U.S. ENVIRONMENTAL PROTECTION AGENCY 

EPA PREMANUFACTURE 

NOTICE 

OPPT rBlC 

01 DEC -4 PH 3:05 

FOR NEW CHEMICAL SUBSTANCES 

DOCUMENT CONTROL OFFICER 

OFFICE OF POLLUTiv1-l PREVENTION 

AND TOXIC SUBSTANCES, 7407 

U.S. E.P.A. 401 M STREET, SW 

W D.C. 

Company Sanitized 

You must provide all information requested in this form to the extent that it is known to or reasonably ascertainable by you. Make reasonable estimates if you do 

not have actual data. 

Before you complete this form, you should read the "Instructions Manual for Premanufacture Notification" (the Instructions Manual is available from the Toxic 

Substances Control Act (TSCA) Information Service by calling 202-554-1404, or faxing 202-554-5603). 

If a user fee has been remitted for this notice (40 CFR 700.45), indicate in the boxes above the TS-user fee identification number you have generated. Remember, 

your user fee ID number must also appear on your corresponding fee remittance, which is sent to EPA, HQ Accounting Operations Branch (PM-226), P.O. 

360399M, Pittsburgh, PA 15251-6399, Attn. TSCA User fee. 

Part I-GENERAL INFORMATION 

You must provide the currently correct Chemical Abstracts (CA) Name of the new 

chemical substance, even if you claim the identity as confidential. You may authorize 

another person to submit chemical identity information for you, but your submission will 

not he complete and the review will not begin until EPA receives this information. A 

letter in support of your submission should reference your TS user fee identification 

number. You must submit an original and two copies of this notice including all test data. 

If you claimed any information as confidential, a single sanitized copy must also he 

submitted. 

Part II- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

If there are several manufacture, processing, or use operations to he described in Part II, 

sections A and B of this notice, reproduce the sections as needed. 

Part III- LIST OF ATTACHMENTS 

Attach additional sheets if there is not enough space to answer a question fully. Label 

each continuation sheet with the corresponding section heading. In Part III, list these 

attachments, any test data or other data and any optional information included in the 

notice. 

OPTIONAL INFORMATION 

You may include any information that you want EPA to consider in evaluating the new 

substance. On page II of this form, space has been provided for you to described 

pollution prevention and recycling information you may have regarding the new 

substance. 

So-called "binding" boxes are included throughout this form for you to indicate your 

willingness to be bound to certain statements you make in this section, such as use, 

production volume, protective equipment ... Tills option is intended to reduce delays 

that routinely accompany the development of consent orders or Significant New Use 

Rules. Except in the case of exemption applications (such as TMEA, L VE, LOREX) 

where certain information provided in such notification is binding on the submitter when 

the Agency approves the exemption application, checking a binding box in this notice 

does not by itself prohibit the submitter from later deviating from the information (except 

chemical identity) reported in the form 

CONFIDENTIALITY CLAIMS 

You may claim any information in this notice as confidential. To assert a claim on the 

form, mark (X) the confidential box n~ .. , to the information that you cmim as 

confidential. To assert a claim in an attachment, circle or bracket the information you 

claim as confidential. If you claim information in the notices as confidential you must 

also provide a sanitized version of the notice (including attachments). For additional 

instructions on claiming information as confidential, read the Instructions Manual. 

Mark (x) if any information in this notice is claimed as confidential. 

TEST DATA AND OTHER DATA 

You are required to submit all test data in your possession or control and to provide 

a description of all other data known to or reasonably ascertainable by you, if these 

data are related to the health and environmental effects on the manufacture, 

processing, distribution in commerce, use, or disposal of the new chemical 

substance. Standard literature citations may be submitted for data in the open 

scientific literature. Complete test data (written in English). not summaries of data. 

must be submitted if they do not appear in the ooen literature. You should clearly 

identify whether test data is on the substance or on an analog. Also, the chemical 

composition of the tested material should be characterized. Following are 

examples of test data and other data. Data should be submitted according to the 

requirements of §720.50 of the Premanufacture Notification Rule (40 CFR Part 

720). 

Test Data (Check Below any included in this notice) 

Environmental fate data D Yes . Other data D Yes 

Health effects data D Yes Risk assessments 

Environmental effects data D Yes Structure/activity relationships 

PhysicaUChemical Properties* D Yes Test data not in the possession 

or control of the submitter 

A physical and chemical properties worksheet is located on the last page of this form. 

TYPE OF NOTICE (Check Only One) 

[8J PMN (Pre manufacture Notice) 

D 

D 

D 

D 

D 

D 

INTERMEDIATE PMN (submitted in sequence with final pi'IJ{Iuct PMN') '. . \ 

SNUN (Significant New Use Notice) 

TMEA (Test Marketing Exemption Application) 

LYE (Low Volume Exemption)@ 40 CFR 723.50(c)(l) ( .. ] 

LOREX (Low Release/Low Exposure Exemption) @ 40 CFR n§~~c)(2) 

L VE Modification 

IS THIS A CONSOLIDATED PMN? 

# of chemicals 

D 

D 

LOREX Modification 

Yes 

(Prenotice Communication# required, enter# on page 3) 

5"30 3.] 
Public reporting burden for this collection of information is estimated to average 110 hours per response, including time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of 

information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for 

reducing this burden, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M. St., S.W., Washington, D.C. 

20460; and to the Office of Management and Budget, Paperwork Reduction Act (2070-0012), Washington, D.C. 20503. 

