## 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 whichyou are submitting information: Chemical name: Ammonium perfluorooctanoate CAS**number:__,3~8~2ci!5-~2~6c:J-lL_**____ _

II. COMPANYIDENTIFICATION
IdentifY the company and location ofthe facility submitting information: Company name: AGC Chemicals Americas Inc. Site location: Bayonne.NewJersey

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 19341III. ON-SITE ACTIVITIES
Calendar year for which you are reporting: Jan 1, 2014 to Dec 31,2014

Provide the amount ofchemical identified above for the reportingyear atspecific site: Imported (virgin)
_**_,o,__~kgs/yr** Imported (externally recycled) _;,<._O
__ kgs/yr Manufactured**_.,0'--~kgs/yr**
Estimate the amount ofsubject chemical distributed off-site: 0 % ofmanufacture/import
Provide the amount used (including any that was manufactured, imported [virgin or externally recycled], orinternally recycled) ofthe subject chemical for the reporting year at specific site: 0 kgs/yr

Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. 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 ofrelease 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 majorprocess instead ofeach 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 ifapplicable)
Inthis 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 reportingperiod. Enter the values as whole numbers to no more than two significant figures. For example, ifyour annual releasesare estimated to be 12,360kgs, au estimate of 12,000 kgs shouldbe reported. Estimate the number ofdays peryear the release occurs. Enter a whole number with a maximum of2 significaut figures. Insert "NA" for release activities not associatedwith the chemical or "0" for releases ofless than 0.5 kgs peryear.

For all releases, the source ofdata aud/or basis for determination shouldbe described in detail. Suggested information about the possible sources/basis includes:
1. Ifthe 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 ofDetection (LOD)/Level ofQuautification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balauce calculation. • Show that the mass balauce closes. • Ifthe mass balance does not close, then report the fraction oftotal feedstock that is not accounted for aud the assumptions you made to correct the balance. Describe the uncertainties.
3. Ifthe source/basis is other thau measurement or mass balauce, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.PartIV (cont.) A. ON-SITE AIR RELEASES Estimate the total fugitive or non-point releases to air and the number ofdays 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 ornon-point air emission. In addition, estimate the total releases that occur through stacks, vents, pipes, or other confined air streams as stack orpoint source releases. Include storage tauk emissions and releases from pollution control equipment. Ifdesired, you canprovide estimates ofthe accuracies ofyourrelease 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 ofSection IV.)

Comments: (This section is available to clarity your responses. Attach additional pages ifdesired.)
Because ofthe plant shutdown at the end of2007, there were no air releases after 2008.PartIV (cont.) B. WATER RELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams orwaterbodies. Include all discharges from process outfalls such as pipes, open trenches, releases from on-site wastewatertreatment, and contribution from storm water runoff, ifapplicable. Do notinclude discharges to a POTWorother off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyourrelease estimate.

Waterreleases: Estimated Total Annual Releases (kgs) Estimated% Accuracy (Optional) #Days/year Release Occurs

Enterthe names ofthe streams or water bodies to which the facility directly discharges the chemical. Also, enter the NPDES permit number for the facility. Ifmore than one numberis 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 eachrelease estimate: (See discussion on source/basis in beginning ofSection IV.)

Comments: (This section is available to clarifY yourresponses. Attach additional pages ifdesired.) Because ofthe plant shutdown at the end of2007, there were no water releases after 2008.PartIV (cont.) C. ON-SITE LAND RELEASES Estimate the total releases ofthe 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 oftotal landfill release. Releases to land treatment/land amendment include all waste containing the chemical that is applied orincorporated into soil on-site. Donotinclude waste that is landfilled. Surface impoundments are natural topographic depressions, man-made excavations, or diked areas formed primarily ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, in porous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other thanthose listed. An example is the accidental release ofthe 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 ofSection IV.) Comments: (This section is available to clarity your responses. Attach additional pages ifdesired.) Because ofthe plant shutdown at the end of2007, there were no on-site land releases after 2008.PartIV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precision to previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: _0_ Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete section below for each POTW to whichyour facility discharges wastewater containing the chemical. Enter the POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): __Q_ Estimated% Accuracy ofTransferEstimate (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 ofSection IV.)
Comments: (This section is available to clarizy your responses. Attach additional pages ifdesired.)
Because ofthe plant shutdown at the end of2007, there were no transfers to POTW after 2008.PartIV (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 ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe 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 orRecovery (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 ofSection IV.)

Comments: Estimated% accuracy (Optional)

(This section is available to clarifY your responses. Attach additional pages ifdesired.) Because ofthe 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. CHEMICALIDENTIFICATION 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 ofproduction):
II. COMPANYIDENTIFICATION IdentifY the company and location ofthe facility submitting information: Company name: AGC Chemicals Americas Inc. Site location: Bayonne.NewJersey
IdentifY a company technical contact who can respond to inquiries about the information submitted: Technical contact: Jonathan Clapp Phone: (201) 805-0989 Address: 55 EastUwchlan Avenue, Exton, PA 19341
III. PRODUCTION Calendaryear for whichyou are reporting: Jan I, 2011 to Dec 31, 2014 Provide the amount ofthe product for the reportingyear at each specific site: GRANULAR PRODUCTS AD PRODUCTS (ED and non ED) CD PRODUCTS Manufactured _O_kgs/yr Manufactured_O_kgs/yr Manufactured __!!_ kgs/yrIV. PRODUCT CONTENT
A. CONCENTRATIONS OF RELEVANT PERFLUOROALKYL CHEMICALS Please provide the concentrations (ppb) ofvarious 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 ofchemicals that should be included: PFOA and its salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) PFOAprecursors • 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,I0,11,11,12, 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,I0-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) • Dodecane, 1,I, 1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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)PartIV (cont.) B. ANALYTICALMETHODS Analyses should be conducted using the most accurate instrumentation and procedures available as ofthe time oftesting. 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 ofReductions in Emissions and Product Content I SECTION 1: REPORT DATE 

## I October 2014 

## I

SECTION 2: COMPANY IDENTIFICATION CompanyName 

### Asahi Glass Co., Ltd., AGC Chemicals Americas Inc., AGC Chemicals Europe Ltd., Seimi Chemical Co., Ltd. 2a Street Address



### SECTION 3: SUMMARY OFEMISSIONS 

### 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 ofcategory kgs ofcategory total kgs released 3a kgs kgs offluoropolymers 1 

### kgs oftelomers 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 dataprovided above. Release to the environment were based on actual measurement or mass balance. Analysis ofrepresentative 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(YearEnd Run Rate) 4a Producttype Fluoropolymer dispersions Other fluoropolymers 1 Telomerbased 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 Telomerbased 

### 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 onthe methods, assumptions, uncertainties and detection limits for the data provided above.

