### U.S. ENVIRONMENTAL**PROTEC~ION** 

### AGENCY 

# &EPA PREMANUFACTURE 'i 

# NOTICE .; Date ofreceipt


## Company Sanitized ( ..

### , -'I 

### FORNEW CHEMICAL SUBSTANCES

-- r --a-- 

### in the Premanufactu.re Notice 

## GENERAL INSTRUCfiONS ' "**l'~·liK** •You must reovide allinfonnalion requested Ia lhiafoi'Dllo Ikeextentthat itIaknown toorreasonably ucertain.ableby you. Makere.uonable estimates ifyou

not**h<~ve<~dual** data. "-"'' w. •'Before you completelhla form, you should read lhe "InstructionsM.mual forPremanufacture Notification" (the Instruction& Manual is**<~Vall**able from theToxic Substances Control Ad ITSCA) Information Servicebycillllng :Z02·554-1404, or fulng 202-554-5603). •If,. user fee hasbeen remitted for this notice (40 CJlR 100.45), lndlc:ate in the boxes**<~bove** the TS-uRrfee identification numberyou have generated. Remember, youruserfee ID numbermustalso appearonyourcorreSponding fee remittance. which is sent to:EPA,HQAccounting OperationsBranch (PM-26 ), P.O.**360399M.Piltab~h,PA** 15251-6399, Attn. TSCA**UterFee~.-,INf** , •"'**.~:'-'"~i** ... Part 1- GENERAL INFORMATION**·~·** You muat providethe currenUy correct Chemlc:al Abstracts (CA) Nameofthe new chemicillaubst.mce,even ifyou datm the Identity • confldeatlal,'.¥ou may authorize anotherperson to aubmitchemlc:al Ideality infonnaUo
.. /for

## f"u'i bui· yoursubmissionwill notbecompleteudthereviewwillnotbizltlil'Jl!qEP,t\:' recelvea thia information. A Jetter Iaaupportofyoursubmiuloaahould**;f~** refei'E'nce yourTS uaerfee identlflaUon number. You must aubmlt

- ...orijlnal**<~nd** two copies ofthla notice including il1l teat d..U .Ifyou claimedany ·**'··.·~\',;l** information as confidential, a single sanitized copymust also besubmitted. -" Part II- HUMAN EXPOSURE AND ENVIRONMENTALRElEASE If there are several manuf.lldure, processing. oruse operations to be desaibed in Part II, sections A and B ofthl.a notice, reproducethe sections as needed. Part III- UST OF A TTAOiMENTS AHach addillonalaheeta ifthere Ia not enough sp..ce to answera question fully. Label e..ch continuation sheet with thecorresponding section huding. In Part III, list these attachments, any lesl dill"orotherdillla and any optional information included in the notice. OPTIONAL INFORMATION . TESTDATA AND OTHERDATA You an: required to submit aU test d.at.a in yourpoueuion orcontrol and to providea deac:riptioll of aU otherdataknown to orreMOnably ascertainable byyou, Ifthuedata a.ae mailed totheheillth and envlronment.al effects ofthe ma.nufadun!, prooeaaing. distribution in mmmesa, use, ordlspo&ill ofthe new chemlcillsubstance. Standard literalun!dtatlont maybeaubmltted for data In the open adentific literalun!. Completetest dati <wriHeo In**EOj~lishl** not sqmmarlesofdab. mutbe subm!Hed ifthey do not apRfarin theORfD l!tera&urc. You should dearly**J~entlfy** whethertest datais on the substanceoron an analog. Also, the chemlc:al composition ofthetested materialahould becharacterized. Following are ex;unplesof lestdilla and otherdata. Datashouldbe submitted according tothe requirements of §720.50 of the Premanufacture NotlflgiJQI\ Rule (40 CFR P.otrt 720). li1l TestData •Check Below any included In this notice)

• Environmental fate d.Ua 

# D Yes • Otherdata 

# D Ye11

• Heitlth effects datil 

# D Yes lliak oil.!laeNmenta
• Environmental effects data 

# D Yes Strudurel.actlvityrelationshi You may includeany information that you wantEPA to considerIn evilluillling the newaubstan('L On page 11 oflhla form, apacehubeeft provided for you to describe pollution prevention and recycling information you may have regarding the new substance. • Physlc.alJChemlcal Properties •