CERTIFICATION 

I certify that to the best of my knowledge and belief: 

1. The company named in Part I, section A, subsection 1 a of this notice form intends to manufacture or import for a 

commercial purpose, other than in small quantities solely for research and development, the substance identified in Part I, 

Section B. 

2. All information provided in this notice is complete and truthful as of the date of submission. 

3. I am submitting with this notice all test data in my possession or control and a description of all other data known to or 

reasonably ascertainable by me as required by §720.50 of the Premanufacture Notification Rule. 

Additional Certification Statements: 

If you are submitting a PMN, Intermediate PMN, Consolidated PMN, or SNUN, check the following user fee certification 

statement that applies: 

~ The Company named in Part I, Section A has remitted the fee of $2500 specified in 40 CFR 700.45(b), or 

D The Company named in Part I, Section A has remitted the fee of $1000 for an Intermediate PMN (defined @ 40 CFR 

700.43) in accordance with 40 CFR 700.45(b), or 

D The Company named in Part I Section A is a small business concern under 40 CFR 700.43 and has remitted a fee of $100 

in accordance with 40 CFR 700.45(b). 

If you are submitting a low volume exemption (L VE) application in accordance with 40 CFR 723 .50( c)( 1) or a Low release 

and low exposure exemption (LoRex) application in accordance with 40 CFR 723.50(c)(2), check the following certification 

statements: 

D The manufacturer submitting this notice intends to manufacture or import the new chemical substance for commercial 

purposes, other than in small quantities solely for research and development, under the terms of 40 CFR 723.50. 

D The manufacturer is familiar with the terms of this section and will comply with those terms; and 

D The new chemical substance for which the notice is submitted meets all applicable exemption conditions. 

D If this application is for an LVE in accordance with 40 CFR 723.50(c)(1), the manufacturer intends to commence 

manufacture of the exempted substance for commercial purposes within 1 year of the date of the expiration of the 30 day 

review period. 

The accuracy of the statements you make in this notice should renect your best prediction of the anticipated facts regarding the chemical substance 

described herei11. Any knowin2 and willful misinterpretation is subject to criminal penalty pursuant to 18 USC 1001. 

Signature and title of Authorized Official (Original Signature Required) Date 

Signature of agent -(if applicable) Date 

EPA FORM 7710-25 (Rev. 5-95) Page 2 

Confidential 

X 
Ia. Person 

Submitting 

Notice (in U.S.) 

b. Agent (if 

applicable) 

Company 

Mailing address (number and street) 

City, State, ZIP Code 

Name 

Company 

Mailing address (number and street) 

City, State, ZIP Code Telephone Area Code 

c. If you are submitting this notice as part of a joint submission, mark (X) this box. ----------------------~ 

Joint Submitter (if 

applicable) 

Name of authorized official 

2. 

4. 

5. 

6. 

Contact (in 

U.S.) 

Company 

address (number and street) 

City, State, ZIP Code 

Name of 

Company 

Mailing address (number and street) 

City, tate, ZIP Code 

you a prenotice (PC) this notice 

and EPA assigned a PC Number to the notice, enter the number. 

If you submitted an exemption application for the chemical 

substance covered by this notice, enter the exemption number assigned by 

EPA. If you previously submitted a PMN for this substance enter the 

PMN number assigned by EPA (i.e. withdrawn or incomplete). ~ 

If you have submitted a Bona fide intent to manufacture or import 

for the chemical substance covered by this notice, enter the notice number 

assigned by EPA. 

I. 

Type of Notice - Mark (X) 

D 

Manufacture 

Only 

Binding Option 

Mark 

EPA FORM 7710-25 (Rev. 5-95) 

Position 

Telephone 

Position 

Telephone 

2. 

D 

Page 3 

Import 

Only 

Mark (X) 

if none 

Mark (X) 

if none 

Mark (X) 

if none 

Binding Option 

Mark 

3. Both 

Confidential 

X 
Section B --

If another person will submit chemical identity information for you (for either Item 1 or 2), mark (X) the box at the right. 

the and address of that in a continuation sheet. 

I. Class I or 2 chemical substances (for definitions of class I and class 2 substances, see the Instructions Manual) 

a. Class of substance - Mark (X) D Class I or 2 D Class 2 

b. Chemical name (Currently correct Chemical Abstracts (CA) Name that is consistent with TSCA Inventory listings for similar substances. 

For Class I substances a CA Index Name must be provided. For Class 2 substances either a CA Index Name orCA Preferred Name must 

be provided, which ever is appropriate based on CA 9CI nomenclature rules and conventions). 

c. Please identify which method you used to develop or obtain the specified chemical identity information reported notice: (check one). 

D Method I (CAS Inventory Expert Service- a copy of the Identification D Method 2 (Other Source) 

report obtained from the CAS Inventory Expert Services must be 

1--------.::.SU:::b::::nu=·tt.::e::::d:...:a::::s...::.a" attachment to this 

d. Molecular formula and CAS Registry Number (if a number already exists for the substance) 

CAS# 

e. For a class I substance, provide a complete and correct structure diagram. For a class 2 substance - (I) List the immediate 

precursor substances with their respective CAS Registry Numbers. (2) Describe the nature of the reaction or process. (3) Indicate the 

range of composition and the typical composition (where appropriate). (4) Provide a correct representative or partial chemical structure 

dia~rram. as comnlete as can he known. if one can he reasonahlv ascertained. 

****This page intentionally left blank.**** 

this box if you attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page4 

Confidential 
a. Indicate the number-average weight of the lowest molecular weight composition of the polymer you intend to manufacture. 

Indicate maximum weight percent of low molecular weight species (not including residual monomers, reactants, or solvents) below 500 and 

below 1,000 absolute molecular weight of that composition. 

