PMN Page 1 ; Page 1 ·.of· 36 

U.S. ENVIRONMENTAL PROTECTION AGENCY 

PREMANUFACTURE 

NOTICE 

.. 

t ................. -....J.VI.UI 14U.IUV~I Vt }J4!$\.:'~<3 

the Prcmanufacturc Notice. 

' . 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 if you do 

not have actual data. . : . . .. , · ' .. - •--· ·· ·· Til ' 

Befor~ you co'mple~'this f~rm. you should read the "Instructions Manual for Pre~anufa~rure Notiticatio~:. (the. i~c·t~6:nis M:tnual is avaifible from the Toxic 

Substances Control Act (TSCA) Information Service by ca1ling 202·5.14-1404, or faxing 202-554-5603).: · · · ' .. ' · · .jl . ) • • c T'~"'"f • I n ~ 

If a user fee has been remitted for this notice (40 CFR 700.45), indicate in the boxes above the TS-user fee iden~,fiC:J.tion:rlumber you hav~:~enerated. Remember, 

your user fee ID number must also appear on your corresponding fee remittance, which is sent to EPA, Washirigttin Finahcial Management:t'enter (3303). P.O. 

360399M. Pittsburgh. PA 15251-6399, Attn.TSCA User fee. "· ; . 1 

•. I • ; I J ~ II' 

Part 1 __:_GENERAL rNFORMA TION; l(!;' 

lif ,, f;,.. . • • I' ' : :1.,. "~1ft 

You must provill"e the ~urrendy correct Chemical· Abstr.lcts {CA) NaJnF of the new., 

chemic~! substance, evtn if you claim.the identity as confidential. You may authon~e 

anothetl·person to submit chemical ide,ntity information f<?r YOJ-1. bul Yii submissi~~will 

not be'eomplete and the review_ will Apt begin ~il EPA.CI!te\ves this. i.!lformatibn.," ~A letter 

in support of your submission should,f~ference }'~ll! TS ~f .fee ident!!lcatiori nu."!ber. '. 

You mtu submtJ an ~gmal and tw'\C.OPies of ~Is, notu;£ mdudmg a'fl test data. If you• 

claimed aov infQrmatis>n as confidential: a singl{ sanitized copy must tel so be submitted: . · .• · . ~.. ~~ 1~·~. h.. .,, . 

. ,,.. ~-..-:: (j' i • • ...... 

Part II- HUMAN EXPOSURE AND ENVIRONMHlTAL RELEASE 

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

sections A and H of this noti,e, reproduce the ~!.ions as.n~ded. ";' 

.· Part Ill-LIST OF ATTACHMENTS 

'\ . ' ~. I 

~z TEST DATA ~~D O~E~~P~i~. /~· . '!' •. 

~·-.: You are re,quir~d to su~mit'~l'I~s?d~tN'in 'yotir.pos~~ssim1:or control and to 

.. :1,: · provi~e a desc~ption q.·fall·.~~i/fia~~nown)f ~~ reason~bly .ascertainable by 

.. ·.·. you, tfthde dat4. are r~ted to th~ he~th and envtronmental effects on the 

# ., manufacture, pl'ocessil)g, di~~b~tio~:~9· c~m~erce. ~se. or disposal of the new 

chemical substance. Standard literature citatwns may be submitted for data in the 

•.'n 1 open scientific literature. Complete test data (written in English). not summaries 

.~.·!· of data must be submitted if they do not aopear in the open literature. You should 

,

1 

Ji clearly identify whether test~ta js on:the su~tance or on;.n an~log. Also, the 

~':' chemical composition of the tested material should be characterized. Following 

are examples oftest dita and other data,_ Oat~ should be sy.bmined a~cording to 

the requirements of §720.50 ofthe:Premanufacture Notifi~atim1Rule"(40 CFR Part 720). . .• . '• .· ~-

'.fl 

~ ·ft. -~ :'t",·.• .:. w; 11-.-...: ·I· ~· ;, <l {' 

Test Data (~heck Btlow:Hny inclu4ed intf.tlisJ!'ltic_e) . , ,

1

) 

··r ! ff; .. /•tJ~. • .J . an .fk tr 

Attnch1kiditional sheets iftherc; Environmental fate data D Ye~ · - ·dlhef Jata 1('0:. Yis 1is not enough space to answer a question fully. Label each 

continuation sheet with the corresponding section heading. In Pactlll,list these 

attachments, any test dalS or other Gta and any optional infonnation included in the Jiotice. ,. t t 

• ~ Health effectsdata t '· .. ,; " D 

D 

D 

Yes 

~ 

OPTIONAL INFORMATION ~~} 

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

substance. On page II of this form. space has been provided for you to describe :~ 

pollution prevention and recycling information you may have regarding the new substance. 

