E"A 

I~IIIIJIIII)111111i' 

uYY bl\;'> I 

• 	 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 ifyou 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 lD number must also appear on your corresponding fee remittance. which is sent to EPA, HQ Accounting Operations Branch (PM·226), P.O. 

U.S. ENVIRONMENTAL PROTECTION AGENCY 

PREMANUFACTURE 

NOTICE 

Jill II1111111111 III!!III/IJill}III,I111)111 II/I 

1 v" ~'" .... 

U.S. EPA,401 M STREET SW 

WASHINGTON DC 20460 

360399M, Pittsburgh, PA 15251·6399, Attn. TSC'A User fee. 

Part I - GENERAL INFORMATION 

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

chemical substance. even ifyou claim the identity as confidential. You may authorize 

another person to submit chemical identity inform3lion for you. but your submission will 

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

letter in support of your subm ission should reference your TS user fee identi fication 

number. You must submit an original and two copies oflhis nalice including all test data. 

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

submitted. 

Part 11- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE 

Ifthere are several manurncture. processing, or use operations to be described in Part II, 

sections A and B ofthis notice, reproduce the sections as needed. 

Part III- LIST OF ATTACHMENTS 

Attach additional sheets ifthere 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 inform3lion 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 ... This 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 appliC3lions (such as TMEA, LVE, LOREX) 

where certain information provided in such notific3Iion is binding on the submitter when 

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

do'~s..IIQt by itself prohibit the submitter from later devi3ling from the infonnation (except 

chemical identity) reported in the fonn. 

CONFIDENTIALITY CLAIMS 

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

form, mark (X) the confidential box next to the information that you claim as 

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

claim as confidential. If you claim infonnation in the notices as con.fl!tential, you must 

'!l!;Ql!rovide a sanitized versionQfthe notice, (incJuding attachments). For additional 

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

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

TEST DATA AND OTHER DATA 

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

a description ofall 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 ofthe 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 ifthey do not appear in the open literature. You should dearly 

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 ofthe Premanufacture Notification Rule (40 CFR Part 

720). 

Test Data (Check Below any included in this notice) 

Environmental fate data 

Health effects data 

Environmental effects data 

PhysicaVChemical Properties' 

• A physical and chemical properties worksheet is located on the last page ofthis fonn. 

TYPE OF NOTICE (Check Only One) 

~ PMN (Premanufacture Nalice) 

D INTERMEDIATE PMN (submitted in sequence with final PrPduct PMN) 

D SNUN (Significant New Use Notice) 


TMEA (Test Marketing Exemption Application) 


D LVE (Low Volume Exemption) (ll! 40 CFR 723.50(c)(I) 


D LOREX (Low Release/Low Exposure Exemption) (iiJ 40 CFR 72J.5O(c)(2) 


D LVE Modification D LOREX Modification 

IS THIS A CONSOLIDATED PMN') D Yes 

# of chemicals 

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

AGENCY USE ONLY 

") 

Company Sanitized 

o Yes Other data 18'1 Yes 

18'1 Yes Risk assessments 

o 	 Yes Structure/activity relationships 

18'1 	 Yes Test data not in the possession 

or control of ihe submitter 
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. 

CERTIFICA TION 

I certify that to the best of my knowledge and belief 

1. 	 The company named in Part I, section A, subsection I a ofthis 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 ofsubmission. 

3. 	 I am submitting with this notice all test data in my possession or control and a description ofall 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: 

I:8J 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 0[$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 (LVE) application in accordance with 40 CFR 723.50(c)(I) or a Low release 

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

statements: 

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 LYE in accordance with 40 CFR 723.50(c)( I), the manufacturer intends to commence 

manufacture of the exempted substance for commercial purposes within I year ofthe 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 regardillg the chemical substallce 

deseribed hereill. AllY Mowing and willful misinterpretation I. subject to criminal pellalty pursuant to 18 USC 1001. 

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

COllfidential 

x 

Signature of agent - (if applicable) Date 
la. Person 

Submitting 

Notice (in U.S.) 