Describe the methods of measurement or the basis for your estimates: GPC 0 Other 0: (Specify) 

i) lowest number average molecular weight: 

ii) maximum weight % below 500 molecular weight: 

iii) maximum weight % below 1000 molecular weight: 

attach a continuation sheet. 

X 

You must make separate confidentiality claims for monomer or other reactant identity, composition information, and information. Mark (X) the 

"Confidential" box next to any item you claim as confidential 

(I) Provide the specific chemical name and CAS Registry Number (if a number exists) of each monomer or other reactant used in the manufacture of 

the polymer. 

(2) Mark (X) this column if entry in column (I) is confidential. 

(3) Indicate the typical weight percent of each monomer or other reactant in the polymer. 

(4) Mark (X) the identity column if you want a monomer or other reactant used at two weight percent or less to be listed as part of the polymer 

description on the TSCA Chemical Substance Inventory. 

(5) Mark (X) this column if entries in columns (3) and (4) are confidential. 

(6) Indicate the maximum weight percent of each monomer or other reactant that may be present as a residual in the polymer as manufactured for 

commercial purposes. 

Mark · column if · confidential. 

Conti- Typical 

% 

X % X 

X % X 

% 

% 

% 

% 

c. Please identify which method you used to develop or obtain the specified chemical identity information reported in this notice (check one). 

0 Method I (CAS Inventory Expert Service- a copy of the identification report 0 Method 2 (other source) 

obtained from CAS Inventory Expert Service must be submitted as 

as attachment to this 

d. The currently correct Chemical Abstracts (CA) name for the polymer that is consistent with TSCA Inventory listings for similar polymers. 

e. Provide a correct representative or partial chemical structure diagram, as complete as can be known, if one can be reasonably ascertained. 

attach a continutation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 5 

Conti-

% 

% X 

% X 

% 

% 

% 

% 
Part I -- GENERAL INFORMATION -- Continued 

Section B -- c rFMI 'A. U~N L\TION --

3. Impurities 

(a) - Identify each impurity that may be reasonably anticipated to be present in the chemical substance as manufactured for commercial purpose. Provide the 

CAS Registry Number if available. If there are unidentified impurities, enter "unidentified." 

(b) - Estimate the maximum weight % of each impurity. [f there are unidentified ;lllpu,;u.:o>, estimate their total weight %. 

Impurity and CAS Registry Number Maximum Contipercent dential 

(a) (b) 

% X 

% 

% 

% 

% 

% 

% 

[ ] Mark (X) this box if you attach a .sheet. 

4. Synonyms - Enter any chemical synonyms for the new chemical identified in subsection I or 2. Contidential 

X 

D Mark (X) this box if you attach a continuation sheet. 

5. Trade identification - List trade names for the new chemical substance identified in subsection I or 2. 

X 

D Mark (X) this box if you attach a continuation sheet. 

6. Generic chemical name - If you claim chemical identify as confidential, you must provide a generic name for your substance that reveals 

the specific chemical identity of the new chemical substance to the maximum extent possible. Refer to the 

TSCA Chemical Substance Inventory, 1985 Edition, Appendix B for guidance on developing generic names. 

Polyalkyleneamine 

D Mark (X) this box if _2'(lll_ attach a continuation sheet. 

7. Byproducts - Describe any byproducts resulting from the mannfa,tnrP processing, use, or disposal of the new chemical substance. Provide the CAS Registry 

Number if available. 

uyp(O'U'-1 CAS Registry Number Conti-

(2) dential 

X 

l J Mark (X) this box if you attach a ;,.,n~et. 

EPA FORM 7710-25 (Rev. 5-95) Page 6 
Part I -- GENERAL INFORMATION -- Continued 

Section C --PRODUCTION, IMPORT, AND USE INFORMATION: 

Mark (X) the "Confidential" box next to any item you claim as confidential. 

1. Production volume·· Estimate the maximum production volume during the first 12 months of production. Also estimate the maximum 

production volume for any consecutive 12-month period during the first three years of production. Estimates should be on 100% new chemical 

substance basis. For a Low Volume Exemption application, if you choose to have your notice reviewed at a lower production volume than 

10,000 kg/yr, specify the volume and mark (x) in the binding box. If granted, you are bound to this volume 

Maximum first 12-month production (kg/yr) Maximum 12-month production (kg/yr) Confi- Binding 

(100% new chemical substance basis) (100% new chemical substance basis) dential Option 

Mark (x) 

X 

2. Use Information •• You must make separate confidentiality claims for the description of the category of use, the percent of production volume 

devoted to each category, the formulation of the new substance, and other use information. Mark (X) the "Confidential" Box next to any item 

you claim as confidential. 

a. (I) -- Describe each intended category of use of the new chemical substance by function and application .. 

(2) -- Mark (X) this column if entry column (I) is confidential business information (CBI). 

(3) -- Indicate your willingness to have the information provided in column (I) binding. 

(4) -- Estimate the percent of total production for the first three years devoted to each category of use. 

(5) -- Mark (X) this column if entry in column (4) is confidential business information (CBI). 

(6) -- Estimate the percent of the new substance as formulated in mixtures, suspensions, emulsions, solutions, or gels as manufactured for 

commercial purposes at sites under your control associated with each category of use. 

(7) -- Mark (X) this column if entry in column (6) is confidential business information (CBI). 

(8) -- Indicate % of product volume expected for the listed "use" sectors. Mark more than one box if appropriate. Mark (X) to indicate 

your willingness to have the use type provided in (8) binding. 

(9) -- Mark (X) this column if entrv(ies) in column (8) is (are) confidential business information (CBI). 