### ~ Yea THl data not lA the poliHHin

So-called "binding"boxes areincluded throughout thla form foryou to indicate yourwiUingness to bebound tooert.ain atatemenlsyou make In lhi& notice, such as use, production volume, protectiveequipment
... Thlaoption Is intended to reduce del.aya that routinely acmmp.any the development of consent orden or Significant New Use Rules. Excepllll thecase ofexemption appllatlona (auch as TMEA, L VE, LOREX) where certa.la Information provided in such notification Is**bindl~g** on the submitterwhen the Agency approves the exemption application, checking a bindingbox In thls notice.dw::l...wU by itaelfprohibit the aubmiHer from I.Uerdevl.Uing from the Information (except chemk:itlldentity) reported In the form.
CONFIDENTIALITY CLAIMS You may d.tlm .any Information In thisnoticeu conftdentl.al. To auert a clalm on the fol"DD. ma.rk 00 the oonfldentl.al box nextlo the lnformilllon that you claim as confidential. To assert a claim in an attachment, drcle or**br<~cket** the information you claim a confidential. Uyou claim lpfgnnat!gn in the ngtic;e 11 confidential you must ,alao proyidc a s.a,nitlzed version of the notice Undyifjq iltacbments). For additlonitlinslrudlonaon claiming infonnalion as confidential, read the InstructionsManuitl.

## ~k (X) If any lnformilllon In this notice Is claimed as confidential.
EPA FORM 7710-25 (Rev. !>-95) orcontrol of the 1ubmitter •A physical and chemlcill properties worksheet laloc.1led on the l•lpage

of this form. TYPE OF NOTICE (Check Only One)

## ~ PMN

## (Pre~anufacture Notice)



# 0 lNTERMEDIATE PMN (submitted in sequencewith finai product PMN) 

# 0 SNUN (Signiflc:ant New Uae Notice) 

# D TMEA CTe.t MuketingExemption Apptlc:.ation) 

# 0 LVE (Low Volume bemptioa) • 40 CFR 123.50 (c)(l) 

# D LOREX (Low Rele.ase/LowExpoaure Exemption) 0 723.50(c)(2) 

# 0 L VE Modlfiatlon 

# 0 LOREX Modification
IS TillS A CONSOLIDATEDPMNl 

# D Yea I ofchemlc.ah; (Prenotice Communication I required, enter I on p,age 3) 

# I 

# I,

# ~ 

# i

.

.



# . (_ Replacesprevious editionsofEPA Form 7710.25 

# J :_;;**~?**

*-**-~;**

## c-·-:;'

··-. , __ 'jPublic reportingburden for this collection ofinformationis estimated to average 110hoursper response, including time for reviewinginstructiom' searching existing data sources, gatheringand maintainingthedataneeded, and completingand reviewing thecollection ofinformation. Send commentsregarding the burden estimateor 

### any otheraspect ofthis collection ofinformation, including suggestionsfor redud.ng this burden, to Cllief, Information Policy Branch, PM·223, U.S. Environmental Protection Agency, 401 M. St., S.W.,Washington, D.C. 20460; and to the Office< Management and Buc!get, PaperworkReduction Act (2070-0012), Washington, D.C. 20503. 

## CERTIFICATION
I certify that to thebestof myknowledge andbelief: 1. Thecompany named in Part I, section A, subsection laofthis notice form intends to manufactureor import for a commercial purpose,otherthan in small quantities solely for research and development, the substanceidentified in Part

### I, Section

### B. 2. All information provided in this notice is complete and truthful as ofthedate of submission. 3. I am submitting with this notice all test data in my possession orcontrol and a description ofall otherdata known to orreasonably ascertainableby me as required by §720.50 ofthe Premanufacture Notification Rule.