Confidential 

x 

Mailing address (number and street) 

ZIP Code 

C. 

Joint Submitter (if Name ofauthorized official 

applicable) 

Company 

Mailing address (number and street) 

2. 	 Technical N arne ofauthorized official 

Contact (in 

U.S.) 

Mailing address (number and 

4. 	 If you previously 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). 

5. 	 Bona intent to manufacture or 

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

assigned by EPA. 

I. 	 Manumcture

6. Type ofNotice - Mark (X) Only 

o Binding Option 

Mark 

City, State, ZIP Code 

b. 	 Agent (if Name ofauthorized official 


applicable) 


Mark (X) 

if none 

Mark (X) 

ifnone 

Mark (X) 

if none 

Company 

ng address (number street) 

Telephone 

Ifyouaresubmittlh·n~g~t~h~is~no~t~icZ.e~a;s;paoa.rt~~~~~~~~~~~O()tlri;bbo~X~.~:'.:':':':':':':':':':':':':':'~:':':':':':':':':':':':':':':':':':':':':':':':':':.:.:.:.:.~~-r"-

Telephone 

Position 

2. 	 Import 

Only 3. 	 o Both 

o 	 Binding Option 


Mark 


.3 

Complete 

If another person will submit chemical identity infonnation for you (for either Item I 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) I D Cla.~s I or 2 D Class 2 

b. Chemical name (Currently correct Chemical Abstracts A) Name that is consistent A Inventory listings for 

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

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

x 

x 

CAS# 

e. 	 For a class I substance, provide a complete and correct chemical structure diagram. For a class 2 the 

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

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

dialmlm. as complete as can be known. ifone can be reasonablv ascertained. 

x 

x 

x 

attach a continuation sheet. 
Confidential 

a. Indicate the numher-average weight ofthe lowest molecular weight composition ofthe polymer you intend to manufucture. 

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

helow 1,000 absolute molecular weight ofthat composition. 

Descrihe 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 0/. below 1000 molecular weight: 

b. You must separate monomer or other rcactant identity, composition information, and residual information. Mark (X) 

"Confidential" box next to any item you claim a~ confidential 

x 

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

e. 

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 ifyou 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 manufuctured for 

commercial purposes. 

Mark this column if in column is confidential. 

Monomer or other reactant and CAS Registry Numher Confi- Typical Confix 

x x x 

x x 

identity information reported in this notice (check one). 

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

obtained from CAS Inventory Expert Service must he submitted as 

as attachment to this 

Abstracts (CA) name for the polymer that is consistent with 

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

Mark (X) this box ifyou attach a continuation sheet. 
(a) 	 Identify each impurity that may be reasonably anticipated to be present in the chemical substance as manufuctured for commercial purpose. Provide the 

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

% of each . [fthereare unidentified estimate their total %.

Impurity and CAS Registry Number Maximum Confipercent dential 

x 

Confidential 

x 

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

5. substance identified in subsection I or 2. 

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

6. 	 chemical name - If you claim chemical identify as confidential, you must name your substance that 

the specific chemical identity ofthe 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. 

Polyalkenyl, N,N'-bistriazole 

D 

7. use, or disposal ofthe new chemical substance. Provide the CAS Registry 

CAS Number Confidential 

x 

Impurities 

- Enter any chemical synonyms for the ncw chemical identified in subsection I or 2. 
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"10 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 (kglyr) 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 tormulation of the new substance, and other use information. Mark (X) the "Confidential" Box next to any item 

you claim as confidential. 

a. (1) Describe each intended category of use of the new chemical substance by function and application.. 

(2) ­ Mark (X) this column if entry column (1) is confidential business information (CBI). 

(3) Indicate your willingness to have the information provided in column (1) 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 ifappropriate. Mark (X) to indicate 

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

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

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

Option tion % Fonn­ (8) 

(by function and application i.e. a dispersive dye Marltlx) ulation Site- Con-· Indus- Com- Hinding 

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

X X X X 

• If you have identified a "consumer" use, please provide on a continuation sheet a detailed description ofthe use(s) ofthis 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. 

