 0-iodo-

(CAS 423-62-1) 

• Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-

53-0) 

• Dodecane, 1,1, 1 ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0-heneicosafluoro-12-iodo-

(CAS 2043-54-1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,1 0,10-heptadecafluorodecyl ester 

(CAS 4980-53-4) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6, 7,7,8,8,9,9,10,1 0,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 
Part IV (cont.) 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures 

available as of the time of testing. Please provide detailed information on the methods 

used (including analytical standards used, sampling, sample treatment, analysis), 

assumptions made, uncertainties and detection limits (LOD, LOQ) for the data provided. 

Company Sanitized 

Dose not Contains Confidential Business Information 

(CBI) 

Appendix C 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Ammonium Perfluorooctanoate 

CAS number: _ ___,_38,_,2"'5"'-2,6:::..e-lc__ 

II. COMPANYIDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co., Ltd. Chemicals Company 

•• 

Site location:. Chiba, Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Hiroaki Shida 

Phone: 81-436-23-1251 

Address: I 0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014_ to Dec 31, 2014_ 

(Normalized data based on year end run rate) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) __ _____,0"-------kgs/yr 

Imported (externally recycled) ___ O_kgs/yr 

Manufactured ___ O_kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

CBI kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 
Narrative Description and Process Flow Schematic: 

CBI 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases ofless than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

1. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surfuce impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Estimated Total Estimated% #Days/year 

Annual Releases Accuracy Release Occurs 

(kgs) (Optional) 

Fugitive (non-point) 

Stack (point) CBI +-20% _330 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

CBI 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

_330_ 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): Tokyo Bay 

NPDES number(s): Not Applicable 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

CBI 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category of land disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground,. in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

na 

na 

na 

na 

na 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: Jill._ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW' s NPDES permit 

number, if known. 

Annual Transfer (kgs): 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWName: __________ _ 

Street Address:----------=---------

City: County: ____ _ State:_______ Zip Code: __ 

NPDES number: ________ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

CBI 

(See discussion on source/basis in beginning of Section IV.) 

CBI 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarifY your responses. Attach additional pages if desired.) 
AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting 

information: 

Product name: PTFE coagulated dispersion grade( CD) 

PTFE aqueous dispersion grade( AD) 

PTFE granular grade; suspension polymerization( G) 

PTFE wet dispersion grade(CDW /S) 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

II. COMPANYIDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co., Ltd. Chemicals company 

Site location: Chiba, Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Techuical contact: Hiroaki Shida 

Phone: 81-436-23-1251 

Address: 10, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 
III. PRODUCTION 

Calendar year for which you are reporting: Jan I, 2014_ to Dec 31, 2014_ 

(N onnalized data based on year end 1un rate) 

Provide the amount of the product for the reporting year at each specific site: 

Imported 

Manufactured 

IV. PRODUCT CONTENT 

---"'0-~kgs/yr 

CD Grade 

AD Grade 

CBI kgs/yr 

CBI kgs/yr 

CBI kgs/yr 

CBI kgs/yr 

GGrade 

CDW/SGrade 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your 

product. For chemicals for which you do not have actual data, please provide range 

estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

PFOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- ammoniun1 salt (CAS 3825-26-1) 

PFOA precursors 

• Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decano1, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,1 0,10-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-

4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,1 0,1 0-heptadecafluorodecyl ester 

(CAS 27905-45-9) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-

heptadecafluorodecyl ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-hexadecafluoro- (CAS 70887-

84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 27854-

31-5) 

Higher homologues 
• Dodecane, 1,1, 1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,10,11,11, 12,12-

pentacosafluoro-12-iodo- (CAS 307-60-8) 

• Decane, 1,1, 1 ,2,2,3 ,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0-heneicosafluoro-1 0-iodo-

(CAS 423-62-1) 

• Nonanoic ac,id, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-

53-0) 

• Dodecane, 1, 1, 1,2,2,3,3,4,4,5,5,6,6, 7, 7,8,8,9,9, 10,1 0-heneicosafluoro-12-iodo-

(CAS 2043-54c 1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,1 0,1 0-heptadecafluorodecyl ester 

(CAS 4980-53-4) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures 

available as of the time of testing. Please provide detailed information on the methods 

used (including analytical standards used, sampling, sample treatment, analysis), 

assumptions made, uncertainties and detection limits (LOD, LOQ) for the data provided. 