1Fluoropolymers manufactured with PFOA orrelated 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 ofchemical in the product as sold bythe reporting company. Ifthe reporting company has information concerning the concentration ofchemical 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 aweighted average concentration and range. 5 This value should be expressed as amaximum 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 ofPFOA, 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 ofproduct (ppm wet- (ppm dry-weight unless stated (kg) produced weight basis) basis) otherwise) PFOA,PFOA salts and 0 Not 0 0 Not Asahi 2014 Higher Applicable Applicable Homologues

Precursors Not ApplicableT bl 2 R a eeportedE
.. IDISSIODS andP d C ro uct ontent ofPFOA P 

### , recursors, andH" h H 1grer f omo ogues rom N USO on 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 ofproduct (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 PercentReductions 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 ofchemical(s) Fluoropolymer Other Telomer based Year Dispersions Fluoropolymers products released from baselineyear PFOA, PFOAsalts 100% 100% 100% Not Applicable Asahi 2014 and Higher Homologues

Precursors Not ApplicableTable 4. Reported Percent Reductions in Emissions and Product Content ofPFOA, Precursors, and HigherHomologues from 

## s 0
. Non U
.. erattons o/o Reduction in Emissions o/o Reduction in Product Content Ninth Chemical Company Reporting % Reductions in total Category quantity ofchemical(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 NotApplicable 100%

### Accomplishment Table Company Facilities Reductions Emissions Product Content 

# us 100% 100% Non-US 100% 100% Global 100% 100%

# Does not contain ConfidentialBusiness 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. COMPANYIDENTIFICATION Identify the company and location ofthe 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 EastUwchlan Avenue, Exton,PA 19341III. ON-SITE ACTIVITIES
Calendar year for which you are reporting: Jan I, 20Hto Dec 31,2014

Provide the amount ofchemical 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 ofsubject chemical distributed off-site: 0 % ofmanufacture/import
Provide the amount used (including any that was manufactured, imported [virgin or externally recycled], or internally recycled) ofthe subject chemical for the reportingyear at specific site: 0 kgs/yr

Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemicalbeingreported, showing releases and products (kgs/year). Use the following pageto provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. 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 ofrelease 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 majorprocess instead ofeach 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 ifapplicable)
Inthis 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 methodyou 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, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs shouldbe reported. Estimate the number ofdays peryear 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 ofless than 0.5 kgs peryear.

For all releases, the source ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:
I. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show that the mass balance closes. • Ifthe mass balance does not close, then report the fraction oftotal feedstock that is not accounted for and the assumptions you made to coiTect the balance. Describe the uncertainties.
3. Ifthe source/basis is other than measurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.PartIV (cont.) A. ON-SITE AIRRELEASES Estimate the total fugitive ornon-point releases to air and the number ofdays 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 ornon-point air emission. In addition, estimate the total releases that occur through stacks, vents, pipes, or other confined air streams as stack orpoint source releases. Include storage tank emissions and releases from pollution control equipment. Ifdesired, you canprovide estimates ofthe accuracies ofyourrelease 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 ofSection IV.)

Comments: (This section is available to clarifY your responses. Attach additional pages ifdesired.)
Because ofthe 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 ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams orwaterbodies. Include all discharges from process outfalls such as pipes, open trenches, releases from on-site wastewater treatment, and contribution from storm water rnnoff, ifapplicable. Donot include discharges to a POTWor other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Waterreleases: Estimated Total Annual Releases (kgs) Estimated% Accuracy (Optional) #Days/year Release Occurs

Enter the names ofthe streams orwater bodies to which the facility directly discharges the chemical. Also, enter the NPDES permit number for the facility. Ifmore than one number is assigned to the facility, list each number for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s): na NPDES number(s): na

Basis for each release estimate: (See discussion on source/basis in beginning ofSection IV.)

Comments: (This section is available to clarifY your responses. Attach additional pages ifdesired.) Because ofthe plant shutdown at the end of2007, there were no waterreleases after 2008.PartIV (cont.) C. ON-SITELAND RELEASES Estimate the total releases ofthe 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 oftotal 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 ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, inporous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land olher than those listed. An example is the accidental release ofthe 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 inbeginning ofSection IV.) Comments: (This section is available to clarifY yourresponses. Attach additional pages ifdesired.) Because ofthe plant shutdown atthe end of2007, there were no on-site land releases after 2008.PartIV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar iuaccuracy and precision to previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs:

## _o_ Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete section below for each POTWto whichyour facility discharges wastewater containing the chemical. Enter the POTW'sNPDES permit number, ifknown.
Annual Transfer (kgs): _Q_ Estimated % Accuracy ofTransfer 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 ofSection IV.)
Comments: (This section is available to clarify yourresponses. Attach additional pages ifdesired.)
Because ofthe plant shutdown atthe end of2007, there were no transfers to POTW after 2008.Part IV (cont.) D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe chemical willbe recycled and the remainder will be treated, estimate each amount separately (i.e., waste treatment and recycling activities).

Incineration Wastewater Treatment (ExcludingPOTW) UndergroundInjection Hazardous Waste (RCRA Subtitle C) Landfill Other Landfill Recycle orRecovery (Does not include internally recycled) Internally Recycled Unknown or Other
Basis for each release estimate: EstimatedAnnual Transfers (kgs) 

## _o_

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

Comments: Estimated% accuracy (Optional)

{This section is available to clarifY your responses. Attach additional pages ifdesired.) Because ofthe plant shutdown atthe 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 whichyou are submitting information: Product name: Fluoropolymers Product description (including concentrations ofperfluoroalkyl chemicals identified in SectionIV below and year ofproduction):
II. COMPANYIDENTIFICATION IdentifY the company and location ofthe 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 EastUwchlan Avenue, Exton, PA 19341
III. PRODUCTION Calendaryear for which you are reporting: Jan 1, 2014 to Dec 31, 2014 Provide the amount ofthe 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/yrIV. PRODUCT CONTENT
A. CONCENTRATIONS OFRELEVANT PERFLUOROALKYL CHEMICALS Please provide the concentrations (ppb) ofvarious 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 ofchemicals that should be included: PFOA and its salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) PFOAprecursors • 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, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,1 0,10-heptadecafluoro- (CAS 27854-31-5) Higher homologues • Dodecane, I,I,I,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12-pentacosafluoro-12-iodo- (CAS 307-60-8) • Decane, 1,1,I,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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, I, I,I,2,2,3,3,4,4,5,5,6,6,7,7,8,8-heptadecafluoro-10-iodo- (CAS 2043-53-0) • Dodecane, I,I,I,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,I0-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 ofthe time oftesting. 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:Ammoniumperfluorononanoate CAS number: 4149-60-4



### II. COMPANY IDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: ASAHI GLASS CO.,LTD Site location: ChibaPlant

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 runrate)

Provide the amount ofchemical identified above for the reporting year at specific site: Imported (virgin) Imported (externallyrecycled) Manufactured
Estimate the amount ofsubject chemical distributed off-site: 0 % ofmanufacture/import ZERO kgs/yr ZERO kgs/yr ZERO kgs/yr

Provide the amount used (including any that was manufactured, imported [virgin or externally recycled], orinternally recycled) ofthe subject chemical for the reporting year at specific site: ZERO kgs/yr
Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. The narrative and process flow schematic should cover majorunit 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 ofrelease ofthe subject chemical in the workplace and to the environment. In the event the subject chemical is used inmany differentprocesses, provide information on each majorprocess instead ofeach 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-siteprocessing/use ifapplicable)
In

### this section, estimate the total media-specific releases after on-sitetreatment 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, ifyour annual releases are estimatedto be 12,360 kgs, an estimate of 12,000 kgs shouldbe reported. Estimate the number ofdays 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 ofdata and/or basis for determination should be described in detail. Suggested information aboutthe possible sources/basis includes:
I. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show that the mass balance closes. • Ifthe mass balance does not close, thenreportthe fraction oftotal feedstock that is not accounted for and the assumptions you made to correctthe balance. Describe the uncertainties.
3. Ifthe source/basis is other thanmeasurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.Part IV (cont.) A. ON-SITE AIRRELEASES Estimate the total fugitive ornon-pointreleases to air and the number ofdays 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 buildingventilation 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. Ifdesired, you canprovide estimates ofthe accuracies ofyour release estimates.