### Additional Certification Statements: Ifyou are submitting a PMN, IntermediatePMN, Consolidated PMN, orSNUN, checkthe following userfee certification statement that applies: 

# J8[The Company named in Part

### t Section A has remitted the fee of$2500 specified in 40 CFR 700.45 (b), or 

# 0 The Company named in Part I, Section A has remitted the fee of$1000 for an IntermediatePMN (defined @ 40 CFR 700.4 ) in accordance with 40 CFR 700.45(b), or 

# 0 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 CFR700.45 (b). Ifyou are submittinga low volume exemption (LVE) 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), checkthe following certification statements: 

# D The manufacturer submitting this notice intends to manufactureor import the new chemical substance for commercial purposes,otherthan in small quantities solely for research and development, under the terms of

### 40 CFR 723.50. 

# 0 The manufactureris familiar with theterms ofthis section and will comply with thoseterms; and 

# 0 The newchemical substance for which the notice is submitted meets all applicable exemption conditions. 

# 0 Ifthis application

### is for an 

### L VEin accordance with 

### 40 CFR 723.50 (c}(l), the manufacturer intends to commence manufacture oftheexempted substancefor commercial purposes within 

### 1year ofthe date oftheexpiration ofthe 30 day review period.

The accuracy ofthe statements you make in this notice should reflectyourbestprediction ofthe anticipated facts regarding the chemical

substance described herein. Any knowing and willful misinterpretation is subject to criminal penalty pwsuant to 18 USC 1001. Signature and title ofAuthorized Official (Original Signature Required) Date

Signature of agent • (if applicable) Date

FORM EPA 7710-25 (Rev. S..95) Page2 Confidenti• 

### 1la. Person Submitting Notice (in U.S.)

b. Agent (if applicable) 

## Part 

## I-- GENERAL INFORMATION

Mailing address (number and street) Gty, State, ZIP Code

Nameof authorized official Company Mailing address (numberand street) Oty,State, ZIP Code Telephone

c. If you are submittingthisnotice as part ofajoint submission, mark (X) this box.

-------------------- Joint Nameof authorizedofficial Submitter (if applicable) Company Mailing address (number and street)

2. Technical Contact (in U.S.) City, State, ZIP Code

Name Company Mailing address (number and street) City, State, ZIP Code

3. Ifyouhave had a prenotice communication (PC) concerning this notice and EPA assigned a PCNumber to the notice, enter thenumber. 4. Ifyoupreviously submittedan exemption application for the chemical substancecovered by this notice, enter the exemption number assigned by EPA. Ifyoupreviouslysubmitted a PMNfor this substanceenter the 

### PMN numberassignedby

### EPA (i.e. withdrawn orincomplete). Ifyouhave submitted a notice of Bonafideintent to manufactureor importfor thechemical substancecovered by this notice, enter the notice number assigned by EPA. 

# > Type ofNotice- Mark (X)

FORM EPA 7710-25 (Rev. 5-95) 1. 

# D D Manufacture Only Binding Option Mark {x) Page3 Position

Telephone
Position

Telephone 1 I

2. 

# 0 

# 0 Import Only Mark (X) ifnone

Mark (X) ifnone
Mark (X) ifnone

BindingOption Mark (x) 3. 

# E2?' Both

## Part 

## I-- GENERAL INFORMATION --CONTINUED :Section B 

### --CHEMICAL IDENTITY INFORMATION: You must provide a currently correct Chemical Abstracts name ofthe substance based on the ninth Collective Index (9CI) ofCA nomenclature rules and conventions. 

### Mark (X) the 

### ··confidential" box next to anv item you claim as confidential. Complete either item t (Class I or 2 substances) or 2 (Polymers) as appropriate. Complete all other items. 

### Ifanother person will submit chemical identity information for you (lor either item I or 2), mark (X) the box at the right Identify the name, company, and address ofthat person in a continuation sheet. 

# D 1'. 

### Class 1or 2 chemical substances (tor definitions ofclass I and class 2 substances, see the Instructions Manual)

a. Class ofsubstance

-- Mark (X) I 

# D Class I or 2 

### Octass 2 

### b. Chemical name (Currently correct Chemical Abstracts (CA) Name that is consistent with TSCA Inventory listings for similar substances. For Class 1substances a CA Index Name must be provided. For Class 2 substances either a CA Index Name orCA Prdcrn.:d Name must be provided. whichever is appropriate based on CA 9Cinomenclature rules and conventions.).

c. Please identi(y which method you used to develop or obtain the specilied chemical information reported in this notice:

(check one). 