1. Determination of perfluorooctanoate 

1-1 Sample 

(!)Product (Powder type) 

(2)Waste water 

1-2 Reagents 

Test substance, ammonium perfluorooctanoate (APFO, over 98%, RM-364, lot. 

210009) were purchased from Miteni (Italy). The surrogate standard, 9-

hydrohexadecafluorononanoic acid (9H-PFNA, 97.8%, lot. C58002501), were purchased 

from Daikin Fine Chemical (Osaka, Japan). Distilled water was produced in-house and 

checked for contaminants by LC/MS before use. Distilled water was filtered through a 

pre-column, Preclean-ORG (GL Sciences Inc. (Tokyo, Japan)) placed between HPLC 

pump and solvent mixing unit. HPLC grade methanol, reagent grade ethanol, and reagent 

grade ammonium acetate were purchased from Kanto Chemical Co., Inc. 

In order to avoid contamination, disposable lab ware (tubes, pipettes, etc) was 

used. 2 mmoi/L ammonium acetate aqueous solution was prepared for HPLC mobile 

phase. 

1-3 Preparation of fortification and surrogate standard 

A fottification standard containing appropriate amount of APFO was prepared using a 

solvent (2 I 8 (wt) mixture of distilled water I ethanol). A smrogate standard containing 
I 00 ng/ml 9H-PFNA was prepared using a solvent (I I I (wt) mixture of distilled water I 

ethanol). 

1-4 Pretreatment of samples 

(I) Product (CD type) 

Ten g of the sample was placed into the sohxlet. The sohxlet-extraction using I 00 ml of 

ethanol was conducted for 5 hours. Appropriate amount of each fortification standards of 

APFO was added into the extracted solution which was put in each of several vials. Each 

mixed solution was appropriately diluted with the surrogate standard. A portion of the 

solution was put into the auto-sampler vial, and injected into LC/MS conditioned as 

follows. The calculation of concentration in sample was conducted using standard 

addition method. 

(2) Waste water 

Appropriate amount of the sample was put in each of several vials. Appropriate 

amount of each fmtification standards of APFO was added into the vials and shaken 

vigorously. The mix solution was appropriately diluted with the surrogate standard. A 

portion of the solution was put into the auto-sampler vial, and injected into LC/MS 

conditioned as follows. The calculation of concentration in sample was conducted using 

standard addition method. 

1-5 LC/MS analytical conditions 

LC/MS analysis was conducted with the conditions listed below. 

<Instruments> 

(l)LC/MS 

HPLC Agilent Technologies, Model II 00 

Mass spectrometer 

(2) LC column 

Agilent Technologies, Modei!IOOMSD (SL) 

Imtakt (Kyoto, Japan), cadenza CD-CIS 2 mm (diameter) 

X IOOmm 

(3) PC Hewlett Packard Kayak PC Workstation OS: MS-Windows NT 

4.0 

(4) Software LC/MSD ChemStation, Rev. A. 08. 03 

(5) LC/MS vial 

400-C80, Tomsic 

(Tokyo, Japan) 

<Analytical conditions> 

2m! vial for auto-sampler, C1n·omatography-Convenience 

(I) Column temp. 35 °C 

(2) Mobile phase Solution A : 2 mmol!L ammonium acetate aqueous solution 

Solution B : Methanol 

(3) !socratic B : 65 % 

( 4) Flow rate 0.3 mL!min 

(5) Injection volume 5 microL 

<MS operating parameters> 

(I) Ionization mode Electrospray (ESI) (negative ion mode) 
(2) Fragmentor voltage 

(3) Ion monitored 

( 4) Desolvation temperature 

(5) Nebulizer gas 

( 6) Desolvation 

lOOV 

rn/z = 413 (C7F15COO-), 445 (CF2H(CF2)7COO-) 

350 oc 

N2 

N2 12 Llmin 
Company sanitized 

Does not contain Confidential Business Information 

(CBI) 

AppendixC 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Perfluoroalkyl Chemicals 

(Carbon chain length of 8 or larger) 

CAS number:. _________ _ 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co., Ltd. 