DMark (X) this box ifyou attach a continuation sheet. 

(3) Generic Ifyou claim any category of use description in subsection 2a as confidential, enter a generic description ofthat category. Read the 

use Instructions Manual for examples of generic use descriptions. 

Description Lubricant Additive 

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

3. Hazard Information ­ Include in the notice a copy of reasonable fucsimile ofany 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 OpMn 

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

Mark (X) this box ifyou attach hazard information. (see Attached MSDS) 
II-HUMAN 


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

claim as confidential 

Complete section A for type ure, processing, or use operation involving Ihe 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 or use after You must describe these See instructions manual 

1. Confiof the site at which the will occur. dential 

x 

Site address 	 and street) 

City, 


If the same operation occur at more one enter of sites. 


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. 


Use x

x I. 	 Batch 


Maximum kglbatch (100% new chemical 
 Hours/batch Batches/year 

substance) 

2. Continuous 

(3) 

sheet. 

Processing 

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 ofall starting materials and 

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

used daily or per batch. J. 

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

) this box if you attach a continuation sheet. 
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. 

(1) -- 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 equipment 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) ofthe new chemical suhstance (e,g., solid: crystal, granule, powder, or dust) and % new chemical substance (ifpart ofa 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 comhined 

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

(IO) and ( II) Estimate the maximum duration ofthe activity for any worker in hours per day and days per year. 

(12) -- Mark (X) this column ifentries in columns (I O) 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 HrsJday Dayslyr 

Mru:I«x) substance Mru:I«x) S 

(I) (2) (3 ) (4) (5) (6) (7) Expose (9) (10) (II) (12) 

d 

(8) 

X X X 

X X X 

X X X 

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

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

released and other release and disposal 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 1d(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). 

X 

X 

X 

(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 ofRCRA 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) ofreleases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct discharges or 

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

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

Number released release 

(I) (2a) (2b) eg. 'lock ~r Binding 

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

~~__ __~~__ ______________~~______~XI 

(7) Mark (X) the 

destination(s) of 

releases to water, 

X 

U POTW provide name(s) below: 

None 

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

CBI 0 Navigable 

--:-:--X waterway 

X 

D Other - Specify provide NPDES # CBI 

x 
Part II-HUMAN 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 . or use after You must describe these See instructions manual 

I. Confiof the site at which the will occur. dential 

x 

Site address (number and street) 

City, County, State, ZIP code 

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

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

production rates or operations, include all the infonnation requested in this section for those 

sites as attachments. 

(3) 

DProcessing 	 Duse x

Hoursfbatch Batches/year 

x 

Maximum kglbatch (100;, new chemical Hoursfbatch Batches/year 

substance) 

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

(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 kglbatch on a 100% new chemical substance basis), and entry point of all starting materials and 

feedstocks (including reactants, solvents, catalysts, etc.), and ofall products, recycle streams, and wastes. Include cleaning chemicals (note frequency ifnot 

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. 

I. Batch 

2. Continuous 

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

8A 
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 deseription of worker activity, physical form ofthe 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, ctc.) 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 equipment 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 ofa mixture) 

at the time of ex posure. 

(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 ifentry in column (8) is confidential business information (CBI). 

(10) and (II) -- Estimate the maximum duration ofthe 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 eBI Protective Equipment! Binding Physical fonns(s) Binding CSI #of eBI Maximu duration CSI 

m 

(i.e.. bag dumping. filling drums) Engineering Controls Option and % new Option Worker Hrslday Dayslyr Mark (x) substance Mark (xl s 

(I) (2) (3) (4) (5) (6 ) (7) Expose (9) (10) (II) (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 disposal information. Mark (X) the "Confidential" box next to each item you claim as confidential. 

(1) Enter the number of each release point identified in the process description, part II, section A. subsection 1<1(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 ifentries in columns (I) and(2) are confidential business information (CBI). 

(4) -- Identify the media (stack air, fugitive air (optional-see Instruction Manual), surfuce 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 ofon 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 ifentries in columns (4) and (5) are confidential business information (CBI). 