# C2J Method I (CAS Inventory Expert Service- a copy ofthe Identification report obtained fi·om the CAS Inventory Expert Service must be submitted as an attachment to this notice) d. rvtolecular Formula and CAS Registry Number (ifa number already exists for the substance) 

# I Method 2 (Other Source)

e. For a class I substance. provide a compkte and correct chemical structure diagram. For a class 2 substance

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

## or composition and the typical composition (where**appropriat~.:).** 

### (4) Provide a correct representative or partial chemical structure**!diag~<un** 

### as complete as can be known, ifone can be reasonably ascertained.



# 0 Mark (X) this box ifyou attach a continuation sheet.**~-ORM** EPA 7710-25 (Rev. 5-95) Page 4 

### Confidential 

## X 

## X

X 

## X X

## Part I-- GENERAL INFORI\1ATION --Continued Section B --CHEMICAL IDENTITY INFORMATION-- Continued 2. 

### Polymers (For a definition ofpolymer, see the Instructions Manual.) Confidential 

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

Indicate maximum weight percent oflow molecular weight species (not including residual monomers, reactants, or solvents) below 500 and below 1000 absolute molecular weight ofthat composition. Describe thl.! methods ofmeasurement or the basis for your estimates: 

### GPCO Other

# 0: Specify: Calculated

i) lowest number average molecular weight ii) maximum weight% below 500 mokcular weight iii) maximum weight% below 1000 molecular weight 

# D ivlark (X) this box ifyou attach a continuation sheet b. You must make separate confidentiality claims for monomer or other reactant identity, composition information, and residual information.

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

- 

### Provide the specific chemical name and CAS Registry Numbl.!r (9fa numba exists) ofeach monomer or other reactant used in thl.!**manufactur~** 

### ofthe polymer. (2)- 

### l\lark (X) this column ifentry in column (1) is conlidentiaL {3)

- 

### Indicate the typical weight percent ofeach 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 kss to be listed as part ofthe polymer description on the TSCA Chemical Substance Inventory. (5)

- Mark (X) this column ifentries in columns (3) and (4) arc confidential. (6) Indicate the maximum weight percent ofeach monomer or other reactant that may be present as a residual in the polymer as manufactured for commercial purposes. (7)- 

### Mark (X) this column ifentry in column (6) is confidential. i\tonomcr or other reactant and CAS H.cgistry Number Confi- Typical Identity Conli- :\laximum Conti- (1) dcntial Composition i\lark (X) dential Residual dential (2) (3) (-') (5) (6) (7) 

### % % 

### % % % % % % % % 

# 0 Mark (X) 

### this box 

### if you attach a continuation sheet. c. Pkase identitY which method used to (kvdop or obtain the spccilkd chemical idl.!ntity information reported in this notice. (check one). 

# 0 Method I {CAS Inventory Expert Service- a copy ofthe idl.!ntilication report 

# 0 Method 1 (other source) obtained from the CAS Inventory Expert**s~rvic~** 

### must be submitted as ·. 

### an attachment to 

### this notice) d. The currently correct Chemical Abstracts (CA) name for the polyml.!r that is consistent \\ith TSCA Inventory listings for similar poIymers.

' 

### c. Pnn·ide a correct representation or partial chemical structure diagram. as complete as can be known, ifone can be reasonably**asccrtain~d.**



# D Mark (X) this box ifyou attach a continuation**shc~l.**

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

## Part I-- GENERAL INFORMATION --Continued Section B -- CHEMICAL IDENTITY INFORMATION-- Continued 3. Impurities (a) ..• Identify each impurity that may be reasonably anticipated to 

### be present in the d1emical substance as manufactured for commercial purposes. Provide the CAS Registry Number ifavailable. Ifthey are unidentified inlJurities, enter ''unidentified." (b)·· Estimate the maximum weight% ofeach impurity. Ifthere are unidentified inlJurities, estimate their total weight%. Impurity and CAS Registry Number Maximum Conti· (a) percent dential {b) 