Fugitive (non-point) Stack (point) Estimated Total Annual Releases (kgs)

Basis for eachrelease estimate: Estimated% Accuracy (Optional)

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

Comments: #Days/year Release Occurs

(This section is available to clarify yourresponses. Attach additional pages ifdesired.) 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 ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or water bodies. Include all discharges from process outfalls such as pipes, opentrenches, releases from on-site wastewatertreatment, and contribution from storm water runoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewater treatment facilities. Ifdesired, you canprovide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs) Estimated% Accuracy (Optional) #Days/year Release Occurs

Enter the names ofthe streams or water bodies to which the facility directly discharges the chemical. Also, enter the NPDES permit numberfor the facility. Ifmore than one number is assigned to the facility, list eachnumber for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s): Tokvo Bay NPDES number(s**):.~N'-"'-ot,_,a,.p"'p~li""ca,b"'"le,_**____ _

Basis for eachrelease estimate: (See discussion on source/basis inbeginning ofSection IV.)

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.) 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 ofthe 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 inyour estimate oftotal landfill release. Releases to land treatment/land amendment include all waste containing the chemical that is applied or incorporated into soil on-site. Do notinclude wastethat is landfilled. Surface impoundments are natural topographic depressions, man-made excavations, or diked areas formed primarily ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, in porous formations ofrocks, through wells or other similar conveyance systems. Otherreleases include any amount ofthe chemical that is released to land other than those listed. An example is the accidental release ofthe chemical from an undergroundpipeline 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 ofSectionIV.) Comments: Estimated% Accuracy (Optional)

(This sectionis available to clarify your responses. Attach additional pages ifdesired.) No such activity.Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy andprecisionto previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: _ZERO_ Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete sectionbelow for eachPOTWto whichyourfacility discharges wastewater containing the chemical. Enter the POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): Estimated % Accuracy ofTransfer Estimate (optional)
__ POTWName: StreetAddress_:
__________ _ City:
_____ _ County:
_____ _ State: Zip Code:
__ NPDES number:
_________ _

Basis for eachrelease estimate: (See discussion on source/basis inbegioning ofSection IV.)

Comments: (This section is available to clarify your responses. Attach additionalpages ifdesired.) 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 ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site locationwhere some ofthe chemical will be recycled and the remainder will betreated, estimate each amount separately (i.e., waste treatment and recycling activities).

Incineration WastewaterTreatment (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 inbeginning ofSection IV.)

Comments: Estimated% accuracy (Optional)

(This section is available to clarify yourresponses. Attach additional pages ifdesired.) 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 Identifythe product (e.g fluoropolymer dispersion) for whichyou are submitting information: Productname: Carboxylate polymer Product description (including concentrations ofperfluoroalkyl chemicals identified in Section IV below and year ofproduction): 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 ofthe facility submitting information: Companyname: ASAHI GLASS Co.,LTD Site location: ChibaPlant Identify a company technical contact who can respond to inquiries aboutthe 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 ofthe 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 RELEVANTPERFLUOROALKYL CHEMICALS Please provide the concentrations (ppb) ofvarious 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 ofchemicals that should be included: PFOA andits salts o Octanoic acid, pentadecafluoro- (CAS 335-67-1) o Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) PFOAprecursors 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, 3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-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

### ,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-heneicosafluoro-10-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, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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 ofthe time oftesting. Please provide detailed information onthe methods used (including analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties and detection limits (LOD, LOQ) for the dataprovided.

# 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 whichyou are submitting information: Chemical name: Ammonium Perfluorononanoate CAS number:
_ __,_4_,_14-'-'9'----6"'0"---_,4
__



### ll. COMPANY IDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: Asahi Glass Co., Ltd. Chemicals Company Site location: Chiba, Japan

Identify a company technical contact who canrespond 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 (Datareported inthe report are equal to data based onyear end runrate.)
Provide tbe amount ofchemical 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 ofsubject chemical distributed off-site: 0 %ofmanufacture/import

Provide the amount used (including any thatwas manufactured, imported [virgin or externally recycled], or internally recycled) ofthe subject chemical for the reporting year at specific site: CBI kgs/yr Narrative Description and Process Flow Schematic: Provide overall material balance oftbe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. The narrative andprocess flow schematic should cover major unit operations and chemical conversions for manufacturing and on-site uses, if applicable. The narrative shouldprovide insight into why and howreleases are caused by the process. The schematic should show the points ofrelease ofthe subject chemical in the workplace and to the environment. In

### tbe event the subject chemical is used in many different processes, provide information on eachmajor process instead ofeach individual process.Narrative Description andProcess Flow Schematic: CBI

### IV. SITE RELEASE AND TRANSFER INFORMATION (For manufacturing and on-siteprocessing/use ifapplicable)
Inthis section, estimate the total media-specific releases after on-site treatment of the chemical from your facility. Youmay estimate the releases by using monitoring data or any other method you believe appropriate. Estimates shouldbe reported inkgs per year for the reporting period. Enter the values as whole numbers to no more than two significant figures. For example, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs should be reported. Estimate the number ofdays per yearthe release occurs. Enter a whole number with a maximum of2 significant figures. Insert "NA" for release activities not associated withthe chemical or "0" for releases ofless than 0.5 kgs peryear.

For all releases, the source ofdata and/orbasis for determination shouldbe described indetail. Suggested information about the possible sources/basis includes:
1. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show that the mass balance closes. • Ifthe mass balance does not close, then report the fraction oftotal feedstock that is not accounted for and the assumptions you made to correctthe balance. Describe the uncertainties.
3. Ifthe source/basis is other than measurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.Part IV (cont.) A. ON-SITE AIRRELEASES Estimate thetotal fugitive or non-pointreleases to air and the number ofdays 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 orpoint source releases. Include storage tank emissions and releases from pollution control equipment. Ifdesired, you canprovide estimates ofthe accuracies ofyour release estimates.

Fugitive (non-point) Stack (point) Estimated Total Annual Releases (kgs)

Basis for eachrelease estimate: Estimated% Accuracy (Optional)

(See discussion on source/basis inbeginning ofSectionIV.) CBI
Comments: #Days/year Release Occurs

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

### PartIV (cont.) 

### B. WATERRELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams orwater bodies. Include all discharges from process outfalls suchas pipes, open trenches, releases from on-site wastewater treatment, and contributionfrom storm water runoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate. Estimated Total Annual Releases (kgs)
Water releases: CBI Estimated% Accuracy (Optional) 

### #Days/year Release Occurs

Enterthe names ofthe streams or water bodies to which the facility directly discharges the chemical. Also, enter the NPDES permit number for the facility. Ifmore 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): NotApplicable

Basis for each release estimate: (See discussion on source/basis in beginning ofSection IV.) CBI
Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### PartIV (cont.) C. ON-SITE LAND RELEASES Estimate the total releases ofthe 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 inyour estimate oftotal landfill release. Releases to land treatment/land amendment include all waste containing the chemical that is applied orincorporated 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 ofearthenmaterials designed to hold an accumulation ofthe chemical. Underground injectionis the technology ofplacing fluids underground, inporous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. 

### An example is the accidental release ofthe 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 ofSection IV.)
Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in

### accuracy andprecisionto previous release estimates.

Dl. Transfer to Publicly OwnedTreatment Works (POTW)
Number ofdays/year the release occurs: __lli!__ 

### Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete sectionbelow for each POTWto which your facility discharges wastewater containing the chemical. Enterthe POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): Estimated%Accuracy ofTransfer Estimate (optional)
__ POTWName:
__________ _ Street Address:----------=--------- City: County:
_____ _ State:_______ Zip Code:
__ NPDES number:
________ _

Basis for each release estimate: (See discussion on source/basis in beginning ofSection IV.)