(7) Identify the destination(s) ofreleases to water. Please supply NPO ES (National Pollutant Diseharge Elimination System) numbers for direct discharges or 

NPDES numbers ofthe POTW (Publich Owned Treatment Works). Mark (X) ifthe POTW name or NPDES # is confidential business information (CBI). 

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

Number released release 

(I) (2a) (2b) eg. slack air Binding 

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

X X 

X X 

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

destination( s) of 7 waterway X releases to water. 

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

9A 

Part 11-- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE -- Continued 

I 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. Sce the Instructions Manual. Complete a separate 

section B for each type ofprocessing, or use operation involving the new chemical substance. Ifthe same operation is perfonned at more than one site describe the 

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

I, Operation Description -. To claim infonnation in this seetion as confidential, circle Of bracket the specific infonnation that you claim as confidential. 

(1)·- 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 ofall 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 ofrelease, 

including small or intennittent releases, to the environment ofthe new chemical substance. (4) Please enter the # ofsites (remember to identifY the locations of 

these sites on a continuation sheet): 

# ofsites 

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

2. Worker ExposureiEnvironmental 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 fonn 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 ofthe new substance as fonnulated 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 kglbatch). 

(12) -- Describe media ofrelease 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 technology, if any, that will be used to limit the release ofthe new substance to the environment. 

(14) IdentifY byproducts which may result from the operation, 

(3), (5), (8), II). (13) and (15) -- Mark (X) this column ifany of the proceeding entries are confidential business infonnation (CBI). 

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

of Workers of Engineering Controls! Fonn- Number New & Control 

Act· Exposed Exposure Physical Fonn and % ulation Substance Technology 

ivity new substance Released 

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

X X X X X 

X X X X X 

14) -- Byproducts: (15)

None 

D Mark (X) this box if you attach a continuation sheet, 
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 risks associated with activities surrounding manufacturing, processing, use and disposal 

ofthe 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 ofchemical wastes by technological 

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

inventory controL Recycling refers to the reclamation ofuseful chemical components from wastes that would 

otherwise be treated or released as air emissions or water discharges, or land disposal. Descriptions ofpo llution 

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 

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

addition, information on the relative cost or performance characteristics ofthe 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 (I) 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 ofproduction and/or improved operation efficiency ofthe 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. 

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

I I 
I 

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 ofthe 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 

page number(s} 

Confidential 

X 

X 

X I 

X 

X 

X 

X 

X 

X 

Material Safety Data Sheet 68-72 

D Mark (X) this box if you attach a continuation sheet. Enter the attachment name and number. 
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 ofthe 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 ofthe neat substance should be provided These 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 oftest data. This worksheet 

is not a substitute for submission oftest data. 

Property Mat\; Page Value Measured 0 Confi­

(X)if number Estimate denrial 

provided Marl< (X) 

(a) (b) (c) (M or E) (d) 

X 

Physical state ofneat substance (s) (1) (g) 

Vapor pressure 

@ Temperature °C Torr 

Density/relative density g/cm3 

Solubility 

@ Temperature °C 

Solvent giL 

X 

Solubility in water @ Temperature °C gIL 

Melting temperature °C 

Boiling I sublimation temperature@) torr pressure °C 

Spectra 

Dissociation constant 

Particle size distribution 

X 

Octanoll water partition coefficient 

Henry's Law constant 

Volitalization from water 

Volitalization from soil j 

pH@ concentration I 

I I 

Flammability 

Explodability 

Adsorption I coefficient 

X 

Other - Specify 

Attachment Page 13 

Part I, Section B, 1 e: Product 5A Raw Materials and Representative Chemical Structure Diagram 

Attachment Page 14 

Manufacturing Description 

Section A, Part D -INDUSTRIAL SITES CONTROLLED BY THE SUBMmER 

Page 15 

Process Description 

Section A, Part D - INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER 

Page 16 

Infrared Spectrum 

Page 17 

ope 

18-22 

CAS IES Report 

23 

Acute Oral Toxicity 

24-36 

Solubility in Water 

37-55 

OctanoliWater Partition Coefficient 

56--67 

~Afton. Material Safety Data Sheet 

CHEMICAL. 