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

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

production volume. protect1ve equipment ... Th1s option is mtended to reduce delays that 

rouunely accompany the development of consent orders or Significant New Use Rules. 

Except m the case of exemption applications (such as TMEA, LVE, LOREX) where 

certam information provided m such notification IS bindmg on the submitter when the 

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

by itself prohibit the submitter from later deviating from the information (except chemical · 

identity) reported in the form. ~~, '! · 

CONFIDENTIALITY CLAIMS 

You may claim any information m this notice as confidential. To assert a claim on tb; i 

form. mark (X) the confidential box next to the infonnation that you claim as confidential. 

To assert a claim in an attachment. circle or bracket the infonnation you claim as :~ 

confidential. If you cla1m information in the notices as confidential you must also paiY;dC 

a sanitized version of the notice f including attachments). For additional instructions on ' 

claimi~rmation as confidential, read the Instructions Manual. 

0 ~1ark (x) if any information in this notice is claimed as confidential. 

' t 'J> 

Environmental effects data 

' ·. t/. 

Physical/Chemical. Properties• 

TYPE OF NOTICE 

Yes 
Public reporting burden for this collection of information i!l estimated to average 110 hours per response, lnduding time for reviewing instructioru, 

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 0\ief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency,401 M. St., S.W., Washington, D.C. 20460; and to the Office c 

Management and Budget. Paperwork Reduction Ad (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 la of this notice form intends to manufacture or import for a 

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

Part I, Section B. 

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

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

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

Additional Certification Statements: 

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

statement that applies: 

(.&] The Company named in Part 1, Section A has remitted the fee of $2.500 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 Intermediate PMN (defined@ 40 CPR 700.~ ) 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 CFR 700.45 (b). 

If you are submitting a low volume exemption (L VE) application in accordance with 40 CFR 723.50 (c) 0) or a Low 

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

certification statements: 

0 

0 

0 

0 

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. 

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

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

If this application is for an L VEin accordance with 40 CFR 723.50 (c)(l), the manufacturer intends to commence 

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

30 day review period. 

The accuracy of the statements you make in this notice should reflect your best prediction of the antidpated facts regarding the chemical 

substance described herein. Arly knowing and willful misinterpretation is subject to criminaJ perulty pursuant to 18 USC 1001. Confidmti• 1 

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

X 

Signature of agent- (if applicable) Date 

FORM EPA 7710-25 (Rev. 5-95) Page2 
la. Person 

f:ubmlttm,~ 

.Notice 

On US.) 

b. Agent (lf 

applicable) 

Part I -GENERAL INFORMATION 

(number and street) 

Oty, State, ZIP Code 

Name of authorized offidal 

Company 

Mailing addre$8 (number and street) 

Cty, State, ZIP Code 

Telephone 

c. If you are submitting this notice as part of a joint submission.. mark 00 thLs box. ---------------. 

joint Name of authorized official 

Submitter 

(if applicable) 

2.Tedlnical 

Contact 

OnUS.) 

Mailing address (number and street) 

Oty, State. ZIP Code 

Name 

Company 

Maili:ng addreae (number U\d street) 

Oty, State, ZIP Code 

3. U you have had a prenotia! communication (PC) mnceming this notice 

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

4. If you previously submitted an exemption application for the chemical 

tubstanc:e covered by this notice.. enter the exemption number assigned 

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

PMN numOOJ" assigned by EPA (i.e. withdrawn or incomplete). __ .,....,.. 

If you have submitted a notice of Bona fide intent to manufacture or 

import for the chemicalaubstance covered by this notice, enter the 

notim number usigned by EPA. > 

Type ol Notice- Mark 00 D Manufacture 

1. Only 

D 

FORM EPA 7710-25 (Rev. 5-95) Page3 

Position 

Tdephone 

Position 

Telephone 1 

I 

2. D Import 

Only 

Mark (X) 

il none 

Mark (X) 

If none 

Mark (X) 

if none 

D BindingOption 

Mark(x) 

> D 

> D 

>- D 

3. [!]Both 

X 

X 

X 
PMN Page 4 ; Page 4 of 36 

Part I - GENERAL INFORMATION- Continued 

Section B- CHEMICAL IDENTITY INFORMATION: I You must provide a currently correct Chemical Abstracts (CA) nam. e of the substance based on the mnrh 

l Collecti\'e Index (9C!) ofCA nomenclature rules and conventions 

Mark (X) the "Confidential" box next to anv item vou claim as confidential 

Cor. 'etc either item I (Class I or 2 substances) or 2 (Polymers) as appropriate. Complete all other items. 