Site location: Chiba Plant, 10, Goikaigan, Ichihara-shi, Chiba, 290-8566, 

Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact:_jS"'i'fig><'eru"""H""an"""'d"'a'---------~ 

Phone: 81-436-23-3871 

Address: 10, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014_ to Dec 31, 201±_ 

(Normalized data based on year end run rate.) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) ---"O __ kgs/yr 

Imported (externally recycled) -~0"-_,kgs/yr 

Manufactured CBI kgs/yr 

CBI deleted. 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

0 kgs/yr 

CBI deleted. 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 

Narrative Description and Process Flow Schematic: 

CBI 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases of less than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

I. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

_o_ 

_Q__ 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginuing of Section IV.) 

Comments: 

#Days/year 

Release Occurs 

(This section is available to clarify your responses. Attach additional pages if desired.) 

CBI deleted. 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): The Tokyo Bay 

NPDES number(s):, _____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

No waste water release from the manufacturing process. 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category of land disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

na 

na 

na 

na 

_.lli!..__ 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

No on-site land releases. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: -=na"'---

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW' s NPDES permit 

number, if known. 

Annual Transfer (kgs): 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWName: Street Addres-s: __________ _ 

City: _____ _ County: _____ _ 

State: Zip Code: __ 

NPDES number: ________ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

No transfer to POTW. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

na 

na 

_na 

na 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

CBI deleted. 
Company sanitized 

Does not contain Confidential Business Information 

(CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting 

information: 

Product name: Telomer Products 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

Products include both polymeric and non-polymeric chemicals. 

Exports are global. 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: Asahi Glass Co. Ltd. 

Site location: Chiba Plant, 10, Goikaigan, Ichihara-shi, Chiba, 290-8566, 

Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact:~S""i"'g""eru,_,._,H""a.,.n"d..,a'-----------

Phone: 81-436-3871 

Address: I 0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan 

III. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2014_ to Dec 31, 2014_ 

(Normalized data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

Imported --'"o __ .kgs/yr 

Manufactured see Section IV kgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your 

product. For chemicals for which you do not have actual data, please provide range 

estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

P FOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) 

P FOA precursors 

• Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-

4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester 

(CAS 27905-45-9) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-

heptadecafluorodecyl ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-hexadecafluoro- (CAS 70887-

84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7, 7,8,8,9,9, 1 0,10, 1 0-heptadecafluoro- (CAS 27854-

31-5) 

Higher homologues 

• Dodecane, 1, 1,1 ,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12, 12-

pentacosafluoro-12-iodo- (CAS 307-60-8) 

• Decane, 1,1, 1 ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0-heneicosafluoro-1 0-iodo-

(CAS 423-62-1) 

• Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-

53-0) 

• Dodecane, 1,1 ,1 ,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0-heneicosafluoro-12-iodo-

(CAS 2043-54-1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9, 10,1 0,1 O-heptadecafluorodecy1 ester 

(CAS 4980-53-4) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6, 7,7,8,8,9,9,10,10,11,11,12, 12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 
Part IV (cont.) 

CBI deleted 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures 

available as of the time of testing. Please provide detailed information on the methods 

used (including analytical standards used, sampling, sample treatment, analysis), 

assumptions made, uncertainties and detection limits (LOD, LOQ) for the data provided. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

Appendix C 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: ammonium perfluorooctanoate 

CAS number: 3825-26-1 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC Chemicals Europe, Ltd 

Site location: Hillhouse, UK 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: 

Phone: 

Address: 

Mr G P Andrews 

+44 (0) 1253 861 989 

York House, Hillhouse International, 

Thornton Cleveleys, 

Lanes., FY5 4QD, UK 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Normalized data based on year end run rate.) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Total CBI 

Imported (Recycled, Source Country Japan) CBI 

Manufactured zero 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

CBl 

Narrative Description and Process Flow Schematic: 

, Provide overall material balance of the chemical being reported, showing releases 

and products (kg/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the enviromnent. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 

CBI 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. Y au may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kg should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases ofless than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

I. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Estimated Total Estimated% #Days/year 

Annual Releases Accuracy Release Occurs 

(kg) (Optional) 

Fugitive (non-point) CBI CBl CBI 

Stack (point) CBI CBJ CBI 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 
Part IV (cont.) 

Comments: 

(This section is available to clarizy your responses. Attach additional pages if desired.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: Estimated Total 

Annual Releases 

(kg) 

CBI 

Estimated% 

Accuracy 

(Optional) 

CBI 

#Days/year 

Release Occurs 

CBI 

Enter the names of the streams or water bodies to which the facility directly discharges 

the chemical. Also, enter the NPDES permit number for the facility. If more than one 

number is assigned to the facility, list each number for the appropriate discharge quantity 

and receiving water identified. 