HiTEC 7135 - For R&D Use Only MSDS no. H7135 

HiTEC is a trademark owned by Afton Chemical Corporation or one of its subsidiaries. 

f. Product and company identification 

Product usc Petrochemical industry: Lubricant component 

Uate of issuelRevisions 24June2009 

In case of emergency - Chemical 

1-800-403-0044 (US & Canada) 

1-804-648-7727 (International) 

32-2-507-20-64 (Europe) 

81-3-5210-4890 (Japan) 

Manufacturer I Supplier 

Afton Chemical Corporation Afton Chemical Limited 

500 Spring St. Euro-Tech Centre 

Richmond, VA 23219 London Road, Bracknell, Berkshire 

1-804-788-5800 RGI22UW, England 

44 1344-304141 

msds@aftonchemical.com 

In Japan: In Australia: 

Afton Chemical Japan Corporation Afton Chemical Asia Pacific Company 

Sumitomo Fudousan Sanbancho Bldg. 5F Level 9, 20 Berry Street 

6-26 Sanbancho, Chiyoda-ku North Sydney, NSW 2060 

Tokyo 102-0075 Japan Australia 

Emergency phone: 81-3-5210-4890 Telephone nwnber: 02-9923-1588 

Business Hours: 9:00am - 5:00pm 

p. Hazards identification 

Notiee to read er 

Afton operates a world-wide system for hazard communication. Some hazards shown in Section 2 may apply to non-EU countries and may not result in 

ciassijiauion and labeling in the Elf. Please see Sections 3 and 15 for country specijic ciassijiClltion information, and Section 11 for additional details. 

Europe: The product is not classified as dangerous according to Directive 1999/45IEC and its amendments. 

Australia: NON-HAZARDOUS SUBSTANCE. NON-DANGEROUS GOODS. 

Primary hnards and critical effects NOTICE! 

1':I\\'ironmental hazards Not classified as dangerous for the environment according to EC criteria. 

Hazardous Material 

Information System 

(U.S.A.) 

3. Composition/information on ingredients 

Note: see section 8 for occupational exposure I imits and section II for LC50lLD50 information 

Sublltllllt't'/Preparatioll : Preparation 

Ingredient name ('AS no. COliC. (% wl\\') Ell Classification 1Y!!M.!li 

Regulated? 

Mineral Oil Mixture. 30 - 60 Not classified. No. 
iTEC 7135 - For R&D Use Only In Case ofEmergency 1-800-403-0044 (US/Canada) 1-804-648-7727 (Int'l) 32-2-507-Page: 215 

20-64 (Eu) 

14. First aid measures 

Inhalation 

Ingl.'stioll 

Skin contact 

Eye contact 

If inhaled, remove to fresh air. If not breathing. give artificial respiration. If breathing is difficult, give oxygen. Get 


medical attention if symptoms appear. 


If affected person is fully conscious. give one glass of water to drink. Never give anything by mouth to an 


unconscious person. Get medical attention if symptoms appear. 


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


In case of contact. immediately flush eyes with plenty of water for at least 15 minutes. Get medical attention 


immediately. 


15. Fire-fighting measures 

Extinguishing media 	 In case of fire. use water spray (fog). foam, dry chemical or CO!. 

Fire-fighting procedures 	 Fire-fighters should wear positive pressure self-contained breathing apparatus (SCBA) and full turnout 

gear. 

Hazardous decomposition products 	 Decomposition products may include the following materials: 

carbon dioxide 

carbon monoxide 

Flash point 	 Closed cup: 150·C (302°F) [Pensky-Martens.MinimumJ 

16. Accidental release measures 

Pl.'rsonal precautions 	 Immediately contact emergency personnel. Keep unnecessary personnel away. Use suitable protective 

equipment (section 8). Follow all fire-fighting procedures (section 5). 