If another person will submit chemical identity information for you (for either hem I or 2). mark (X) the box at the right. O 

Identify the name. company. and address ofthat_E_crson in a continuation sheet. 

1. Class 1 or 2 chemical substances (for definitions of class I and class 2 substances. sec the Instructions Manual) 

a. Class of substance - Mark (X) I 0 Class I or 2 0 Class 2 

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

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

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

c. 

d. 

c. 

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

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

report obtained from the CAS Inventory Expcn Services must be 

submitted as an attachment to this notice) 

Molecular formula CBI 

D 

CAS Registry Number 

(if a number already 

exists for the substance) 

For a class I substance, provide a complete and correct chemical structure diagram, For a class 2 substance, provide a correct representative or 

panial chemical structure d1agram. as complete as can be known. if one can be reasonably ascertained. Please sec the E-PM>J Instruction Manual for 

discussion of "native format" diagram software which can be helpful in reviewing your substance. 

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

EPA FORM 7710-25 (Rev. 5-95) Page 4 

Confidential 

D 

D 

D 

D 
PMN Page 4a ; Page 5 of 36 

For a class 1 substance- (I) List the immediate precursor substances with their respective CAS Registry Numbers. (2) Describe the nature of the reaction or process. 

(2 ;. Indicate tl.c range of composition and the typical composition (where appropriate). 

c. (I) List the immediate precursor substances with their respective CAS Registry Numbers. ConfiName (CAS#) dential 

D 

c. (2) Describe the nature of the reaction or process. D 

c. (3) lnd1catc the range of composition and the typical composition (where appropriate). D 

D Mark (XJ this box ifvou attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 4a 
PMN Page 5 ; Page 6 of 36 

Part I- GENERAL INFORMATION- Continued 

Section B CHEMICAL IDENTITY I:'IJFORMATION- Continued 

2. Polymers (For a definition of polymer. sec the Instructions Manual.) Confidcntial 

a. Indicate the number-average weight of the lowest molecular weight composition of the polymer you intend to manufacture. 0 Indicate maximum weight percent of low molecular weight species (not including residual monomers. reactants. or solvents) below 500 and 

below 1.000 absolute molecular weight of that composition. 

Describe the methods of measurement or the basis for your estimates: GPCD Other D: (Specify below) 

(i) lowest number average molecular weight: 

I I 

(ii) maximum weight % below 500 molecular weight: 

(iii) maximum weight% below 1000 molecular weight: 

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

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

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

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

the polymer. 

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

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

(4) Choose "yes" from drop down menu if you want a monomer or 01her 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) arc confidential. 

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

commercial purposes. 

(7) - Mark (Xl this column if entrv in column (6) is ccnfidcntial. 

Monomer or other reactant and CAS Registry Number Conti- Typical Include in Confi- Maximum Confidential composition identity dcntial res1dual dcntial 

(I) (2) (3) (4) (5) (6) (7) 

00 o;o D 00 "lO 00 

[RJ % D 00 % 00 

D o;o D D % D 

D ~'0 D D % D 

D % D D % D 

D ~0 D D % D 

D ~'0 D D 01~ D 

D % I ID % I 

D % D ~~ I 

D % I ID % I 

D o/o I ID % I 

D % I I D % I I 

D o/o il D o/o I I 

D Mark (X) th1s box if you attach a continuation sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 5 
PMN Page Sa; Page 7 of 36 

c. o Please identify which method you used to develop or obtain the specified chemical identity infol1113tion reported in thts notice (check one). CBI 

Method I (CAS Inventory Expert Service- a copy of the identification report D Method 2 (other source) 00 obtained from CAS Inventory Expert Service must be submitted as an attachment to this notice) 

tl. The c,1rrently correct Chemical Abstracts (CA) name for the polymer that is consistent with TSCA Inventory listings for Similar polymers. 

00 

CAS Registry Number (if a number already exists for the substance) m c. Provide a correct representative or partial chemical structure diagram. as complete as can be known, if one can be reasonably ascertained .. Please 

sec the E-PMN Instruction Manual for discussion of"native format" diagram software which can be helpful in reviewing your substance. [KJ 

I 

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

EPA FORM 7710-25 !Rev. 5-95) Page Sa 
PMN Page 5 ; Page 8 of 36 

Part I-- GENER-\L INFORMATION- Continued 

Section B- CHEMICAL IDENTITY INFORMATION- Continued 

2. Pol:rmcrs (For a definition of polymer, sec the Instructions Manual.) Contidential 

a. Indicate the number-average weight of the lowest molecular weight composition ofthc polymer you intend to manufacture. 0 Indicate maximum weight percent of low molecular weight species (not including residual monomers. reactants. or solvents) below 500 and 

below 1.000 absolute molecular weight of that composition. 