Receiving Water Name(s): River Wyre (tidal estuary) 

NPDES number(s): Not applicable 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

See part A 

Comments: 

(This section is available to clarizy your responses. Attach additional pages if desired.) 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natnral topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Estimated Total 

Annual Releases 

(kg) 

Landfill Zero 

Land Treatment/Land Amendment Zero 

Surface Impoundments Zero 

Underground Injection Zero 

Other (specify): Zero 

Comments: 

Estimated% 

Accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

Solid waste sent to specialist landfill site (see section 02) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _ 0 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kg): _ 0 

Estimated % Accuracy of Transfer Estimate (optional) __ 

POTWName: 

Street Address: __ _ 

City: __ 

State: 

NPDES number: 

Basis for each release estimate: 

County:~-----­

ZipCode: __ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

(This section is available to clarifY your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity ofthe subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

UK hazardous Waste Landfill 

site 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kg) 

CBI 

zero 

ZCJ'O 

CBI 

zero 

zero 

CBI 

zero 

(See discussion on source/basis in beginning of Section IV.) 

See pmt A 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarity your responses. Attach additional pages if desired.) 
AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identity the product (e.g. fluoropolymer dispersion) for which you are submitting information: 

Product name Fluoropolymers 

Product description (including concentrations ofperfluoroalkyl chemicals identified in Section IV below 

and year of production): 

II. COMPANY IDENTIFICATION 

Identity the company and location of the facility submitting information: 

Company name: AGC Chemicals Europe, Ltd 

Site location: Hillhouse, UK 

Identity a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: 

Phone: 

Address: 

Mr G P Andrews 

+44 (0) 1253 861 989 

York House, Hillhouse International, 

Thornton Clcvcleys, 

Lanes FY5 4QD, UK 
III. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31,2014 

(Normalized data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

CBI 

IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations {ppb) of various perfluoroalkyl chemicals in your product. For 

chemicals for which you do not have actual data, please provide range estimates. 

The following is a nonexhaustive list of chemicals that should be included: 

P FOA and its salts 

• Octanoic acid, pentadecafluoro- (CAS 335-67-1) 

• Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-I) 

PFOA precursors 

• Octane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7, 8,8-heptadecafluoro-8-iodo- (CAS 507-63-1) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• 1-Decene, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 21652-58-4) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

27905-45-9) 

• 2-Propenoic acid, 2-methy1-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,1 0,10,10-heptadecafluorodecyl 

ester (CAS 1996-88-9) 

• 2-Decenoic acid, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-hexadecafluoro- (CAS 70887-84-2) 

• Decanoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 27854-3 1-5) 

Higher homologues 

• Dodecane, 1, 1,1,2,2,3,3,4,4,5,5,6,6, 7, 7 ,8,8,9,9,1 0,10,11 ,11 ,12,12-pentacosafluoro-12-iodo-

(CAS 307-60-8) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-heneicosafluoro-10-iodo- (CAS 423-62-

1) 

• Nonanoic acid, heptadecafluoro- (CAS 375-95-1) 

• Decanoic acid, nonadecafluoro- (CAS 335-76-2) 

• 1-Decanol, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluoro- (CAS 678-39-7) 

• Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-53-0) 
PartN (cont.) 

• Dodecane, 1, 1,1 ,2,2,3,3,4,4,5,5,6,6,7 ,7 ,8,8,9,9,1 0,1 0-heneicosafluoro-12-iodo- (CAS 

2043-54-1) 

• 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl ester (CAS 

4980-53-4) 

• 2-Propenoic acid, 2-methyl-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,12-

heneicosafluorododecyl ester (CAS 17741-60-5) 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures available 

as of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties 

and detection limits (LOD, LOQ) for the data provided. 

(i) Derivatisation to the methyl ester and quantification by gas chromatography. Methods SAM/GC/254 

and SAM/CHEM/PAF/7 previously submitted. 