## X X X X X X


# D Mark (X) this box ifyou attach a continuation sheet 4. Synonyms·· Enter Conti· dential



## X 

# D rvlark (X) this box ifyou attach a continuation sheet 5. Trade ickntitication ·· 

## X 

# D Mark {X) this box ifyou attach a continuation sheet 6. Generic chemical name·· Ifyou claim chemical identity as confidential. you must provide a generic chemical name for your substance that reveal s the specific chemical identity ofthe new chemical substam:c to the maximum extent possible. Refer to the TSCA Chemical Substance Inventory. 1985 Edition, Appendix B for**guidanc~** on developing generic names.


### Acrylate Ester 

# D Mark (X) this box 

### ifyou attach a continuation sheet 7. Byproducls -· 0-:scribl.! any byproducts from the**manu!l1ctur~. proc~ssing.**  usc. or disposal ofthe new chemical substance. Provide the CAS Rc!l.istrv Number if availabk. Byproduct CAS Registry Number Conli· (I) 

### (2) dcntial 

## X X 

## X X X 

## X X X 

# D Mark (X) this box ifyou attach a continuation sheet FORM EPA 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. I. Production volume- Estimate the 

### maximum production volume during the first 12 months ofproduction. Also estimate the maximum production volume for any consecutive 12 month period during the first three years ofproduction. Estimates should be on 100% new chemical substances basis. For Low Volume Exemption application, ifyou choose to have your notice reviewed at a lower production volume than I0,000 kg/yr., specify the volume and mark (x) in the binding box. Ifgranted, you are bound to this volume. Maximum first 12-month production (kg/yr) Maximum 12-month production (kg/yr) Conti- Binding ( 100% new chemical substance basis) ( 100% new chemical substance basis) dential Option Mark (X) 

## X
2. Use Inf'ormation- You must make separate confidentiality claims for the description ofthe category ofuse, the percent ofproduction volume devoted to each category, the formulation ofthe 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 ofuse ofthe new chemical substance by function and application. (2) --l'vlark (X) this column ifentry in column (I) is confidential business information (CBI). (3) --Indicate your willingness to have the information provided in column (I) binding. (4) --Estimate the percent oftotal production for the tirst three years devoted to each category ofusc. (5) --Mark (X) this column ifentry in column ( 4) is confidential business information (CBI). (6) --Estimate the percent ofthe new substance as formulated in mixtures. suspensions, emulsions, solutions, or gels as manufactured for commercial purposes at sites under your control associated \vith each category ofuse. (7) --Mark (X) this column ifentry in column (6) is confidential business information (CBI). (8) --Indicate% ofproduct 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 ofuse (I) CBI Binding Produc- CBI %in CBI 0/ ofsubstance expected per use CBI /0 (b) functional and application. i.e
.. a dispersive dye Option lion'% Form- (8) ll)r finishing polyester fibers) Mark (x) ulation (2) (3) (4) (5) (6) 

### (7) Site- Con- Indus- Com- Binding 

### (9) limitt:d sumer• trial mercia! Option 

## X X X 

## X X 

## X X X

*!!"you have identified a ··consumer'" usc. please provide on a continuation sheet a detailed description ofthe use(s) of this chemical substance in consumer:**product~.** In additi_on**in~lude** estimates ofthe concentration ofthe ne\\ chemical substance as expected in consumer products and describe the chemrcal reacttons by \\hJch thts substance loses its identity in the consumer product. 

