### , Saititpzect Copy p. 1 Public reporting burden for this collection ofinformation is estimated to average 110 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, U .S. Environmental Protection Agency, 401 M . St., S.W

., Washington, D

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

### CERTIFICATION I certify that to the best of my knowledge and belief : 1 . The company named in Part I, section A, subsection 1 a of this notice formintends 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 ofthe date of submission. 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 ofthe Premanufacture Notification Rule. Additional Certification Statements : Ifyou are submitting a PMN, Intermediate. PN1N, Consolidated PMN, or SNUN, check the following user fee certification statement that applies: ® The Company named in Part I, Section Ahas remitted the fee of $2500specified in 40 CFR 700 .45(b), or

~ The Company named in Part I, Section Ahas remitted the fee of $1000for an Intermediate PMN(defined @ 40 CFR 700 .43) in accordance with 40 CFR 700 .45(b), or 0The Company named in Part I Section Ais 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)(1) or a Low release and low

exposure exemption (LoRex) application in accordance with 40 CFR 723.50(c)(2), check the following certification statements: Fj 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 CFR723.50 . 0The manufacturer is familiar with the terms of this section andwill comply with those terms ; and 

### R The new

chemical substance for which the notice is submitted meets all applicable exemption conditions. Fj If this application is for an LVE in accordance with 40 CFR 723.50(c)(1), the manufacturer intends to commence manufacture ofthe exempted substance for commercial purposes within 1 year ofthe date of the expiration ofthe 30 day reviewperiod. The accuracy of the statements you make in this notice should reflect your best prediction of the anticipated facts regarding thechemical substance described herein. Any knowing and willful misinterpretationis subjectto criminal penalty pursuant to 18 USC 1001 . Signature and title ofAuthorized Official (Original SignatureRequired) I Date 

### Richard Green, M

.S ., Director, Regulatory Affairs Signature ofagent - (ifapplicable) Date Confidential

EPA FORM

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