(ii) In house UV-vis spectroscopy. Method FTM166 previously submitted. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixC 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: PFOA and salts 

CAS number:, _________ _ 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO .. LTD 

Site location:3-2-1 O.Chigasaki,Chigasaki Citv.Kanagawa,253-8585 Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-lO,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan 
III. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan I, 2014 to Dec 31,2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) _:,!.o ___ ,kgs/yr 

Imported (externally recycled) --"0'-----'kgs/yr 

Manufactured CBl kgs/yr 

(as impurities) 

Estimate the amount of subject chemical distributed off-site: 

100 %of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

0 kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include iuformation that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the environment. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 
Narrative Description and Process Flow Schematic: 

CBI 
N. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases ofless than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

I. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confmed air streams as stack or point source releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

0 

0 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

Practically, all operations are conducted under closed system. 

Comments: 

#Days/year 

Release Occurs 

0 

0 

(This section is available to clarity your responses. Attach additional pages if desired.) 
Part IV (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from . 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

0 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

_o_ 

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): ____ _ 

NPDES number(s): _____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

No waste water release from the manufacturing process. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

Releases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment · 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

Accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _0_ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs): 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWNarne: 

Street Address-:----------~ 

City:-----~ County: _____ _ 

State: Zip Code: __ 

NPDES number: -----------

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

Not applicable 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

0 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

Appendix C 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Precursors 

CAS number: _________ _ 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO.,LTD 

Site location:3-2-1 O,Chigasaki,Chigasaki City,Kanagawa,253-8585 Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-lO,Chigasaki,Chigasaki City,Kanagawa,253-8585 Japan 
lll. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31,2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of chemical identified above for the reporting year at specific site: 

Imported (virgin) 0 kgs/yr 

Imported (externally recycled) 0 kgs/yr 

Manufactured 0 kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any that was manufactured, imported [virgin or 

externally recycled], or internally recycled) of the subject chemical for the reporting year 

at specific site: 

0 kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance of the chemical being reported, showing releases 

and products (kgs/year). Use the following page to provide a narrative description and 

process flow schematic of on-site activities, and include information that gives an 

understanding of the nature and extent of potential exposures to the subject chemical. 

Attach additional pages if desired. The narrative and process flow schematic should cover 

major unit operations and chemical conversions for manufacturing and on-site uses, if 

applicable. The narrative should provide insight into why and how releases are caused by 

the process. The schematic should show the points of release of the subject chemical in 

the workplace and to the enviromnent. In the event the subject chemical is used in many 

different processes, provide information on each major process instead of each individual 

process. 
Narrative Description and Process Flow Schematic: 

No manufacturing activity. 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In this section, estimate the total media-specific releases after on-site treatment of 

the chemical from your facility. You may estimate the releases by using monitoring data 

or any other method you believe appropriate. Estimates should be reported in kgs per 

year for the reporting period. Enter the values as whole numbers to no more than two 

significant figures. For example, if your annual releases are estimated to be 12,360 kgs, 

an estimate of 12,000 kgs should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number 

with a maximum of 2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for 

releases ofless than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be 

described in detail. Suggested information about the possible sources/basis includes: 

1. If the source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, 

sample treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level of Detection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total 

feedstock that is not accounted for and the assumptions you made to . 

correct the balance. Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are 

used, give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per 

year the releases occur. These releases include equipment leaks from valves, pump seals, 

flanges, compressors, sampling connections, and open-ended lines; evaporative losses 

from surface impoundments and spills; releases from building ventilation systems; and, 

any other fugitive or non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or 

other confined air streams as stack or point soillce releases. Include storage tank 

emissions and releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

0 

0 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in beginning of Section IV.) 

No manufacturing activity. 

Comments: 

#Days/year 

Release Occurs 

0 

0 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Part IV (cont.) 
B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility 

from all discharge points to all streams or water bodies. Include all discharges from 

process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, 

and contribution from storm water runoff, if applicable. Do not include discharges to a 

POTW or other off-site wastewater treatment facilities. If desired, you can provide an 

estimate of the accuracy of your release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

0 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

~0-

Enter the names of the streams or water bodies to which the facility directly 

discharges the chemical. Also, enter the NPDES permit number for the facility. If more 

than one number is assigned to the facility, list each number for the appropriate discharge 

quantity and receiving water identified. 

Receiving Water Name(s): ____ _ 

NPDES number(s): _____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

No manufacturing activity. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Part IV (cont.) 
C. ON-SITE LAND ltELEASES 

Estimate the total releases of the chemical for each category ofland disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. 

This should be accounted for in your estimate of total landfill release. 

lteleases to land treatment/land amendment include all waste containing the 

chemical that is applied or incorporated into soil on-site. Do not include waste that is 

landfilled. 