Category of use (I) CBI Binding Produc- CBI %in CBI % of substance expected per use CBI 

Option tion% Form- (8) 

(by function and application i.e. a dispersive dye Mark (x) ulation Site- Con-* Indus- Com- Binding 

for finishing polyester fibers) (2) (3) (4) (5) (6) (7) limited sumer trial mercia! Option (9) 

X X X X X 

% % 

X X X X X 

% % 

% % 

% % 

% % 

% % 

% % 

* If you have identified a "consumer" use, please provide on a continuation sheet a detailed description of the use(s) of this chemical substance in consumer products. 

In addition include estimates of the concentration of the new chemical substance as expected in consumer products and describe the chemical reactions by which this 

substance loses its identity in the consumer product. 

0Mark (X) this box if you attach a continuation sheet. 

b. Generic If you claim any category of use description in subsection 2a as confidential, enter a generic description of that category. Read the 

use Instructions Manual for examples of generic use descriptions. 

description Emulsifier 

0 Mark (X) this box if you attach a continuation sheet. 

3. Hazard Information·· Include in the notice a copy of reasonable facsimile of any hazard warning statement, label, material safety data sheet, or other Binding 

information which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective equipment or practices Option 

for the safe handing, transport, use, or disposal of the new substance. List in part III hazard information you include. Mark (x) 

C8J Mark (X) this box if you attach hazard information. 

EPA FORM 7710-25 (Rev. 5-95) Page 7 
Part 11-- AND ENVIRONMENTAL RELEASE 

Section A -- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER Mark (X) the "Confidential" box next to any item you 

claim as confidential 

Complete section A for each type of manufacture, processing, or use operation involving the new chemical substance at industrial sites you 

control. Importers do not have to complete this section for operations outside the U.S.; however, you may still have reporting requirements if 

there are further industrial after · You must describe these See instructions manual 

l. 

Site address (number and street) 

City, County, State, ZIP code 

If the same operation will occur at more than one site, enter the number of sites. Identify the 

additional sites on a continuation sheet, and if any of the sites have significantly different 

production rates or operations. include all the information requested in this section for those 

sites as attachments. 

b. 

I. Batch 

2. Continuous 

substance) 

Maximum kg/batch (100% new chemical Hours/batch 

substance) 

Use 

Batches/year 

Batches/year 

Confidential 

X 

X 

X 

d. Process description Mark (X) to indicate your willingness to have your process description binding. 

(I) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport containers (specify- e.g. 5 gallon pails, 55 gallon 

drum, rail car, tank truck, etc.). 

(2) Provide the identity, the approximate weight (by kg/day or kg/batch on a 100% new chemical substance basis), and entry point of all starting materials and 

feedstocks (including reactants, solvents, catalysts, etc.), and of all products, recycle streams, and wastes. Include cleaning chemicals (note frequency if not 

used daily or per batch.). 

(3) Identify by number the points of release, including small or intermittent releases, to the environment of the new chemical substance. 

Mark (X) this box if attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 8 
Part 11-- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE-- Continued 

Section A -- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER -- Continued 

2. Occupational Exposure-- You must make separate confidentiality claims for the description of worker activity, physical form of the new chemical substance, 

number of works exposed, and duration of activity. Mark (X) the "Confidential" box next to any item you claim as confidential. 

(I)-- Describe the activities (i.e. bag dumping, tote filling, unloading drums, sampling, cleaning, etc.) in which workers may be exposed to the substance. 

(2) --Mark (X) this column if entry in column (I) is confidential business information (CBI). 

(3) --Describe any protective eauipment and engineering controls used to protect workers. 

(4) and (6) --Indicate your willingness to have the information provided in column (3) or (5) binding. 

(5) --Indicate the physical form(s) of the new chemical substance (e.g., solid: crystal, granule, powder, or dust) and% new chemical substance (if part of a mixture) 

at the time of exposure. 

(7) --Mark (X) this column if entry in column (5) is confidential business information (CBI). 

(8) --Estimate the maximum number of workers involved in each activity for all sites combined. 

(9) --Mark (X) this column if entry in column (8) is confidential business information (CBI). 

(10) and (II)-- Estimate the maximum duration of the activity for any worker in hours per day and days per year. 

(12) -- Mark (X) this column if entries in columns (I 0) and (II) are confidential business information (CBI). 

Worker activity CBI Protective Equipment! Binding Physical forms(s) Binding CBI #of CBI Maximu duration CBI 

m 

(i.e., bag dumping, filling drums) Engineering Controls Option and %new Option Worker Hrs/day Days/yr Mark (•) substance Mark (x) s 

(1) (2) (3) (4) (5) (6) (7) Expose (9) (10) (11) (12) 

d 

(8) 

X X X X 

X X X X 

D Mark (X) this box if you attach a continuation sheet. 

3. Environmental Release and Disposal -- You must make separate confidentiality claims for the release number and the amount of the new chemical substance 

released and other release and rusposal information. Mark (X) the "Confidential" box next to each item you claim as confidential. 

(I) --Enter the number of each release point identified in the process description, part II, section A, subsection ld(3). 

(2) --Estimate the amount of the new substance released (a) directly to the environment or (b) into control technology (in kg/day or kg/batch). 

(3) --Mark (X) this column if entries in columns (I) and (2) are confidential business information (CBI). 

(4) --Identify the media (stack air, fugitive air (optional-see Instruction Manual), surface water, on-site or off-site land or incineration, POTW, or other (specify)) to 

which the new substance will be released from that release point. 