Describe the methods of measurement or the basis for your estimates: GPcD Other D· (Specify below) 

(i) lowest number average molecular weight: 

I I 

(ii) maximum weight% below 500 molecular weight: 

(iii) maximum weight% below 1000 molecular weight: 

[l !\lark (X) this box if you 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 

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

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

the polymer. 

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

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

(4) Choose "yes" from drop down menu if you want a monomer or other reacmnt 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) arc confidential. 

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

commercial purposes. 

(7) Mark (X) this column if cntrv in column (6) is confidential. 

Monomer or other reactant and CAS Registry Number Conti- Typical ldent1ty Confi- Maximum Confidcntial composition Mark (X) dcntial residual dcntial 

(I) (2) (3) (4) (5) 16) (7) 

00 % D 00 <}Q 00 

IK 0' /0 D 00 % 00 

D 0/0 D D 0' /0 D 

D 0' /0 D D % D 

D o/'0 D D 0;0 D 

D % D D % D 

D ~0 D D ~~ 

CJ o/o I II I % 

II I o;o I II I 00 

II I o;o % I I 

CJ o/o % I I 

CJ o;o o;o I I 

CJ %11 % I I 

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

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

d. 

c. 

PMN Page Sa ; Page 9 of 36 

Please identify which method you used to develop or obtain the specified chemical identitv infonnation reported m this notice (check one). o Method I. (CAS Inventory Expert Service- a copy of the identification report 0 Method 2 (other source) 

obtamcd from CAS Inventory Expert Serv1ce must be submitted as an attachment to this not1ce) 

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

CAS Registry Number (if a number already exists for the substance) 

Provide a correct representative or partial chemical structure d1agram. as complete as can be known. if one can be reasonably ascertamed .. Please 

sec the E-PMN Instruction Manual for discussion of "native fonnat" diagram software which can be helpful in reviewing your substance. 

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

EPA FOR1v1 7710-25 (Rev. 5-95) Page Sa 1 

CBI 

00 
PMN Page 5 ; Page 1 0 of 36 

Part I- GENERAL INFORMATION- Continued 

Section B CHEMICAL IDENTITY INFORMATION- Continued .., Polymers (For a definition of polymer, sec the Instructions Manual.) Contidcntial 

a. Indicate the number-average weight of the lowest molecular weight composition of the pol)mcr you intend to manufacture. 0 lndtcate maximum weight percent of low molecular weight species (not including residual monomers. reactants, or solvents) below 500 and 

below 1.000 absolute molecular weight of that composition. 

Describe the methods of measurement or the basis for your estimates: GPcD Other D: (Specify below) 

(i) lowest number average molecular weight: 

I I 

(ii) maximum weight% below 500 molecular weight: 

(iii) maximum weight% below 1000 molecular weight: 

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

b. You must make separate confidcntiahry claims for monomer or other reactant identity. composition information. and residual informatiOn. Mark (Xl the 

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

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

the pol)mcr. 

(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 pol>mer. 

(4) Choose "yes" from drop down menu if you want a monomer or other reactant used at two weight percent or less to be listed as part of the polymer 

description on the TSCA Chemical Substance Inventory. 

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

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

commercial purposes. 

(7) t-.tark (X) this column if cntrv in column (6) is confidential. 

Monomer or other reactant and CAS Registry Number Confi- Typical Identity Confi- Maximum Contidcntial composition Mark (X) dcntial residual dcntial 

(I) (2) (3) (4) (5) (6) (7) 

00 % D 00 % 00 

00 o/o D 00 % 00 

00 ~0 D 00 % 00 

D q,o D D % D 

D % D D % D 

D o• IO D D % D 

D 0. 

/0 D D % 

CJ % % I I 

CJ "' /0 I % I I 

CJ 0. 

IO II I % I I 

CJ 0• 

/0 II % I I 

CJ n,o II I % I I 

CJ o• 10 II I % I I 

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

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

fO 
PMN Page Sa ; Page 11 of 36 

c. Please identifv which method you used to develop or obtain the specified chemical identifY information reported in thts notice (check one). CBI 0 Method.! (CAS Inventory Expert Service· a copy of the identification report 0 Method::! (other source) 00 obtained from CAS Inventory Expert Semce must be submitted as an attachment to thts nottcc) 

d. The cu,Tently correct Chemical Abstracts (C A) name for the polymer that ts consistent with TSCA Inventory listings for similar polymers. 