Surface impoundments are natural topographic depressions, man-made 

excavations, or diked areas formed primarily of earthen materials designed to hold an 

accumulation of the chemical. 

Underground injection is the technology of placing fluids underground, in porous 

formations of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other 

than those listed. An example is the accidental release of the chemical from an 

underground pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

iulnuallteleases 

(kgs) 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

Accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Part IV (cont.) 
D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to 

previous release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _0_ 

Estimate the total quantity of the subject chemical, not the waste stream, 

transferred to the POTW. Complete section below for each POTW to which your facility 

discharges wastewater containing the chemical. Enter the POTW's NPDES permit 

number, if known. 

Annual Transfer (kgs ): 0 ---

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWNarne: __________ _ 

Street Address: _________________ _ 

City: County: _____ _ State:_______ Zip Code: __ 

NPDES number: _________ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

No manufacturing activity . 

• 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Part IV (cont.) 
D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends 

the subject chemical in waste to an off-site location where some of the chemical will be 

recycled and the remainder will be treated, estimate each amount separately (i.e., waste 

treatment and recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground I~ection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

0 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

The amount is the one having actually measured it. 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

No manufacturing activity. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixC 

Draft Facility Report on Emissions 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Emissions 

I. CHEMICAL IDENTIFICATION 

Identify the chemical for which you are submitting information: 

Chemical name: Precursors 

CAS number: _________ _ 

II. COMPANYIDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO .. LTD 

Site location: 2276-2.Nada,Hirai.Kashima City.Ibaraki,314-00 12 Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-lO.Chigasaki,Chigasaki City,Kanagawa,253-8585 Japan 
ill. ON-SITE ACTIVITIES 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of chemical identified above for the reporting year at specific site: 

hnported (virgin) 0 kgs/yr 

hnported (externally recycled) 0 kgs/yr 

Manufactured 0 kgs/yr 

Estimate the amount of subject chemical distributed off-site: 

0 % of manufacture/import 

Provide the amount used (including any tbat was manufactured, imported [virgin or externally 

recycled], or internally recycled) of the subject chemical for tbe reporting year at specific site: 

0 kgs/yr 

Narrative Description and Process Flow Schematic: 

Provide overall material balance oftbe chemical being reported, showing releases and 

products (kgs/year). Use tbe following page to provide a narrative description and process flow 

schematic of on-site activities, and include information that gives an understanding ofthe 

nature and extent of potential exposures to the subject chemical. Attach additional pages if 

desired. The narrative ani:! process flow schematic should cover major unit operations and 

chemical conversions for manufacturing and on-site uses, if applicable. The narrative should 

provide insight into why and how releases are caused by the process. The schematic should 

show the points of release of the subject chemical in the workplace and to tbe environment. In 

the event the subject chemical is used in many different processes, provide information on each 

major process instead of each individual process. 
Narrative Description and Process Flow Schematic: 

No manufacturing activity. 
IV. SITE RELEASE AND TRANSFER INFORMATION 

(For manufacturing and on-site processing/use if applicable) 

In tbis section, estimate the total media-specific releases after on-site treatment of the 

chemical from your facility. You may estimate the releases by using monitoring data or any 

other method you believe appropriate. Estimates should be reported in kgs per year for the 

reporting period. Enter the values as whole numbers to no more than two significant figures. 

For example, if your annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs 

should be reported. 

Estimate the number of days per year the release occurs. Enter a whole number with a 

maximum of2 significant figures. 

Insert "NA" for release activities not associated with the chemical or "0" for releases of 

less than 0.5 kgs per year. 

For all releases, the source of data and/or basis for determination should be described in 

detail. Suggested information about tbe possible sources/basis includes: 

1. If tbe source/basis is an analytical measurement, then 

• Describe the method (including analytical standards used, sampling, sample 

treatment, analysis). 

• Describe the uncertainties and assumptions made. 

• Give the Level ofDetection (LOD)/Level of Quantification (LOQ). 

2. If the source/basis is a mass balance, then 

• Show the mass balance calculation. 

• Show that the mass balance closes. 

• If the mass balance does not close, then report the fraction of total feedstock 

that is not accounted for and the assumptions you made to correct the balance. 

Describe the uncertainties. 