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### Part IV (cont.) D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe 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 ofSection IV.)

Comments: Estimated% accuracy (Optional)



### (This section is available to clarify your responses. Attach additional pages ifdesired.)

# 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 ofperfluoroalkyl chemicals identified in Section IV below and year ofproduction): CBI



### ll. COMPANY IDENTIFICATION Identify the company and location ofthe 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 aboutthe information submitted: Technical contact::----:'H'-'1". r,oak""-'-i_,S,hi".d,a:L_
____ _ Phone: 81-436-23-3326 Address: I0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan


### III. PRODUCTION Calendar year for whichyou are reporting: Jan 1, 2013 to Dec 31, 2013_ (Datareported in the report are equal to data based on year end runrate.) Provide the amount ofthe 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) ofvarious perfluoroalkyl chemicals inyour product. For chemicals for which you do not have actual data, please provide range estimates. The following is a nonexhaustive list ofchemicals that should be included: PFOA andits salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- armnonium salt (CAS 3825-26-1) PFOAprecursors • 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, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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) • Dodecane, 1,1, 1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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 METHODS Analyses should be conducted using the most accurate instrumentation and procedures available as ofthe time oftesting. 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 dataprovided.

# 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 ofthe 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: I0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan

### III. ON-SITE ACTIVITIES
Calendaryear for which youare reporting: Jan 1, 2014_ to Dec 31, 2014_ (Normalized data based on year end run rate)

Provide the amount ofchemical identified above for the reporting year at specific site: Imported (virgin) __ _____,0"-------kgs/yr Imported (externallyrecycled)
___ O_kgs/yr Manufactured
___ O_kgs/yr

Estimate the amount ofsubject chemical distributed off-site: 0 % 

### ofmanufacture/import

Provide the amount used (including any that was manufactured, imported [virgin or externallyrecycled], or internally recycled) ofthe subject chemical for the reporting year at specific site: CBI kgs/yr

Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include informationthat gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. 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 howreleases are caused by the process. The schematic should show the points ofrelease ofthe subject chemical in the workplace and to the environment. Inthe event the subject chemical is used in many different processes, provide information on each major process instead ofeach individual process.Narrative Description and Process Flow Schematic: CBI

### IV. SITE RELEASE AND TRANSFER INFORMATION (For manufacturing and on-site processing/use ifapplicable)
Inthis section, estimate the total media-specific releases after on-sitetreatment of the chemical from your facility. You may estimate the releases by usingmonitoring data or any other method you believe appropriate. Estimates should be reported inkgs per year for the reporting period. Enter the values as whole numbers to no more thantwo significant figures. For example, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs should be reported. Estimate the number ofdays 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 ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:
1. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show that the mass balance closes. • Ifthe mass balance does not close, thenreport the fraction oftotal feedstock that is not accounted for and the assumptions you made to correct the balance. Describe the uncertainties.
3. Ifthe source/basis is other than measurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.

### Part IV (cont.) 

### A. ON-SITE AIRRELEASES Estimatethetotal fugitive or non-pointreleases to air and the number ofdays 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 ornon-point air emission. In addition, estimate the total releases that occur through stacks, vents, pipes, or other confined air streams as stack orpoint source releases. Include storage tank emissions and releases from pollution control equipment. Ifdesired, you can provide estimates ofthe accuracies ofyourrelease estimates. Estimated Total Estimated% #Days/year Annual Releases Accuracy Release Occurs (kgs) (Optional) 

### Fugitive (non-point) Stack (point) CBI +-20% _330

Basis for eachrelease estimate: (See discussion on source/basis in beginning ofSection IV.) CBI
Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)Part IV (cont.) 

### B. WATER RELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or waterbodies. Include all discharges from process outfalls such as pipes, opentrenches, releases from on-site wastewater treatment, and contribution from storm water runoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs) Estimated% Accuracy (Optional) #Days/year Release Occurs
_330_

Enter the names ofthe streams or water bodies to whichthe facility directly discharges the chemical. Also, enter theNPDES permit number for the facility. Ifmore than one number is assigned to the facility, list eachnumber for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s): Tokyo Bay NPDES number(s): Not Applicable

Basis for eachrelease estimate: (See discussion on source/basis inbeginning ofSection IV.) CBI
Comments: (This section is available to clarify your responses. Attach additionalpages ifdesired.)Part IV (cont.) C. ON-SITE LAND RELEASES Estimate the totalreleases ofthe 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 inyour estimate oftotal 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 wastethat is landfilled. Surface impoundments are natural topographic depressions, man-made excavations, or diked areas formed primarily ofearthenmaterials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground,.in porous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. 

### An example is the accidental release ofthe chemical from an undergroundpipeline 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 ofSection IV.)
Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precision to previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: Jill._ 

### Estimate the total quantity ofthe subject chemical, notthe waste stream, transferred to the POTW. Complete sectionbelow for each POTWto which yourfacility discharges wastewater containing the chemical. Enterthe POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): Estimated% Accuracy ofTransfer Estimate (optional)
__ POTWName:
__________ _ Street Address:----------=--------- City: County:
____ _ State:_______ Zip Code:
__ NPDES number:
________ _

Basis for each release estimate: (See discussion on source/basis inbeginning ofSection IV.)

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)Part IV (cont.) D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for eachcategory listed. Ifyour facility sends the subject chemical inwaste to anoff-site locationwhere some ofthe chemical will be recycled andthe 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: EstimatedAnnual Transfers (kgs)

CBI

(See discussion on source/basis inbeginning ofSection IV.) CBI
Comments: Estimated% accuracy (Optional)

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

# AppendixD 

# DraftFacility 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 ofperfluoroalkyl chemicals identified in SectionIV below and year ofproduction):



### II. COMPANYIDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: Asahi Glass Co., Ltd. Chemicals company Site location: Chiba, Japan Identify a company technical contact who canrespond 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 Calendaryear for whichyou are reporting: Jan I, 2014_to Dec 31, 2014_ 

### (Nonnalized data based on year end 1unrate) Provide the amount ofthe 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) ofvarious perfluoroalkyl chemicals in your product. Forchemicals for which you do not have actual data, please provide range estimates. The following is a nonexhaustive list ofchemicals that should be included: 

### PFOA andits 

### salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- ammoniun1 salt (CAS 3825-26-1) 

### PFOAprecursors • 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, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-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, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,1 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, 1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11, 12,12- pentacosafluoro-12-iodo- (CAS 307-60-8) • Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-heneicosafluoro-10-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, 1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-heneicosafluoro-12-iodo- (CAS 2043-54c1) • 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 usingthe most accurate instrumentation and procedures available as ofthe time oftesting. Please provide detailed information onthe methods used (including analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties and detection limits (LOD, LOQ) for the data provided. 1. Determination ofperfluorooctanoate 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 offortification and surrogate standard A fottification standard containing appropriate amount ofAPFO was prepared using a solvent (2 