(5) --a. Describe control technology, if any, and control efficiency that will be used to limit the release of the new substance to the environment. For releases 

disposed of on land, characterize the disposal method and state whether it is approved for disposal of RCRA hazardous waste. On a continuation sheet, for 

each site describe any additional disposal methods that will be used and whether the waste is subject to secondary or tertiary on-site treatment. b. Estimate 

the amount released to the environment after control technology (in kg/day). 

(6) --Mark (X) this column if entries in columns (4) and (5) are confidential business information (CBI). 

(7) --Identify the destination(s) of releases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct discharges or 

NPDES numbers of the POTW (Publici Owned Treatment Works). Mark (X) if the POTW name or NPDES #is confidential business information (CBI). 

Release Amount of new substance CBI Media of Control technology and efficiency (you may wish to optionally attach efficiency data) CBI 

Number released release 

(I) (2a) (2b) e.g stack ru.r Binding 

(3) (4) (Sa) Mark(X) (5b) (6) 

1 X X 

2 X X 

3 X X 

(7) Mark (X) the D POTW provide name(s) below: CBI D Navigable D Other - Specify provide NPDES # CBI 

1--- destination(s) of waterway 

releases to water. 

D Mark (X) this box if you attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 9 
Part 11-- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE-- Continued 

Section B -- INDUSTRIAL SITES CONTROLLED BY OTHERS 

Complete section B for typical processing or use operations involving the new chemical substance at sites you do not control. Importers do not have to complete this 

section for operations outside the U.S.; however, you must report any processing or use activities after import. See the Instructions Manual. Complete a separate 

section B for each type of processing, or use operation involving the new chemical substance. If the same operation is performed at more than one site describe the 

typical operation common to these sites. Identify additional sites on a continuation sheet. 

1. Operation Description -- To claim information in this section as confidential, circle or bracket the specific information that you claim as confidential. 

(I)-- Diagram the major unit operation steps and chemical conversions, including interim storage and transport containers (specify- e.g. 5 gallon pails, 55 gallon 

drums, rail cars, tank trucks, etc). On the diagram, identify by letter and briefly describe each worker activity. (2) --Provide the identity, the approximate weight 

(by kg/day or kg/batch, on an 100% new chemical substance basis), and entry point of all feedstocks (including reactants, solvents and catalysts, etc) and all 

products, recycle streams, and wastes. Include cleaning chemicals (note frequency if not used daily or per batch). (3) -- Identify by number the points of release, 

including small or intermittent releases, to the environment of the new chemical substance. ( 4) Please enter the# of sites (remember to identify the locations of 

these sites on a continuation sheet): 

[#ofsites l 

...._ 

' 7 

/ 

- -

D Mark (X) this box if you attach a continuation sheet. 

2. Worker Exposure/Environmental Release 

(I)-- From the diagram above, provide the letter for each worker activity. Complete 2-8 for each worker activity described. 

(2) --Estimate the number of workers exposed for all sites combined. 

(4) --Estimate the typical duration of exposure per worker in (a) hours per day and (b) days per year. 

(6) --Describe physical form of exposure and% new chemical substance (if in mixture), and any protective equipment and engineering controls, if any, used to 

protect workers. 

(7) -- Estimate the percent of the new substance as formulated when packaged or used as a final product. 

(9) --From the process diagram above, enter the number of each release point. Complete 9-13 for each release point identified. 

(10) --Estimate the amount of the new substance released (a) directly to the environment or (b) into control technology to the environment (in kg/day or kg/batch). 

(12) --Describe media of release i.e. stack air, fugitive air (optional-see Instructions Manual), surface water, on-site or off-site land or incineration, POTW, or other 

(specify) and control teclnnJlogy, if any, that will be used to limit the release of the new substance to the environment. 

(14) --Identify byproducts which may result from the operation. 

(3), (5), (8), (11), (13) and (15) --Mark (X) this column if anv of the proceeding entries are confidential business information (CBI). 

Letter #of CBI Duration CBI Protective Equip./ %in CBI Release Amount of CBI Media of Release CBI 

of Workers of Engineering Controls/ Form- Number New & Control 

Act- Exposed Exposure Physical Form and % ulation Substance Technology 

ivity new substance Released 

(I) (2) (3) (4a) (4b) (5) (6) (7) (8) (9) (lOa) (lOb) (II) (12) (13) 

14) -- Byproducts: (15) 

D Mark (X) this box if you attach a continuation sheet, 

EPA FORM 7710-25 (Rev. 5-95) Page 10 
OPTIONAL POLLUTION PREVENTION INFORMATION 

To claim information in this section as confidential circle or bracket the specific information that you claim as confidential. 

In this section you may provide information not reported elsewhere in this form regarding your efforts to reduce 

or minimize potential ri"ks associated witr activities surrounding manufacturing, processing, use and disposal 

of the PMN substance. Please include new information pertinent to pollution prevention, including source 

reduction, recycling activities and safer processes or products available due to the new chemical substance. 

Source reduction includes the reduction in the amount or toxicity of chemical wastes by technological 

modification, process and procedure modification, product reformulation, raw materials substitution, and/or 

inventory control. Recycling refers to the reclamation of useful chemical components from wastes that would 

otherwise be treated or released as air emissions or water discharges, or land disposal. Descriptions of pollution 

prevention, source reduction and recycling should emphasize potential risk reduction subsequent to compliance 

with existing regulatory requirements and can be either quantitative or qualitative. The EPA is interested in the 

information to assess overall net reductions in toxicity or environmental releases and exposures, not the shifting 

of risks to other environmental media or non-environmental areas (e.g., occupational or consumer exposure). In 

addition, information on the relative cost or performance characteristics of the PMN substance to potential 

alternatives may be provided. 