3. If the source/basis is other than measurement or mass balance, then 

• Describe the method used. For example, if engineering calculations are used, 

give a general description and state your assumptions. Describe the 

uncertainties. 
Part IV (cont.) 

A. ON-SITE AIR RELEASES 

Estimate the total fugitive or non-point releases to air and the number of days per year 

the releases occur. These releases include equipment leaks from valves, pump seals, flanges, 

compressors, sampling connections, and open-ended lines; evaporative losses from surface 

impoundments and spills; releases from building ventilation systems; and, any other fugitive or 

non-point air emission. 

In addition, estimate the total releases that occur through stacks, vents, pipes, or other 

confmed air streams as stack or point source releases. Include storage tank emissions and 

releases from pollution control equipment. 

If desired, you can provide estimates of the accuracies of your release estimates. 

Fugitive (non-point) 

Stack (point) 

Estimated Total 

Annual Releases 

(kgs) 

0 

0 

Basis for each release estimate: 

Estimated% 

Accuracy 

(Optional) 

(See discussion on source/basis in begirming of Section IV.) 

No manufacturing activity. 

Comments: 

#Days/year 

Release Occurs 

0 

0 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part N (cont.) 

B. WATER RELEASES FROM SITE 

Estimate the total releases of the chemical leaving the fence line of your facility from 

all discharge points to all streams or water bodies. Include all discharges from process outfalls 

such as pipes, open trenches, releases from on-site wastewater treatment, and contribution from 

storm water runoff, if applicable. Do not include discharges to a POTW or other off-site 

wastewater treatment facilities. If desired, you can provide an estimate of the accuracy of your 

release estimate. 

Water releases: 

Estimated Total 

Annual Releases 

(kgs) 

0 

Estimated% 

Accuracy 

(Optional) 

#Days/year 

Release Occurs 

Enter the names of the streams or water bodies to which the facility directly discharges 

the chemical. Also, enter the NPDES permit number for the facility. If more than one number 

is assigned to the facility, list each number for the appropriate discharge quantity and receiving 

water identified. 

Receiving Water Name(s): ____ _ 

NPDES number(s):. _____ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section N.) 

No manufacturing activity. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

C. ON-SITE LAND RELEASES 

Estimate the total releases of the chemical for each category of land disposal, if 

applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. This 

should be accounted for in your estimate oftotallandfill release. 

Releases to land treatment/land amendment include all waste containing the chemical 

that is applied or incorporated into soil on-site. Do not include waste that is landfilled. 

Surface impoundments are natural topographic depressions, man-made excavations, or 

diked areas formed primarily of earthen materials designed to hold an accumulation of the 

chemical. 

Underground injection is the technology of placing fluids underground, in porous formations 

of rocks, through wells or other similar conveyance systems. 

Other releases include any amount of the chemical that is released to land other than 

those listed. An example is the accidental release of the chemical from an underground 

pipeline or storage tank. 

Landfill 

Land Treatment/Land Amendment 

Surface Impoundments 

Underground Injection 

Other (specify): 

Basis for each release estimate: 

Estimated Total 

Annual Releases 

(kgs) 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

Accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 
Part IV (cont.) 

D. OFF-SITE TRANSFERS 

Estimates of off-site transfers should be similar in accuracy and precision to previous 

release estimates. 

Dl. Transfer to Publicly Owned Treatment Works (POTW) 

Number of days/year the release occurs: _o_ 

Estimate the total quantity of the subject chemical, not the waste stream, transferred to 

the POTW. Complete section below for each POTW to which your facility discharges 

wastewater containing the chemical. Enter the POTW's NPDES permit number, if known. 

Annual Transfer (kgs ): --

0 

Estimated% Accuracy of Transfer Estimate (optional) __ 

POTWName: __________ _ 

Street Address: -----------==-----------

City:______ County: _____ _ 

State: Zip Code: __ 

NPDES number: _________ _ 

Basis for each release estimate: 

(See discussion on source/basis in beginning of Section IV.) 

No manufacturing activity. 

Comments: 

(This section is available to clarify your responses. Attach additional pages if desired.) 

Part IV (cont.) 
D2. Transfers to other off-site locations 

In this section, estimate the quantity of the subject chemical, not the waste stream, 

transferred and the accuracy of the estimate for each category listed. If your facility sends the 

subject chemical in waste to an off-site location where some of the chemical will be recycled 

and the remainder will be treated, estimate each amount separately (i.e., waste treatment and 

recycling activities). 