Environmental precautions 	 If emergency personnel are unavailable, contain spilled material. For small spills, add absorbent (soil may be 

and dean-up methods 	 used in the absence of other suitable materials) and use a non-sparking or explosion-proof means to transfer 

material to a sealable, appropriate container for disposal. For large spills, dike spilled material or otherwise 

contain material to ensure runoff does not reach a waterway. Place spilled material in an appropriate container for 

disposal. Avoid contact of spilled material with soil and prevent runoff entering surface waterways. 

Note: see section 1 for emergency contact information and seetion 13 for waste disposal. 

17. Handling and storage 

Ihmdling : Wash thoroughly after handling. 


Stol'agc : Keep container tightly closed. Keep container in a cool, well-ventilated area. 


8. Exposure controls/personal protection 

Engineering controls 

Personal protective equipment 

Respil"l\lory system 

Skin and body 

Ilands 

Eyes 

Occupational exposure limits 

Ingredient name 

1) Mineral Oil 

Provide exhaust ventilation or other engineering controls to keep the airborne concentrations of vapors 

below their respective threshold limit value. 

Use appropriate respiratory protection if there is the potential to exceed the exposure limit(s). 

Disposable outer gannents when there is the potential for contact with the material. 

Use chemical-resistant. impervious gloves. 

Safety glasses with side shields. Goggles with a face shield may be necessary depending on quantity of 

material and conditions of use. 

Of], United States OEI. Canada OEl Europe OEL Australia 

ACGIH (United (Canada). EH40 (UK) (Europe. NOHSC (Australia, 

States). 	 2002). 2003). 

TWA: 5mg/m' TWA: 5 mg/m' TWA: 5 mg/m' 8 TWA: 5 mg/rn' 8 

STEL: 10 mg/m3 STEL: 10 mg/m' hourIs). houris). 

OSHA (United 

States). 

TWA: 5 mg/rn" 

19. Physical and chemical properties 

Physical stale and Appearance Liquid. [Viscous liquid.] 

Color Brown. [Dari<] 

I)cnsity Not detennined. 

Specific ~ra\"ity 0.9236 @ 25°C 

Solubility Insoluble in the follOWing materials: cold water. 

bCf 
iTEC 7135 - For R&D Use Only In Case ofEmergency 1-800-403-0044 (US/Canada) 1·804-648·7727 (Int'l) 32-2-507-Page: 3/S 

20-64 (Eu) 

633 cSt@ 100° C 

.\ulo-ignition tempel'atll n.' Not determined. 

I·lash point Closed cup: 150°C (302°F) [Pensky-Martens.Minimuml 

\10. Stability and reactivity 

Stability The product is stable. 

Materials to avoid Strong oxidizing and reducing agents. 

Conditions to avoid High temperatures, sparks, and open flames. 

Ill. Toxicological information 

Routes of entry Skin, Eyes, Ingestion, and Inhalation. 

Target organs None known. 

Acute l"ffccls 

Inhalation Inhalation of oil mist or vapors at elevated temperatures may cause respiratory irritation. 


Ingcstion Not determined. 


Skin contact 


Repeated or prolonged contact with the preparation may cause removal of natural fat from the skin, resulting in 

non-allergic contact dermatitiS and absorption through the skin. 

Elc contact 

Advent' effects 

Non-irritating to the eyes. 

Not determined. 

Product/ingredient name ACGIH tARC 

Not classified or listed by IARC, NTP, OSHA, EU and ACGIH. 

EPA NIOSH NTP OSHA EU 

Toxklty data 

Product/ingredient name 

Not determined. 

Result Species Dose Exposure 

Other informatioll : Not available. 

\12. Ecological information 

Environmental hazard~ Not classified as dangerous for the environment according to EC criteria. Based on calculation. 

I':nvironmental fate This product contains components which may be persistent in the environment. 

113. Disposal considerations 

Waste handling and : Waste must be disposed of in accordance with federal, state and local environmental control regulations. 

disposal 

114. Transport information 

RcgulatOl,) liN number Proper shl ppl nil lIa me Class Packing group l.abel ,\ddltional informatioll 

information 

nOT Not - - - . Class!Ikation regulated. 

TIlG Not - - - - Classi ticat Ion egulated. 