All information provided in this section will be taken into consideration during the review of this 

substance. See Instructions Manual and Pollution Prevention Guidance manual for guidance and 

examples. 

Describe the expected net benefits, such as (1) an overall reduction in risk to human health or the environment; (2) a reduction in the 

volume manufactured; (3) a reduction in the generation of waste materials through recycling, source reduction or other means; (4) a 

reduction in potential toxicity or human exposure and/or environmental release; (5) an increase in product performance, a decrease in 

the cost of production and/or improved operation efficiency of the new chemical substance in comparison to existing chemical 

substances used in similar application; or (6) the extent to which the new chemical substance may be a substitute for an existing 

substance that poses a greater overall risk to human health or the environment. 

J } Mark (X) this box if you attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 11 
Part III-- LIST OF ATTACHMENTS 

Attach continuation sheets for sections of the form and test data and other data (including physical/chemical properties and 

structure/activity information), and optional information after this page. Clearly identify the attachment and the section of the form to 

which it relates, if appropriate. Number consecutively the pages of the attachments. In the column below, enter the inclusive page 

numbers of each attachment. 

Mark (X) the "Confidential" box next to any attachment name you claim as confidential. Read the Instructions Manual for guidance on 

how to claim any information in an attachment as confidential. You must include with the sanitized copy of the notice form a sanitized 

version of any attachment in which you claim information as confidential. 

Attachment name Attachment Contioage number(s) dential 

14-19 

Material Safetv Data Sheet <MSDS) 

2. General Comments 20 X 

3. Inventory Expert Servir1s Report 21 X 

4. Manufacturing Location 23 X 

5. Gel Permeation Chromatography 24-29 X 

6. UV Spectrum 30-32 X 

7. Infrared Spectrum 33-35 X 

8. NMR Analyses 36-39 X 

9. Confidentiality Statement 40-49 X 

D Mark (X) this box if you attach a continuation sheet. Enter the attachment name and number. 

EPA FORM 7710-25 (Rev. 5-95) Page 12 
PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET 

To assist EPA's review of physical and chemical properties data, please complete the following worksheet for data you provide and 

include it in the notice. Identify the property measured, the page of the notice on which the property appears, the value of the property, 

the units in which the property is measured (as necessary), and whether or not the property is claimed as confidential. The physical 

state of the neat subst 1ce should be provided. T.:ese measured properties should be for the neat (100% pure) chemical substance. 

Properties that are measured for mixtures or formulations should be so noted(% PMN substance in_). You are not required to 

submit this worksheet; however, EPA strongly recommends that you do so, as it will simplify review and ensure that confidential 

information is properly protected. You should submit this worksheet as a supplement to your submission of test data. This worksheet 

is not a substitute for submission of test data. 

Property Mark Page Value ~easured o Contidential (X) if 

(a) provided 

Physical state of neat substance 

Vapor pressure 

@Temperature oc 

Density/relative density 

Solubility 

@ Temperature oc 

Solvent 

Solubility in water @ Temperature 25 oc 

Melting temperature 

Boiling I sublimation temperature@ torr pressure 

Spectra X 

Dissociation constant 

Particle size distribution 

Octanol I water partition coefficient 

Hemy's Law constant 

Volitalization from water 

Volitalization from soil 

pH@ concentration 

Flammability 

Explodability 

Adsorption I coeffic .. ;nt 

Other - Specify 

number 

(b) (c) 

(s) X (I) (g) 

Torr 

0.9 g/cm3 

g/l 

Insoluble giL 

oc 

oc 

30-39 UV, IR and NMR spectra 

Estimate Mark (X) 

(MorE) (d) 

M 

E 

E 

M X 

ATTACHMENT 

PAr.!= 1-:l 
Material Safety Data Sheet [ J Page 1 of 6 

Material Safety Data Sheet [ J 

1 Chemical Product and Company Identification 

[ 1 

This material is to be used for research purposes only under the supervision of a technically qualified individual. The 

toxicological properties may have not been completely characterized. To determine your responsibilities under the Toxic 

Substances Control Act (TSCA), please see the R~ulatory Information Section. 

Product Trade Name [ j 

CAS Number Confidential. 

Synonyms Confidential. 

Generic Chemical Name 

Product Type 

Preparation!Revisio:._ Date 

Transportation Emergency Phone 

No. 

Polyolefin amide 

Not applicable. 

06 Nc.1ember 2001 

(CHEMTREC) 1-800-424-9300. 

MSDSNo. 5001530-6922047-9385074 

2 Composition/Information on Ingredients 

Hazardous Ingredients This material has no known hazards under applicable laws. 

!Hazards Identification 

Principal Hazards 

• This material has no known hazards. 

See Section 11 for complete health hazard information. 

I First Aid Measures 

Oral DO NOT INDUCE VOMITING. If conscious, give 2 glasses of water. Get immediate 

medical attention. 

Eyes 

Skin 

Inhalation 

Additional Information 

Flush with water at least 15 minutes. Get medical attention if eye irritation develops or 

persists. 

Wash with soap and water. Get medical attention if irritation develops. Launder 

contaminated clothing before reuse. 

Remove exposed person to fresh air if adverse effects are observed. 

Note to physician: Treat symptomatically. 