# D Mark (x) this box ifyou attach a continuation sheet. b. Generic Ifyou claim any category**o~·**use description in subsection 2a as confidentiaL enter ageneric description ofthat usc category. Read the InstructtOns Manual for examples ofgeneric use descriptions. description Monomer in radiation cured coatings and inks 

# D Mark (x) this box ifyou attach 

### a continuation sheet.
3.**Ha~ar? Info:matiOJ_1-In~lude**  in**th~** notice a copy ofthe reasonable facsimile ofany hazard warning statement, label, material safety data sheet, or Binding other mtormation \\htch will be provided to any person who is reasonably likely to be exposed to this substance reoa d. t t" · • • • . . · ' :o r mg pro ec tve equtpment or Option practtces tor the sate handlmg, transport, usc, or disposal ofthe new substance. List in part III hazard information you include. Mark (X) 

# L8J Mark (x) this box ifyou attach hazard information. 

# D FORM EPA 7710-25 (Rev. 5-95) Page 7

## Part II -- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE Section A-- INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER: Mark (X) the "Confidential" box next to any item you claim as confidential.**Compkt~ s~ction**  

### A for**~ach typ~**  

### of manufacture, processing. or use operation involving the ne\v chemical substance at industrial sites you control. lmport<:.:rs do not have to compkte this section for operations outside the U.S.; however, you may still have reporting requirements 

### ifthere are further industrial processing or use operations after import. You must describe these operations. See instructions manual. I. 

### Opcratien description Contia. Identify-- Enter the identity ofthe site at which the operation will occur. dential Name 

## X

Site Address (number and street)
City. County, State. ZIP 

### Code

If

### the same operation will occur at 

### more than one site. enter the 

### number ofsites. Identify the Additional sites on a continuation sheet. and ifany ofthe sites have significantly different Production rates or operations. include all the information requested in this section for those Sites as attachments. 

# D Mark (X) 

### this box 

### ifyou attach a continuation sheet. b. 

### Type-- Mark (X) 

# D Manufacturing 

# D Processing c. Amount and Duration

-- Complete 

### I or 

### 2 as appropriate

I 

### Batch

2. Continuous Maximum kg/batch (100".;, nc'' chemical 

### Hours/batch substam:c)


### Maximum kg/day !IOO"o new d1cmical 

### Hours/day substaiH.:c) 

# D Use

d. Process description: 

# D Mark (X) to indicate your willingness to have your process description binding. 

### #ofsites

Batches/year
Days/year

(I l**Di~gra~1~** 

### the major unit**~peration** 

### steps and chemical conversions. Include interim storage and transport containers (specify-e.g. 5 gallon palls.)) gallon drum. rml car, tank truck. etc.) (2) Prov.ide the**id~ntity. th~** **appropria~e** 

### wei¥ht (by kg/day or kg/hatch on a 100% 

### new chemical substance basis), and entry point ofall startmg mater.wls and Icedstocks (mcludmg reactants. solvents. and catalysts. etc.). and ofall products. recycle streams. and wastes. Include cleanmg chemicals (note frequency 

### ifnot used daily or per batch). (3) Identify by number the points ofrelease. including small or intermittent releases. to the environment ofthe new chemical substances.

FORM EPA 7710-25 (Re\. 5-95) Page 8 '

.·.

.. 

## X

X

X



## X

## Part II-- HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE

-- Continued Section A INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER-- Continued 2. Occupational Exposure •• You must make separate conlidentiality claims for the description ofworker activity; physical fo.rm ofthe _new**~hemical** substance. number ofworkers exposed, and duration ofactivity. Mark (x) the
..Confidential" box next to any ttem you clatm as conhdenttal. {1

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

substance. (2)--Mark (X) this column ifentry in column (I) is confidential business information (CBI). (3)--Describe any protective equipment and engineering cnntrols used to p·otect workers. (4) and (6)-- Indicate your willingness to havr.:: the information provided in column (3) or (5) bind.ing.
. . . (5)--lndicate the physical form(s) and% new chemical substance (ifin mixture) ofthe new d1etmcal substance at the ttme ofexposure (t.e., solld: crystal, granule, powder, or dust) and %new chemical substance (ifin mixture). (7)--tvtark (X) this column ifentry in column {5) is confidential business information (CBI). (8)--Estimate the maximum number ofworkers involved in each activity for all sites combined. (9)--Mark (X) this column ifentry in column {8) is confidential businc.:ss information {CBI). (I0) and (II)--Estimate the maximum duration ofthe activity for any worker in hours per day and days per year. (12)--Mark (X) this column ifentry in columns (10) and (II) arc confidential business information (CBI). Worker activity CBI Protective Equipment/ Binding Physical torm(s Binding CBI #of CBI Maximum duration 