AI>RfRIJ) Class Not - - - egulated. 

IMIlG Class Not - - - - regulated. 

IATA-IlCR Not . - - - (,hiSS regulated. 

70 

iTEC 7135 - For R&D Use Only 

I

Not /­ regulated. 

In Case ofEmergency 1-800-4a3-0044 (US/Canada) 1-804-648-7727 (Int'l) 32-2-S07-Page: 415 

20-64 (Eu) 

1­

Not available. 

Notil"e to reader 

The above transport information is provided to assist in the proper classification of this product and may not be suitable for all shipping conditions. 

115. Regulatory infonnation 

Ell regulations 

Risk phrases 

Safet)! phrases 

liS rcl'(ulations 

SARA 313 toxic chemical 

notification a nd release 

reportinl'( (w/w%) 

SARA 3111312 lIazardous 

Catel'(orizalion 

RQ (Reportable quantity) 

State - Califol'Uia Prop. 65 

("anadian rel/ulations 

W 111\11S (Classification) 

International Inventor)! Statns 

llnited States (TSCA) 


Canada 


Europe 


JapUlI (EN('S) 


Australia (NICNAS) 


Korea (EC!.) 


(:hinR (It:CSC) 


Philippines (PICCS) 


116. Other infonnation 

This product is not classified according to EU legislation. 


Not applicable. 


No SARA 313 chemicals are present above the reporting threshold. 


SARA 311/312 MSDS distribution - chemical inventory hazard identification: Immediate (acute) health hazard 


CERClA: Hazardous substances.: No products were found. 


No products were found. 


Not controlled under WHMIS (Canada). 


United States inventory (TSCA 8b): Not determined. 


Canada inventory: Not determined. 


Europe inventory: Not determined. 


Japan inventory (ENCS): Not determined. 


Australia inventory (AICS): Not determined. 


Korea inventory (KECI): Not determined. 


China inventory (IECSC): Not determined. 


Philippines inventory (PICCS): Not determined. 


PREPARATION INFORMATION 

Validated by IIS&E I)epartment (Tel: +18047885800) on 6/24/2009. 

,... 

Uatc 01' printing 6/2412009. 

Indicat('s infol'mationthat has chnnl'(ed from previously issued version. 

Notice to reader 

This information and these recommendations are offered in good faith and believed to be correct as ofthe date hereof. Information and recommendations are 

supplied upon the condition that the recipients will make their own decision as to sofety and suitability for their purposes. No representations or warranties, 

either expressed or implied, of merchantability, fitness for a particular purpose, or ofany other nature, are made with respect to the product or the 

information and recommendations. Afton makes no representation as to completeness or accuracy. In no event will Afton be responsible for damages ofany 

nature whatsoever resulting from the use or reliance upon the information and recommendations. 

ADDRESS CONTACT INFORMATION 

/1 

iTEC 7135 - For R&D Use Only In Case ofEmergency 1-800-403-0044 (US/Canada) 1-804-648-7727 (Int'l) 32-2-507-Page: 5/5 

20·64 (Eu) 

In the United States and Canada: 

Afton Chemical Corporation 

500 Spring Street 

Richmond, Virginia 

USA 23219-2183 

Telephone number: 804-788-5800 

In Singapore: 

I II Somerset Road 

#09-05 

Singapore Power Building 

Singapore 238164 

Telephone number: 65-6732-0822 

In Australia: 

Afton Chemical Asia Pacific Company 

Level 9, 20 Berry Street 

North Sydney, NSW 2060 

Australia 

Telephone number: 02-9923-1588 

Business Hours: 9:00am - 5:00pm 

* * * END OF MSDS * * * 

In Europe: 

Afton Chemical Limited 

Euro-Tech Centre 

London Road, Bracknell, Berkshire 

RGI2 2UW, England 

44-1344-304141 

In Japan: 

Afton Chemical Japan Corporation 

Sumitomo Fudousan Sanbancho Bldg. 5F 

6-26 Sanbancho, Chiyoda-ku 

Tokyo 102-0075 Japan 

Emergency phone: 8 J -3-5210-4890