Is I Fire Fighting Measures 

http://msds/1941/1941.asp 

I~ 11121101 
Material Safety Data Sheet -L J Page 2 of6 

Flash Point 

Extinguishing Media 

Firefighting Procedures 

Unusual Fire & Explosion 

Hazards 

Spill Procedures 

Loading Temperature 

Maximum Handling 

Temperature 

Handling Procedures 

Maximum Storage 

Temperature 

Storage Procedures 

8 

Ventilation Procedures 

Gloves Procedures 

Eye Protection 

Respiratory Protection 

Clothing Recommendation 

Flash Point 

Upper Flammable Limit 

Lower Flammable Limit 

Autoignition Point 

Explosion Data 

Vapor Pressure 

pH 

Specific Gravity 

Water Solubility 

Percent Volatile 

PercentVOC 

Vapor Density 

Evaporation Rate 

Odor 

> 100 Deg C, 212 Deg F PMCC (Minimum) 

C02, dry chemical, or foam. Water can be used to cool and protect exposed material. 

Recommend wearing self-contained breathing apparatus. Water may cause splattering. 

Material will float on water. 

Toxic fumes, gases or vapors may evolve on burning. 

!Accidental Release Measures 

Personal Protective Equipment must be worn, see Personal Protection Section for PPE 

recommendations. Ventilate area if spilled in confined space or other poorly ventilated areas. 

Prevent entry into sewers and waterways. Pick up free liquid for recycle and/or disposal. 

Residual liquid can be absorbed on inert material. Check under Transportation and Labeling 

(DOT/CERCLA) and Other Regulatory Information Section (SARA) for hazardous 

substances to determine regulatory reporting requirements for spills. 

I Handling a;;d Storage 

Not determined. 

Not determined. 

Keep containers closed when not in use. Wash thoroughly after handling. Empty container 

contains product residue which may exhibit hazards of product. 

Not determined. 

No special storage precautions required. 

Exposure Controls/Personal Protection 

Use with adequate ventilation. 

Use nitrile or neoprene gloves. 

Safety Glasses. 

Under normal use conditions, respirator is not usually required. 

Long sleeve shirt is recommended. 

I Physical and Chemical Properties 

> 100 Deg C, 212 Deg F PMCC (Minimum) 

Not determined. 

Not determined. 

Not determined. 

Material does not have explosive properties. 

Not determined. 

Not determined. 

0.85 (15.6 Deg C) 

Insoluble. 

Unknown. 

Not determined. 

Not determined. 

Not determined. 

Aromatic hydrocarbon 

http://msds/1941/1941.asp ·IS 11/21101 
Material Safety Data Sheet -L J Page 3 of6 

Viscosity 

Odor Threshold 

Boiling Point 

Pour Point Temperature 

Freezing Point 

Molecular Weight 

Octanol!Water Partition 

Coefficient 

lw 

Stability 

Unknown. 

Unknown. 

Not determined. 

Not determined. 

Not determined. 

Not determined. 

Not determined. 

The above data are typical values and do not constitute a specification. 

I Stability and Reactivity 

Material is normally stable at moderately elevated temperatures and pressures. 

Decomposition Temperature Not determined. 

Incompatibility None known, avoid contact with reactive chemicals. 

Polymerization Will not occur. 

Thermal Decomposition Smoke, carbon monoxide, carbon dioxide, aldehydes and other products of incomplete 

combustion. Under combustion conditions, oxides of the following elements will be formed: 

nitrogen. 

In I Toxicological Information 

Oral Toxicity 

Eye Irritation 

Skin Irritation 

Dermal Toxicity 

Inhalation Toxicity 

Respiratory Irritation 

Dermal Sensitization 

Inhalation Sensitization 

Chronic Toxicity 

Carcinogenicity 

Mutagenicity 

Reproductive Toxicitv 

Teratogenicity 

http://msds/1941/1941.asp 

-- ACUTE EXPOSURE--

The LD50 in rats is between 2000 mg/kg and 5000 mg/kg. Based on data from similar 

materials. 

Insufficient data on components and similar materials to determine potential for eye 

irritation. 

Insufficient data on components and similar materials to determine potential for skin 

irritation. 

The LD50 in rabbits is > 2000 mg/Kg. Based on other data or data on similar materials. 

No data available to indicate product or components may be a toxic inhalation hazard. 

No data available to indicate product or components may cause respiratory irritation under 

normal workplace conditions and good industrial hygiene practices. 

No data available to indicate product or components may be a skin sensitizer. 

No data available to indicate product or components may be respiratory sensitizers. 

-- CHRONIC EXPOSURE--

No data available to indicate product or components present at greater than 1% are chronic 

health hazards. 

No data available to indicate any components present at greater than 0.1% may present a 

carcinogenic hazard. 

No data available to indicate product or any components present at greater than 0.1% are 

mutagenic or genotoxic. 

No data available to indicate either product or components present at greater than 0.1% that 

may cause reproductive toxicity. 

No data available to indicate product or any components contained at greater than 0.1% may 

cause birth defects. 

11/21/01 
Material Safety Data Sheet L J Page 4 of6 

Other 

Exposure Limits 

Freshwater Fish Toxicity 

Freshwater Invertebrates 

Toxicity 

Algal Inhibition 

Saltwater Fish Toxicity 

Saltwater Invertebrr ~es 

Toxicity 

Bacteria Toxicity 

Miscellaneous Toxicity 

Biodegradation 

Bioaccumulation 

Soil Mobility 

Waste Disposal 

ICAO/IATA 

IMDG (Ambient) 

IMDG (Elevated) 

IMDGEMS 

IMDGMFAG 

IMO Marine Bulk 

USCG Compatibility 

U.S. DOT Bulk (Ambient) 

U.S. DOT Bulk (Elevated) 

U.S. DOT Non-Bulk 

DOTNAERG 

TDG Bulk (Ambient) 

TDG Bulk (Elevated) 

TDG Non-Bulk 

Mexico 

ADRIRID (Ambient) 

ADRIRID (Elevated) 

ADG (Ambient) 

--ADDITIONAL INFORMATION--

No other health hazards known. 