### em (i.e., bag dumping, tilling Engineering Controls Option and% new Option Workt:rs Hr/day Days/yr drums) Mark(x) substance Mark (x Exposed ( I) (2) (3) (4) (5) 

### (6) 

### (7) 

### (8) (9) (10) (II) (12) X 

### X X 

## X X X X 

# x. X X 

### X 

## X X X X X 

# 0 tvlark (X) this box ifyou attach a continuation sheet. 3. Environmental Release and Disposal-- You must make separate conlidentiality claims for the release number and the amount ofthe new chemical substance released and other release and disposal information. Mark (x) the "Conlidc.:ntial" box next to each item you claim as confidential. (I)-- Enter the number ofeach release point iclentitkd 

### in the process description. part II. section A. subsection Id(3 ). (2)--Estimate tht: amount ofthe new substance released (a) directly to the ern-ironment or (b) into control technology (in kg/day or kg/batch). (3 )--tvlark (X) this column 

### in entries in columns {1) and (2) arc conlidcntial business information (CBI).**{-t)--l<.kntif~:** the media (stack air. fugitive air (optional-s!.!e Instruction tv1anual). surface water. on-sit!.! or off-site land or incineration. POT\\', or other (specify) to which the new substance will be released fi·om that release point. (5 )--a. Describe control technology. ifany. and control efficiency that will be used to limit the release ofthe new substance to the environment. For releases disposed on land, characterize the disposal method and state whether it is approved for disposal ofRCRA hazardous waste. On a continuation sheeL for each site describe any additional disposal methods that \viii 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)--ivlark {X) this column ifentries in columns (..J.) and (5) are confidential business information (CBI). (7)--ldentify the tkstination(s) orrekascs to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct dischargers or NJ>DES numbers ofthe POT\\' (Publicly Owned \Vater Treatment Works). !\lark (X) ifthe POTW name or NPDES #is contidential business information {CBI). Rckasc Amount of nc\\ CBI Media of Control tcchnolo£!.\' and eflicicncv (you may wish to optionally attach efficiency data) CI31 Number substance released release c g. Binding slack air Mark (I) (2a) (2b) (3) 

### (4) (5a) (x) (5b) 

### (6) X 

## X X 

## X X 

## X X 

## X (7) Mark (x) the 

# D POTW provide names bclmv: CI31 

# 0 Navigable 

# D Other-specify provide NPDES # CBI destinations or Waterway releases to water t-- 

# 0 Mark (X) this box ifyou attach a continuation sheet.
FORM EPA 7710-25 (Rev. 5-95)**Pag~:9**

## Part II --HUMAN EXPOSURE AND ENVIRONMENTAL RELEASE -- Continued Section B -- INDUSTRIAL SITES CONTROLLED BY OTHERS

Complete section B for typical processing use operations involving the new chemical substance at sites you do not control. Optional for typical manLifacturing or processing operations involving the new chemical substance at sites outside the U.S. that you do not control- see Instructions Manual. Complete a separate section B for each type ofprocessing, or usc operation involving the new chemical substance. Ifthe same operation is performed at more than one site describe the typical operation common to these sites. Identify additional sites on a continuation sheet. Optional for sites outside the United States.

- See Instructions Manual.

· t. 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- 5 gallon pails, 55 gallon drums, rail cars, tank trucks, etc.). On the diagram, identil)' by letter and brielly describe each worker activity. (2)

-- Provide the identity, the approximate weight (by kg/day or kg/batch, I00% ne\v chemical substance basis), and entry point ofall feedstocks (including reactants solvents and 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 ofthe new chemical substance. (4)- Please enter the# ofsites (remember to identity the location ofthese on a continuation sheet. Enter# ofsites

__ _



## [g) tvlark (X) this box ifyou attach a continuation sheet. 2. Worker Exposure I Environmental Release (I)-- From the diagram above. provide the letter for each \vorker activity. Complete 