### I 8 (wt) mixture ofdistilled water 

### I ethanol). A smrogate standard containingI00 ng/ml 9H-PFNA was prepared using a solvent (I 

### I I (wt) mixture ofdistilled water 

### I ethanol). 1-4 Pretreatment ofsamples (I) Product (CD type) Ten g ofthe sample was placed into the sohxlet. The sohxlet-extractionusing I00 ml of ethanol was conducted for 5 hours. Appropriate amount ofeach fortification standards of APFO was added into the extracted solution which was putin each ofseveral vials. Each mixed solution was appropriately diluted with the surrogate standard. A portion ofthe solution was put into the auto-sampler vial, and injected into LC/MS conditioned as follows. The calculation ofconcentration in sample was conducted using standard addition method. (2) Waste water Appropriate amount ofthe sample was put in each ofseveral vials. Appropriate amount ofeach fmtification standards ofAPFO was added into the vials and shaken vigorously. The mix solution was appropriately diluted withthe surrogate standard. A portion ofthe solution was put into the auto-sampler vial, and injected into LC/MS conditioned as follows. The calculation ofconcentration 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 II00 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 SolutionA : 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 whichyou are submitting information: Chemical name: Perfluoroalkyl Chemicals (Carbon chain length of8 or larger) CAS number:.
_________ _



### II. COMPANY IDENTIFICATION Identify the company and location ofthe 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 canrespond 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, Chiba290-8566, Japan

### III. ON-SITE ACTIVITIES
Calendar year for whichyou are reporting: Jan 1, 2014_to Dec 31, 201±_ (Normalized databased on year end run rate.) Provide the amount ofchemical identified above for thereporting year at specific site: Imported (virgin) ---"O
__ kgs/yr Imported (externally recycled)**-~0"-_,kgs/yr** 

### Manufactured CBI kgs/yr CBI deleted. Estimate the amount ofsubject chemical distributed off-site: 0 % 

### ofmanufacture/import

Provide the amount used (including any that was manufactured, imported [virgin or externally recycled], or internally recycled) ofthe subject chemical for the reporting year at specific site: 0 kgs/yr CBI deleted.
Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. 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 ofrelease ofthe subject chemical in the workplace and to the environment. In the event the subject chemical is used in many different processes, provide information oneach major process instead ofeach individual process. Narrative Description and Process Flow Schematic: 

### CBI

### IV. SITE RELEASE AND TRANSFER INFORMATION (For manufacturing and on-site processing/use ifapplicable)
In this section, estimate the total media-specific releases after on-sitetreatment of the chemical from your facility. You may estimate the releases by using monitoring data or any othermethod you believe appropriate. Estimates should be reported inkgs per year for the reporting period. Enterthe values as whole numbers to no more than two significant figures. For example, ifyour annual releases are estimatedto be 12,360 kgs, an estimate of 12,000 kgs should be reported. Estimate the number ofdays per year the release occurs. Enter a whole number with a maximum of2 significant figures. Insert "NA"for release activities not associated withthe chemical or "0" for releases ofless than 0.5 kgs per year.

For all releases, the source ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:


### I. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show thatthe mass balance closes. • Ifthe mass balance does not close, thenreport the fraction oftotal feedstock that is not accounted for andthe assumptions you made to correct the balance. Describe the uncertainties.
3. Ifthe source/basis is other than measurement or mass balance, then • Describe the method used. For example, ifengineering 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 ornon-point releases to air and the number ofdays 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 ornon-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. Ifdesired, you canprovide estimates ofthe accuracies ofyour release estimates.

Fugitive (non-point) Stack(point) Estimated Total Annual Releases (kgs) 

# _o_ _Q__

Basis for eachrelease estimate: Estimated% Accuracy (Optional)

(See discussion on source/basis inbeginuing ofSection IV.)

Comments: #Days/year Release Occurs

(This section is available to clarify your responses. Attach additional pages ifdesired.) CBI deleted.Part IV (cont.) B. WATERRELEASES FROM SITE Estimate thetotal releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or water bodies. Include all discharges from process outfalls such as pipes, opentrenches, releases from on-sitewastewatertreatment, and contribution from storm water runoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewatertreatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs) Estimated% Accuracy (Optional) #Days/year Release Occurs

Enter the names ofthe streams or water bodies to whichthe facility directly discharges the chemical. Also, enter the NPDES permit numberfor the facility. Ifmore than one number is assigned to the facility, list eachnumber for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s): The Tokyo Bay NPDES number(s):,
_____ _

Basis for eachrelease estimate: (See discussion on source/basis in beginning ofSection IV.)

Comments: (This section is available to clarify yourresponses. Attach additionalpages ifdesired.) No waste water release from the manufacturing process.

### Part IV (cont.) C. ON-SITE LAND RELEASES Estimate the total releases ofthe chemical for eachcategory ofland disposal, if applicable. Estimate only on-site releases. Do not estimate leaks from landfills separately. This should be accounted for inyour estimate oftotal landfill release. Releases to land treatment/land amendment include all waste containingthe chemical that is applied or incorporated into soil on-site. Donot include waste that is landfilled. Surface impoundments are natural topographic depressions, man-made excavations, or diked areas formed primarily ofearthenmaterials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, inporous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. An 

### example is the accidental release ofthe 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 inbeginning ofSection IV.) No on-site land releases. Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precisionto previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: -=na"'--- Estimate the total quantity ofthe subject chemical, notthe waste stream, transferred to the POTW. Complete sectionbelow for each POTW to whichyour facility discharges wastewater containing the chemical. Enterthe POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): Estimated% Accuracy ofTransfer Estimate (optional)
__ POTWName: Street Addres-s:
__________ _ City:
_____ _ County:
_____ _ State: Zip Code:
__ NPDES number:
________ _

Basis for eachrelease estimate: (See discussion on source/basis in beginning ofSection IV.) No transfer to POTW.

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### 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 ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe chemical will be recycled andthe 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 ofSection IV.) Comments: Estimated% accuracy (Optional)



### (This sectionis available to clarify your responses. Attach additional pages ifdesired.) 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: Productname: Telomer Products Product description (including concentrations ofperfluoroalkyl chemicals identified in Section IV below and year ofproduction): Products include both polymeric and non-polymeric chemicals. Exports are global.


### II. COMPANY IDENTIFICATION Identify the company and location ofthe 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: I0, Goikaigan, Ichihara-shi, Chiba 290-8566, Japan


### III. PRODUCTION Calendar year for whichyou are reporting: Jan 1, 2014_to Dec 31, 2014_ (Normalized databased onyear end run rate.) Provide the amount ofthe productfor 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) ofvarious perfluoroalkyl chemicals inyour product. For chemicals for which you do nothave actual data, please provide range estimates. The following is a nonexhaustive list ofchemicals that should beincluded: PFOA and its salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-1) PFOAprecursors • 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, 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, 10,10-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) • Dodecane, 1,1,1 ,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-heneicosafluoro-12-iodo- (CAS 2043-54-1) • 2-Propenoic acid, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,1O-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 conductedusing the most accurate instrumentation and procedures available as ofthe time oftesting. 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 dataprovided.

# 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 whichyou are submitting information: Chemical name: ammonium perfluorooctanoate CAS number: 3825-26-1

II. COMPANY IDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: AGC Chemicals Europe, Ltd Site location: Hillhouse, UK

Identify a company technical contact who canrespond 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, UKIII. ON-SITE ACTIVITIES
Calendaryear for which you are reporting: Jan 1, 2014 to Dec 31, 2014 (Normalized data based on year endrun rate.)
Provide the amount ofchemical identified above for the reporting year at specific site: Total CBI Imported (Recycled, Source Country Japan) CBI
Manufactured zero
Estimate the amount ofsubject chemical distributed off-site: 0 % ofmanufacture/import

Provide the amount used (including any thatwas manufactured, imported [virgin or externally recycled], or internallyrecycled) ofthe subject chemical for the reportingyear at specific site:
CBl Narrative Description and Process Flow Schematic:

, Provide overall material balance ofthe chemical beingreported, showing releases and products (kg/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. The narrative and process flow schematic should cover majorunit operations and chemical conversions for manufacturing and on-site uses, if applicable. The narrative shouldprovide insight into why and howreleases are caused by the process. The schematic should showthepoints ofrelease ofthe subject chemical in the workplace and to the enviromnent. In the event the subject chemical is used in many different processes, provide information on eachmajorprocess instead ofeach individual process. CBIIV. SITE RELEASE AND TRANSFERINFORMATION (For manufacturing and on-site processing/use ifapplicable)
In this section, estimate the total media-specific releases after on-site treatment of the chemical from yourfacility. Yaumay 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. Forexample, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kg should be reported. Estimate the number ofdays peryear 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 peryear.

