United States Environmental Protection Agency

Washington, DC 20460

Section 4 Submission

This is an original submission:

✔

This is an amendment:

CERTIFICATION

I hereby certify to the best of my knowledge and belief that (1) all information entered on this form is

complete and accurate; and (2) any confidentiality claims are true and correct as to that information

for which they have been asserted. Any knowing and willful misinterpretation is subject to criminal

penalty pursuant to 18 USC 1001.

Signature: Official Title:

Director

Contact Person:

Tracy E. Guerrero

Email Address:

tracy_guerrero@americanchemistry.com

Date Signed:

01/20/2015

PART 1 Contact Information

Submission

Information

Submission Type:

ECA

Form Alias:

ECA-20150120-13:09:57 EST

Federal Register Notice:

79 FR 18822

Chemical Name:

Octamethylcyclotetrasiloxane (D4)

Date Submitted:

01/20/2015

Submitter

Information

Company Name:

American Chemistry Council

Address:

700 2nd Street, NW

Washington, DC, 20002

United States

Contact Person:

Tracy E. Guerrero

Phone Number:

2022496196

Email Address:

tracy_guerrero@americanchemistry.c

om

Technical Contact

Information

CBI

Yes: 	No: 

✔

Company Name:

American Chemistry Council

Address:

700 2nd Street, NW

Washington, DC, 20002

United States

Contact Person:

Mrs Tracy E. Guerrero

Not for Submission
SEC4 Submission Page 2

Phone Number:

2022496196

Email Address:

tracy_guerrero@americanchemistry.c

om

PART 2 Study Plans & Conduct of Testing

Principal Test

Sponsor

CBI

Yes: 	No: 

✔

Contact Person:

Tracy Guerrero

Address:

700 2nd Street, NE

Washington, DC, 20002

United States

Phone Number:

2022496196

Email Address:

tracy_guerrero@americanchemistry.com

Sponsor

Organizations

CBI

Yes: 	No: 

✔

Contact Person:

Tracy Guerrero

Address:

700 2nd St. NE

Washington, DC, 20002

United States

Phone Number:

2022966196

Email Address:

tracy_guerrero@americanchemistry.com

Testing Facilities Testing Facility:

ERM

Address:

1590 S. Milwaukee Ave.

Suite 211

Libertyville, IL, 60048

United States

Phone Number:

8475730587

CBI

Yes: 	No: 

✔

Contact Person:

Tracy Guerrero

Address:

700 2nd Street NE

Washington, DC, 20002

United States

Contact Role:

PROJECT MANAGER

Phone Number:

2022966196

Email Address:

tracy_guerrero@americanchemistry.c

om

Study Professionals CBI

Yes: 	No: 

✔

Not for Submission
SEC4 Submission Page 3

Company Name:

ACC/SEHSC

Address:

700 2nd Street NE

Washington, DC, 20002

United States

Contact Role:

STUDY DIRECTOR

Phone Number:

2022966196

Email Address:

tracy_guerrero@americanchemistry.c

om

Experience:

Director, ACC/SEHSC: D4 ECA Monitoring Program

PART 3 Additional Information

Additional

Information

File Name:

D4 ECA Schedule Change Request

20-Jan-2015 Final.docx

Document Type:

Amendment to

the Study Plan

Attachment Date:

01/20/2015

Paperwork Reduction Act: The Government Paperwork Elimination Act (GPEA) (44 U.S.C. 3501) provides that, when practicable, Federal organizations use electronic forms, electronic filings, and

electronic signatures to conduct official business with the public. EPA's Cross-Media Electronic Reporting Regulation (CROMERR) (40 CFR part 3), published in the Federal Register on October 13,

2005 (70 FR 59848) (FRL-7977-1)(Ref. 2), provides that any requirement in title 40 of the Code of Federal Regulations (CFR) to submit a report directly to EPA can be satisfied with an electronic

submission that meets certain conditions once the Agency published a notice in the Federal Register announcing that EPA is prepared to receive certain documents in electronic form. For more

information about CROMERR, go to http://www.epa.gov/cromerr/.

Not for Submission