See Hazardous Ingredients Section for any applicable exposure limits for components. 

I Ecological Information 

--ENVIRONMENTAL TOXICITY--

Not determined. 

Not determined. 

Not determined. 

Not determined. 

Not determi::ed. 

Not determined. 

Not determined. 

--ENVIRONMENTAL FATE--

Not determined. 

Not determined. 

Not determined. 

I Disposal Consideration 

This material, if discarded, is not a hazardous waste under RCRA Regulation 40 CFR 261. 

I Transport Information 

Not regulated. 

Not regulated. 

Not determined. 

Not applicable. 

Not applicable. 

Not determined. 

Not determined. 

Not regulated. 

Not determined. 

Not regulated. 

Not applicable. 

Not regulated. 

Not determined. 

Not regulated. 

Not regulated. 

Not regulated. 

Not determined. 

Not regulated. 

http://msds/1941/1941.asp 1'1 11/21/01 
Material Safety Data Sheet -[ J Page 5 of 6 

ADG (Elevated) Not determined. 

I Regulatory Information 

U.S. TSCA Inventory Requires notification in the U.S. Commercial shipments from[ Ju.S. location must 

be exported :o non U.S. customers only. Research and development quantities must bear 

special labels and shipping papers. Sample recipients must comply with the requirements for 

an R&D exemption under TSCA. 

Other TSCA Reg. None known. 

SARA ExL Haz. Subst. This product does not contain greater than 1.0% of any chemical substance on the SARA 

Extremely Hazardous Substances list. 

SARA Section 313 This product does not contain greater than 1.0% (greater than 0.1% for carcinogenic 

substance) of any chemical substances listed under SARA Section 313. 

TDG Regulated Limits 

CERLA Hazardous 

Substances 

None known. 

None known. 

Cal. Prop. 65 This product does not intentionally contain any chemicals known by the State of California 

to cause cancer and/or birth defects. Moreover,[ }oes not routinely analyze its 

U.S. Fuel Registration 

U.S. Dept of Agriculture 

products for impurities which may be such chemicals. 

Not applicable. 

This product has not been filed with the USDA to support H2 approvals. 

U.S. Tariff Heading Number Not determined. 

Schedule B Number Not determined. 

FDA Approval Not applicable. 

EEC EINECS May require notification under EC Seventh Amendment Directive 92/32/EEC. 

Finnish Registration 

Number 

Sweden Registration 

Number 

Norway Registration 

Number 

Not Registered 

Not Registered 

Not Registered 

Danish Registration Number Not Registered 

Switzerland Bag T Not Registered 

Registration Number 

Japan METI May require notification in Japan. 

Australia 

Canada 

Switzerland 

Korea 

Korean Registration 

Number 

Philippines 

May require notification before sale under Australian regulations. 

May require notification before sale under Canadian regulations. 

May require notification before sale in Switzerland. 

May require notification before sale in Korea. 

Not Registered 

May require notification before sale under Philippines Republic Act 6969. 

China This product may require notification in China. 

China Registration Number Not Registered 

New Zealand Registration Not Registered 

Number 

Malta Registration Limber Not Registe .. !d 

Ukraine Registration Not Registered 

Number 

I other Information 

http:/ /msds/1941/1941.asp 11/21/01 
Material Safety Data Sheet -[ J 

US NFPA Codes 

HMIS Codes 

Precautionary Labels 

Revision Indicators 

Health Fire Reactivity Special 

1 1 0 N/E 

Health Fire Reactivity 

0 

• This material has no known hazards. 

Section: 1 GENERIC/CHEMICAL NAME Changed: 06 November 2001 

Section: 1 PRODUCT TRADE NAME Changed: 06 November 2001 

Page 6 of6 

The information prese~ed herein has been ckpiledfrom sources cojidered to be dependable and is accurate to the best ofr· 

nowledge; however, . makes no warranty whatsoever, expressed or implie;/-of 

MERCHANTABILIT O~ITNESS FOR E P4jlTICULAR PURPOSE, regarding the accuracy of such data or the results to be 

obtained from use thereof J~ssumes no responsibility for injury to recipient or to third persons or for any 

damage to any property a recipient assumes all such risks. 

http://msds/194111941.asp 1'1 11/21101 
Attachment 2 

General Comments 
ern Inventory Expert Service 

A division of the American Chemical Society Phone: 800-631-1884, 614-447-3870 

INVENTORY EXPERT SERVICE REPORT 

Fax: 614-447-3747 

E-mail: answers@cas.org 

Internet: http://www.cas.org/Supportlclient.html 

IES-ORDER NUMBER: ~ 

REGISTRY NUMBER:~ 

1 

] 

CA INDEX NAME 

[ 

Please print the above CA Index Name on the appropriate page of your PMN. 

0 If this box is checked, CAS has made correction(s} marked in red to 

your IES order. Please make the same correction(s} to your PMN before 

submitting it to the EPA. 

2540 Olentangy River Road P.O. Box _, 3343/ • Columbus. Ohio 43210-0334 
ATTACHMENT 4 

Manufacturing Location 
ATTACHMENT 5 

Gel Permeation Chromatography 
ATTACHMENT 6 

UV Spectrum 
ATTACHMENT 7 

Infrared Spectrum 
ATTACHMENT 8 

NMR Analyses 
ATTACHMENT 9 

Confidentiality Statement