For all releases, the source ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:
I. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Show that the mass balance closes. • Ifthe mass balance does not close, then report the fraction oftotal feedstock that is not accounted for and the assumptions you made to correct the balance. Describe the uncertainties.
3. Ifthe source/basis is other than measurement ormass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.PartIV (cont.) A. ON-SITE AIRRELEASES Estimate the total fugitive ornon-point releases to air and the number ofdays 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 buildingventilation 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 orpoint source releases. Include storage tank emissions and releases from pollution control equipment. Ifdesired, you can provide estimates ofthe accuracies ofyourrelease 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 ofSection IV.)PartIV (cont.) Comments: (This section is available to clarizy yourresponses. Attach additional pages ifdesired.)
B. WATERRELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyourfacility 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 waterrunoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyourrelease estimate.
Water releases: Estimated Total AnnualReleases (kg)
CBI Estimated% Accuracy (Optional)

CBI #Days/year Release Occurs

CBI
Enter the names ofthe streams or water bodies to which the facility directly discharges the chemical. Also, enter the NPDES permit number for the facility. Ifmore than one number is assigned to the facility, list each number for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s): River Wyre (tidal estuary) NPDES number(s): Not applicable
Basis for each release estimate: (See discussion on source/basis in beginning ofSection IV.) See part A

Comments: (This section is available to clarizy your responses. Attach additional pages ifdesired.)Part IV (cont.) C. ON-SITE LAND RELEASES Estimate the total releases ofthe 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 inyour estimate oftotal landfill release. Releases to land treatment/land amendment include allwaste 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 ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, in porous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. An example is the accidental release ofthe chemical from an underground pipeline or storage tank. Estimated Total Annual Releases (kg) Landfill Zero LandTreatment/Land Amendment Zero Surface Impoundments Zero Underground Injection Zero Other (specify): Zero
Comments: Estimated% Accuracy (Optional)

(This section is available to clarify yourresponses. Attach additional pages ifdesired.)PartIV (cont.) Solid waste sent to specialist landfill site (see section 02) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precision to previous release estimates.
Dl. Transfer to Publicly Owned TreatmentWorks (POTW)
Number ofdays/year the release occurs: _0 Estimate the total quantity ofthe subject chemical, notthe waste stream, transferred to the POTW. Complete sectionbelow for each POTWto whichyour facility discharges wastewater containing the chemical. Enter the POTW'sNPDES permit number, ifknown. Annual Transfer (kg):
_0 Estimated % Accuracy ofTransfer Estimate (optional)
__ POTWName: Street Address:
__ _ City:
__ State: NPDES number:

Basis for eachrelease estimate:**County:~-----­** ZipCode:
__

(See discussion on source/basis in beginning ofSection IV.)
Comments: (This section is available to clarifY your responses. Attach additional pages ifdesired.)PartIV (cont.) D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe 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 OtherLandfill Recycle orRecovery (Does not include internally recycled) Internally Recycled Unknown or Other
Basis for eachrelease estimate: Estimated Annual Transfers (kg)
CBI

zero ZCJ'O CBI

zero
zero
CBI
zero
(See discussion on source/basis inbeginning ofSection IV.)

See pmt A
Comments: Estimated% accuracy (Optional)

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

# 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 ofproduction):

II. COMPANY IDENTIFICATION Identity the company and location ofthe facility submitting information: Company name: AGC Chemicals Europe, Ltd Site location: Hillhouse, UK Identity a company technical contact who canrespond 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, UKIII. PRODUCTION Calendar year for which you are reporting: Jan 1, 2014 to Dec 31,2014 (Normalized databased on year end run rate.) Provide the amount ofthe product for the reporting year at each specific site:
CBI
IV. PRODUCT CONTENT
A. CONCENTRATIONS OF RELEVANTPERFLUOROALKYL CHEMICALS Pleaseprovide the concentrations {ppb) ofvarious perfluoroalkyl chemicals inyour product. For chemicals for which you do nothave actual data, please provide range estimates. The following is a nonexhaustive list ofchemicals that should be included: PFOA and its salts • Octanoic acid, pentadecafluoro- (CAS 335-67-1) • Octanoic acid, pentadecafluoro- ammonium salt (CAS 3825-26-I) PFOAprecursors • 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-, 3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-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 27854-3 1-5) Higher homologues • Dodecane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11 ,12,12-pentacosafluoro-12-iodo- (CAS 307-60-8) • Decane, 1,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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 ,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10-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 shouldbe conducted using the most accurate instrumentation and procedures available as ofthe time oftesting. 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 whichyou are submitting information: Chemical name: PFOA and salts CAS number:,
_________ _



### II. COMPANY IDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: AGC SEIMI CHEMICAL CO
..LTD Site location:3-2-1O.Chigasaki,Chigasaki Citv.Kanagawa,253-8585 Japan

Identify a companytechnical contact who canrespond 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 databased onyear end run rate.)

Provide the amount ofchemical 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 ofsubject chemical distributed off-site: 100 %ofmanufacture/import

Provide the amount used (including any that was manufactured, imported [virgin or externally recycled], or internally recycled) ofthe subject chemical for the reporting year at specific site: 0 kgs/yr

Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include iuformation that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. The narrative andprocess 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 andhowreleases are causedby the process. The schematic should show the points ofrelease ofthe subject chemical in the workplace and to the environment. In

### the event the subject chemical is used inmany different processes, provide information oneach majorprocess instead ofeach individual process.Narrative Description andProcess Flow Schematic: CBI

### N. SITE RELEASE AND TRANSFER INFORMATION 

### (For manufacturing and on-site processing/use ifapplicable)
In

### this section, estimate the total media-specific releases after on-site treatment of the chemical from your facility. Youmay estimate the releases by using monitoring data or any othermethod you believe appropriate. Estimates should be reported inkgs per year for the reporting period. Enter the values as whole numbers to no more thantwo significant figures. For example, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs should bereported. Estimate the number ofdays per yearthe release occurs. Enter a whole number with a maximum of2 significant figures. Insert "NA" for release activities not associated withthe chemical or "0" for releases oflessthan 0.5 kgs per year.

For all releases, the source ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:


### I. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Showthat the mass balance closes. • Ifthe mass balance does not close, thenreportthe fraction oftotal feedstock that is not accounted for and the assumptions you made to correctthe balance. Describe the uncertainties.
3. Ifthe source/basis is otherthan measurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describe the uncertainties.

### Part IV (cont.) A. ON-SITE AIRRELEASES Estimate the total fugitive ornon-pointreleases to air and the number ofdays 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. Ifdesired, you canprovide estimates ofthe accuracies ofyour release estimates.

Fugitive (non-point) Stack (point) Estimated Total Annual Releases (kgs)



### 0 0

Basis for eachrelease estimate: Estimated% Accuracy (Optional)



### (See discussion on source/basis in beginning ofSectionIV.) 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 ifdesired.)