### 2- 8 for each worker activity described. (2) --Estimate the number ofworkers exposed for all sites combined. ( 4)

-- Estimate the typical duration ofexposure per \vorker in (a) hours per day and (b) days per year. ((l) --Describe physical form ofexposure and% new chemical substance (ifin mixture), and any protective equipment and engineering controls, if any used to protect workers. {7)
-- Estimate the percent ofthe new substance as formulated when packaged or used as a final product. (9) --From the process diagram above. enter the number ofeach release point. Complete 9-13 for each release point identified

1 (10) --Estimate the amount of the new chemical substance release (a) directly to the environment or (b) into control technology to the en\ironmcnt (in kg/day or kg/batch). ( 12) --Describe media ofrelease (stack air, fugitive air, (optional- sec Instructions Manual), surface water, on-site or otT-site land or incineration POTW, or other (specify)) and control technology. ifany. 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 ofthe proceeding entries are confidential business information (CBI). Letter # of CBI Duration CBI Protective Equip. I % in CBI Release Amount of CBI Control CBI of Workers of Engineering Controls I Form- Number New Technology Act- Exposed Exposure Physical Form and % ulation Substance 1iYity ne\\' 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 ifyou attach a continuation sheet

fORI\! EPA 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 n1inin1ize potential risks associated with activities surrounding n1anufacturing, 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 an1ount or toxicity ofchen1ical wastes by technological n1odification, process and procedure n1odification, product reformulation, raw materials substitutions, and/or inventory control. Recycling refers to the reclamation ofuseful chemical discharges, or land disposal. Descriptions ofpollution prevention, source reduction and recycling should en1phasize potential risk reduction subsequent to con1pliance with existing regulatory requiretnents and can be either quantitative or qualitative. The EPA is interested in this infonnation to assess overall net reductions in toxicity or environn1ental releases and exposures, not the shifting ofrisks to other environmental media or non-environmental areas (e.g., occupational or consumer exposure). In addition, inforn1ation on the relative cost or perfonnance characteristics 

## f the PMN substance to potential alternatives may be provided. 

## All information provided in this section will be taken into consideration during the review o f 

## 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 ofwaste materials through recycling, source reduction or other means; (4) a reduction in potential toxicity or human exposure and /or environmental release; (5) and increase in product performance, a decrease in the cost ofproduction and /or improved operation efficiency ofthe new chemical substance in comparison to existing chemical substance used in similar applications; 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.



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

rORM EPA 7710-25 (Rev. 5-95) Page II

## Part III-- LIST OF ATTACHMENTS
Attach continuation sheets for sections ofthe form and test data and other data (including physical I 

### chemical properties and structure I 

### activity information), and optional information after this page. Clearly identify the attachment and the section ofthe form towhich 

### it relates, ifappropriate. Number consecutively the pages ofthe attachments. In the column below, enter the inclusive pagenumbers of each attachment. Mark (X) 

### the "Confidential" box next to any attachment name you claim as confidential. Read the Instructions Manual forguidance on how to claim any information in an attachment as confidential. You must include with the sanitized copy ofthe noticeform a sanitized copy ofany attachment in which you claim information as confidential. Attachment name Attachment Conftpage number(s) 

### dential 

## X X X X X X X X X



# 0 Mark (X) 

### this box ifyou attach a continuation sheet. Enter the attachment name and number.

FORI\! EPA 7710-25 (Rev. 5-95) Page 12

## PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET To assist in EPA's revi.-:w ofphysical 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 ofthe 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 arc 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 Mark (X) 

### if Page Value Measured 

### Confiprovided number or Estimate 

### dcntial (a) (b) (c) (MorE) 

### Mark (x) (d)
Physical state ofneat substance _(s)_(l)

__(g) 

## X Vapor pressure@ Temperature 

# oc torr Dc1isity I 

### relative density glcm3 

## X Solubility

@Temperature Solvent giL Solubility in water@ Temperature g/L 

## X Mdting temperature 

# oc Boiling I 

### sublimation temperature @ 

### torr pressure Spectra 

## X Dissociation constant Particle size distribution Octanol I 

### \\akr partition coefficient I

### knr{s Law constant Volatilization from water Volatilization from soil 

### pH 

### @concentration

__ Flammability Explodability Adsorption I 

### coefficient Other- 

### specify 

## X X

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