Incineration 

Wastewater Treatment 

(Excluding POTW) 

Underground Injection 

Hazardous Waste (RCRA 

Subtitle C) Landfill 

Other Landfill 

Recycle or Recovery 

(Does not include internally recycled) 

Internally Recycled 

Unknown or Other 

Basis for each release estimate: 

Estimated Annual 

Transfers (kgs) 

0 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

_o_ 

(See discussion on source/basis in beginning of Section IV.) 

Comments: 

Estimated% 

accuracy 

(Optional) 

(This section is available to clarify your responses. Attach additional pages if desired.) 

No manufacturing activity. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting information: 

Product name: Fluorinated Surfactant( monomeric) 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

All products under the name of"Fluorinated Surfactant (monomeric)" are 

considered to be precursors to PFOA and higher homologues. 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO.,LTD 

Site location:3-2-l O,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan 

:2276-2,Nada,Hirai,Kashima Citv.Ibaraki,314-00 12 Japan 

Identify a company teclmical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-1 O,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan 

III. PRODUCTION 

Calendar year for which you are reporting: Jan I, 2014 to Dec 31, 2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

Imported _ _,o __ kgs/yr 

Manufactured _O_kgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your product. For 

chemicals for which you do not have actual data, please provide range estimates. 

No manufacturing activity. 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures available 

as of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties 

and detection limits (LOD, LOQ) for the data provided. 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting information: 

Product name: Fluorinated Surfactant( oligomeric) 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

All products under the name of"Fluorinated Surfactant (Oligomeric)" are 

considered to be precursors to PFOA and higher homologues. 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO.,LTD 

Site location:3-2-10,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan 

:2276-2,Nada,Hirai,Kashima City,Ibaraki,314-0012 Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-lO,Chigasak:i,Chigasak:i City,Kanagawa,253-8585 Japan 

ill. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

Imported --"o __ kgs/yr 

Manufactured JLkgs/yr 
IV. PRODUCT CONTENT 

A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your product. For 

chemicals for which you do not have actual data, please provide range estimates. 

No manufacturing activity. 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures available 

as of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties 

and detection limits (LOD, LOQ) for the data provided. 

I 
Company sanitized 

Does not contain Confidential Business 

Information (CBI) 

AppendixD 

Draft Facility Report on Product Content 
2010/15 PFOA Stewardship Program 

Draft Facility Report on Product Content 

I. CHEMICAL IDENTIFICATION 

Identify the product (e.g fluoropolymer dispersion) for which you are submitting information: 

Product name: Fluorinated Surfactant(Polymeric) 

Product description (including concentrations of perfluoroalkyl chemicals 

identified in Section IV below and year of production): 

II. COMPANY IDENTIFICATION 

Identify the company and location of the facility submitting information: 

Company name: AGC SEIMI CHEMICAL CO.,LTD 

Site location:3-2-IO.Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan 

:2276-2.Nada.Hirai,Kashima City,Ibaraki,314-0012 Japan 

Identify a company technical contact who can respond to inquiries about the information 

submitted: 

Technical contact: Shunji Odaka 

Phone: +81-467-82-4398 

Address: 3-2-lO,Chigasaki.Chigasaki City,Kanagawa,253-8585 Japan 

III. PRODUCTION 

Calendar year for which you are reporting: Jan 1, 2014 to Dec 31, 2014 

(Data reported in the report are equal to data based on year end run rate.) 

Provide the amount of the product for the reporting year at each specific site: 

Impotted _ _-._O __ kgs/yr 

Manufactured CBI kgs/yr (As active ingredients) 

IV. PRODUCT CONTENT 
A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS 

Please provide the concentrations (ppb) of various perfluoroalkyl chemicals in your product. 

For chemicals for which you do not have actual data, please provide range estimates. 

CBI 

B. ANALYTICAL METHODS 

Analyses should be conducted using the most accurate instrumentation and procedures available 

as of the time of testing. Please provide detailed information on the methods used (including 

analytical standards used, sampling, sample treatment, analysis), assumptions made, 

uncertainties and detection limits (LOD, LOQ) for the data provided. 

• PFOA content in fluorinated acrylate used as monomer was analyzed by LC-MS. 

• 8-2 OH and 8-2 Olefin contents in fluorinated acrylate used as monomer was analyzed by GC-MS. 

CBJ deleted.