### Part IV (cont.) B. WATER RELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or water bodies. Include all discharges from
. process outfalls such as pipes, opentrenches, releases from on-site wastewatertreatment, and contribution from storm waterrunoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs)
0 

### Estimated% Accuracy (Optional) 

### #Days/year Release Occurs


# _o_

Enterthe names ofthe streams or waterbodies to whichthe facility directly discharges the chemical. Also, enterthe NPDES permitnumber for the facility. Ifmore than one number is assigned to the facility, list eachnumber for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s):
____ _ NPDES number(s):
_____ _

Basis for each release estimate: (See discussion on source/basis inbeginning ofSection IV.) No waste water release from the manufacturing process.

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

### Part IV (cont.) C. ON-SITE LAND RELEASES Estimate the total releases ofthe 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 inyour estimate oftotal 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 thatis landfilled. Surface impoundments are natural topographic depressions, man-made excavations, or diked areas formed primarily ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, 

### inporous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. An 

### example is the accidental release ofthe 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 ofSection IV.)
Comments: Estimated% Accuracy (Optional)

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

### Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precision to previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: _0_ Estimate the total quantity ofthe subject chemical, notthe waste stream, transferred to the POTW. Complete sectionbelow for each POTW to which your facility discharges wastewater containingthe chemical. Enter the POTW's NPDES permit number, ifknown.
Annual Transfer (kgs): Estimated% Accuracy ofTransfer Estimate (optional)
__ POTWNarne: Street**Address-:----------~ City:-----~**  

### County:
_____ _ State: Zip Code:
__ NPDES number:



### -----------

Basis for each release estimate: (See discussion on source/basis inbeginning ofSectionIV.) Not applicable
Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)Part IV (cont.) D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical inwaste to an off-site location where some ofthe 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 inbeginning ofSection IV.)

Comments: Estimated% accuracy (Optional)

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

# 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: Chemicalname: Precursors CAS number:
_________ _



### II. COMPANY IDENTIFICATION Identify the company and location ofthe facility submitting information: Company name: AGC SEIMI CHEMICAL CO.,LTD Site location:3-2-1O,Chigasaki,Chigasaki City,Kanagawa,253-8585 Japan

Identify a company technical contact who canrespond 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 (Datareported inthe report are equal to data based onyear end runrate.)

Provide the amount ofchemical 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 ofsubject chemical distributed off-site: 0 % 

### ofmanufacture/import

Provide the amountused (including any that was manufactured, imported [virgin or externally recycled], orinternally recycled) ofthe subject chemical for the reporting year at specific site: 0 kgs/yr

Narrative Description and Process Flow Schematic: Provide overall material balance ofthe chemical being reported, showing releases and products (kgs/year). Use the following page to provide a narrative description and process flow schematic ofon-site activities, and include information that gives an understanding ofthe nature and extent ofpotential exposures to the subject chemical. Attach additional pages ifdesired. The narrative and process flow schematic should cover majorunit 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 ofrelease ofthe 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 ofeach individual process.Narrative Description and Process Flow Schematic:



### No manufacturing activity.

### IV. SITE RELEASE AND TRANSFER INFORMATION (For manufacturing and on-site processing/use ifapplicable)
In this section, estimate the total media-specific releases after on-site treatment of the chemical from your facility. You may estimate the releases byusing monitoring data or any other method you believe appropriate. Estimates should be reported inkgs per year for the reporting period. Enterthe values as whole numbers to no more than two significant figures. For example, ifyour annual releases are estimated to be 12,360 kgs, an estimate of 12,000 kgs should be reported. Estimate the number ofdays 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 ofdata and/or basis for determination should be described in detail. Suggested information about the possible sources/basis includes:


### 1. Ifthe 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 ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Showthatthe mass balance closes. • Ifthe mass balance does not close, thenreportthe fraction oftotal feedstock that is not accounted for and the assumptions youmade to . correct the balance. Describethe uncertainties.
3. Ifthe source/basis is otherthan measurement ormass balance, then • Describe the method used. For example, ifengineering 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 ofdays 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 ornon-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. Ifdesired, you canprovide estimates ofthe accuracies ofyour 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 inbeginning ofSectionIV.)
No manufacturing activity.

Comments: #Days/year Release Occurs 

### 0 0

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

Part IV (cont.)B. 

### WATER RELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or water bodies. Include all discharges from process outfalls such as pipes, opentrenches, releases from on-site wastewater treatment, and contributionfrom storm waterrunoff, ifapplicable. Do not include discharges to a POTW or other off-site wastewatertreatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs)
0 Estimated% Accuracy (Optional) 

### #Days/year Release Occurs**~0-**


### Enter the names ofthe streams or waterbodies to which thefacility directly discharges the chemical. Also, enter the NPDES permitnumber for the facility. Ifmore than one number is assignedto the facility, list each number for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s):
____ _ NPDES number(s):
_____ _
Basis for each release estimate: (See discussion on source/basis inbeginning ofSection IV.) 

### No manufacturing activity.

Comments: (This section is available to clarify yourresponses. Attach additional pages ifdesired.) Part IV (cont.)

### C. ON-SITE LAND ltELEASES Estimate the total releases ofthe chemical for each category ofland disposal, if applicable. Estimate only on-site releases. Donot estimate leaks from landfills separately. This should be accounted for inyour estimate oftotal landfill release. lteleases to land treatment/land amendment include all waste containingthe chemical that is applied orincorporated 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 ofearthenmaterials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, in porous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is released to land other than those listed. 

### An example is the accidental release ofthe 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 inbeginning ofSectionIV.)
Comments: Estimated% Accuracy (Optional)

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

### D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar inaccuracy and precisionto previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs: _0_ Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete section below for eachPOTWto which your facility discharges wastewater containing the chemical. Enterthe POTW'sNPDES permit number, ifknown.
Annual Transfer (kgs): 0

--- 

### Estimated% Accuracy ofTransfer Estimate (optional)
__ POTWNarne:
__________ _ Street Address:
_________________ _ City: County:
_____ _ State:_______ Zip Code:
__ NPDES number:
_________ _

Basis for each release estimate: (See discussion on source/basis inbeginning ofSectionIV.)



### No manufacturing activity
. 

# • Comments: (This section is available to clarify yourresponses. Attach additional pages ifdesired.) Part IV (cont.)

### D2. Transfers to other off-site locations Inthis section, estimate the quantity ofthe subject chemical, not the waste stream, transferred andthe accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical inwaste to an off-site location where some ofthe 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: EstimatedAnnual Transfers (kgs)
0 

# _o_ _o_ _o_ _o_ 

# _o_ _o_ _o_

(See discussion on source/basis inbeginning ofSection 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 ifdesired.) 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 Identifythe company and location ofthe 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 companytechnical 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 Japanill. 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 ofchemical identified above for the reporting year at specific site: hnported (virgin) 0 kgs/yr hnported (externallyrecycled) 0 kgs/yr Manufactured 0 kgs/yr

Estimate the amount ofsubject chemical distributed off-site: 0 % ofmanufacture/import

Provide the amount used (including any tbat was manufactured, imported [virgin or externally recycled], orinternally recycled) ofthe 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, showingreleases and products (kgs/year). Use tbe following pageto provide a narrative description and process flow schematic ofon-site activities, and include information that gives anunderstanding ofthe nature and extent ofpotential 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, ifapplicable. Thenarrative should provide insight into why and how releases are caused by the process. The schematic should show the points ofrelease ofthe 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 ofeach individual process.Narrative Description and Process Flow Schematic:

No manufacturing activity.IV. SITE RELEASE AND TRANSFER INFORMATION (For manufacturing and on-site processing/use ifapplicable)
Intbis section, estimate the total media-specific releases after on-site treatment ofthe chemical from your facility. You may estimate the releases byusing monitoring data or any other method you believe appropriate. Estimates shouldbe reported in kgs per year for the reporting period. Enter the values as whole numbers to no more than two significant figures. For example, ifyour annual releases are estimatedto be 12,360 kgs, an estimate of 12,000 kgs should be reported. Estimatethe number ofdays per year the release occurs. Enter a whole number with a maximum of2 significant figures. Insert "NA" for release activities not associated withthe chemical or "0" for releases of less than 0.5 kgs peryear.

For all releases, the source ofdata and/or basis for determination should be described in detail. Suggested information about tbe possible sources/basis includes:
1. Iftbe source/basis is an analytical measurement, then • Describe the method (including analytical standards used, sampling, sample treatment, analysis). • Describethe uncertainties and assumptions made. • Give the Level ofDetection (LOD)/Level ofQuantification (LOQ).
2. Ifthe source/basis is a mass balance, then • Show the mass balance calculation. • Showthat the mass balance closes. • Ifthe mass balance does not close, then report the fraction oftotal feedstock that is not accounted for and the assumptions you made to correct the balance. Describethe uncertainties.
3. Ifthe source/basis is other than measurement or mass balance, then • Describe the method used. For example, ifengineering calculations are used, give a general description and state your assumptions. Describethe uncertainties.Part IV (cont.) A. ON-SITE AIRRELEASES Estimate the total fugitive or non-point releases to air and the number ofdays 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, orother confmed air streams as stack or point source releases. Include storage tank emissions and releases from pollution control equipment. Ifdesired, you can provide estimates ofthe accuracies ofyour 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 ofSection IV.) No manufacturing activity.

Comments: #Days/year Release Occurs 0 0

(This section is available to clarify your responses. Attach additional pages ifdesired.)Part N (cont.) B. WATERRELEASES FROM SITE Estimate the total releases ofthe chemical leaving the fence line ofyour facility from all discharge points to all streams or water bodies. Include all discharges from process outfalls such as pipes, opentrenches, releases from on-site wastewater treatment, and contribution from storm water runoff, ifapplicable. Do not include discharges to a POTWor other off-site wastewater treatment facilities. Ifdesired, you can provide an estimate ofthe accuracy ofyour release estimate.

Water releases: Estimated Total Annual Releases (kgs)
0 Estimated% Accuracy (Optional) #Days/year Release Occurs

Enter the names ofthe streams or waterbodies to which the facility directly discharges the chemical. Also, enter the NPDES permit number for the facility. Ifmore than one number is assigned to the facility, list each number for the appropriate discharge quantity and receiving water identified. Receiving WaterName(s):
____ _ NPDES number(s):.
_____ _

Basis for each release estimate: (See discussion on source/basis in beginning ofSection N.) No manufacturing activity.

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)Part IV (cont.) C. ON-SITE LANDRELEASES Estimate the total releases ofthe 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 oftotallandfill release. Releases to landtreatment/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 ofearthen materials designed to hold an accumulation ofthe chemical. Underground injection is the technology ofplacing fluids underground, in porous formations ofrocks, through wells or other similar conveyance systems. Other releases include any amount ofthe chemical that is releasedto land other than those listed. An example is the accidental release ofthe 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 ofSection IV.)
Comments: Estimated% Accuracy (Optional)

(This section is available to clarify your responses. Attach additional pages ifdesired.)Part IV (cont.) D. OFF-SITE TRANSFERS
Estimates ofoff-site transfers should be similar in accuracy and precision to previous release estimates.

Dl. Transfer to Publicly Owned Treatment Works (POTW)
Number ofdays/year the release occurs:

## _o_ Estimate the total quantity ofthe subject chemical, not the waste stream, transferred to the POTW. Complete section below for each POTWto which your facility discharges wastewater containing the chemical. Enter the POTW'sNPDES permit number, ifknown.
Annual Transfer (kgs): 0

-- Estimated%Accuracy ofTransfer Estimate (optional)
__ POTWName:
__________ _ Street Address: -----------==----------- City:______ County:
_____ _ State: Zip Code:
__ NPDES number:
_________ _

Basis for each release estimate: (See discussion on source/basis in beginning ofSection IV.) No manufacturing activity.

Comments: (This section is available to clarify your responses. Attach additional pages ifdesired.)

Part IV (cont.)D2. Transfers to other off-site locations In this section, estimate the quantity ofthe subject chemical, notthe waste stream, transferred and the accuracy ofthe estimate for each category listed. Ifyour facility sends the subject chemical in waste to an off-site location where some ofthe chemical will be recycled and the remainder will betreated, estimate each amount separately (i.e., waste treatment and recycling activities).

Incineration Wastewater Treatment (Excluding POTW) Underground Injection Hazardous Waste (RCRA Subtitle C) Landfill OtherLandfill Recycle orRecovery (Does not include internallyrecycled) 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 inbeginning ofSection IV.)

Comments: Estimated% accuracy (Optional)

(This section is available to clarify your responses. Attach additional pages ifdesired.) 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 whichyou are submitting information: Productname: Fluorinated Surfactant( monomeric) Product description (including concentrations ofperfluoroalkyl chemicals identified in SectionIVbelow and year ofproduction): 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 ofthe facility submitting information: Company name: AGC SEIMI CHEMICAL CO.,LTD Site location:3-2-lO,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan :2276-2,Nada,Hirai,Kashima Citv.Ibaraki,314-0012 Japan Identify a company teclmical contactwho canrespond to inquiries about the information submitted: Technical contact: Shunji Odaka Phone: +81-467-82-4398 Address: 3-2-1O,Chigasaki,Chigasaki Citv,Kanagawa,253-8585 Japan


### III. PRODUCTION Calendar year for whichyou are reporting: Jan I, 2014 to Dec 31, 2014 (Data reported in the report are equal to data based onyear end run rate.)
Provide the amount ofthe 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) ofvarious perfluoroalkyl chemicals in your product. For chemicals for whichyou do nothave actual data, please provide range estimates. No manufacturing activity.

B. ANALYTICAL METHODS Analyses should be conductedusing the most accurate instrumentation and procedures available as ofthe time oftesting. Please provide detailed information onthe 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: Productname: Fluorinated Surfactant(oligomeric) Product description (including concentrations ofperfluoroalkyl chemicals identified in Section IV below and year ofproduction): 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 ofthe facility submitting information: Companyname: 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 contactwho canrespond 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 Calendaryear for which you are reporting: Jan 1, 2014 to Dec 31, 2014 (Data reported in the report are equal to databased onyear end run 

### rate.)
Provide the amount ofthe 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) ofvarious perfluoroalkyl chemicals in your product. For chemicals for which you do nothave actual data, please provide range estimates.
No manufacturing activity.

B. 

### ANALYTICAL METHODS Analyses should be conducted using the most accurate instrumentation andprocedures available as ofthe time oftesting. Please provide detailed information onthe methods used (including analytical standards used, sampling, sample treatment, analysis), assumptions made, uncertainties and detection limits (LOD, LOQ) for the dataprovided.



# 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 ofperfluoroalkyl chemicals identified in Section IV below and year ofproduction):



### II. COMPANY IDENTIFICATION Identify the company and location ofthe 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 (Datareported in the report are equal to data based on year end run rate.) Provide the amount ofthe 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) ofvarious perfluoroalkyl chemicals in your product. For chemicals for whichyou 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 ofthe time oftesting. 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.