00 

CAS Registry Number (if a number already exists for the substance) rn c. Provide a correct representative or parttal chemical structure diagram. as complete as can be known. if one can be reasonably ascertained .. Please I K J sec the E-PMN Instruction Manual for discussion of "native format" diagram software which can he helpful in rcvicwmg your substance. 

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

EPA FORM 7710-~5 (Rev. 5-95) Page 5a 2 
PMN Page 5 ; Page 12 of 36 

Part I- GENERAL INFORMATION- Continued 

Section B- CHEMICAL IDENTITY INFORMATION- Continued 

2. Polymers (For a definition of polymer, sec the Instructions Manual.) Confidcntial 

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

Indicate maximum weight percent of low molecular weight species (not including residual monomers. reactants. or solvents) below 500 and IT] below 1.000 absolute molecular weil!ht of that composition. 

Describe the methods of measurement or the basis for your estimates: GPCD Other U: (Specify below) 

(i) lowest number average molecular weight: 

I I 

(ii) maximum weight% below 500 molecular weight: 

(iii) maximum weight% below 1000 molecular weight: 

0 Mark (X) this box if you anach a contmuation sheet. 

b. You must make separate confidentiality claims for monomer or other reactant identity. composition information. and residual inform:mon. Mark (X) the 

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

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

the polymer. 

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

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

(4) Choose "yes" from drop down menu if you want a monomer or other reactant used at two weight percent or less to be listed as part of the polymer 

description on the TSCA Chemical Substance Inventory. 

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

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

commercial purposes. 

(7) - Mark (X} this column if entrv in column (6) is confidential. 

Monomer or other reactant and CAS Registry Number Conti- Typical Identity Conti- Max1mum Contidential composition Mark (X) dential residual dcntial 

(I} (2) (3) (4) (5) 16) (7) 

00 '% D 00 ~0 00 

00 % D 00 % 00 

00 % D 00 0

;0 00 

D ot'O D D ~(s D 

D 0. 

IO D D o,o D 

D 0' /0 D D {J/0 D 

D % D D 0' IO 

CJ % I I % I 

CJ o/o I I % I 

c=J 0

/o I I 0;0 I 

CJ 0' IO I I % I 

CJ '% I I % I 

CJ o/o I I I % II 

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

EPA FORM 7710-25 (Rev. 5-95) Page 5 3 

(W,. 
PMN Page Sa Page 13 of 36 

C. Please identify which method you used to develop or obtain the specified chemical idcntitv information reported in this notice (check one). CBI 0 Method I (CAS Inventor)' Expert Service- a copy of the identification report 0 Method 2 (other source) 00 obtained from CAS Inventory Expert Service must be submitted as an attachment to this notice) 

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

00 

CAS Registry Number (if a number already exists for the substance) [!] c. Provide a correct representative or partial chemical structure diagram. as complete as can be known, if one can be reasonably ascertained. Please I X I sec the E-PMN Instruction Manual for discussion of "native format" diagram software which can be helpful in reviewing your substance. 

0 !\lark (X) this box if you attach a continuation sheet. 

EPAFORI\17710-25 (Rcv.S-95) Pagc5a 3 

·.f~ 
PMN Page 6 ; Page 14 of 36 

3. Impurities 

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

the CAS Registry Number if available. If there an: unidentified impurities, eoter "unidentified." 

Estimate the maximum · % of each If there unidentified · estimale their local %. 

Impurity and CAS Registry Number Maximum 

none 

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

5. Trade idenlification List trade names for the new chemical substance identified in subsection 1 or 2. 

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

6. Generic cb~mical name- If you claim chemical identify ll.ll coofidential, you muJt provide a generic name for your substance that reveals 

the specific chemical identity of the new chemical substaoce to the mnimum extent possible. Refer to the 

TSCA Chc:mical Substance Inventory, 1985 Edition, Appendix B for guidan::e on developing generic names. 

Treated Silica 

attach 11 continuation sheet. 

percent 

% 

% 

~-

% 

% 

% 

% 

Confidential 

D 

D 

D 

D 

D 

D 

D 

Coofidential 

D 

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

Number if available. 

CAS Number 

none D 

D 

D 

D 

EPA FORM 7710-25 (Rev. 5-95) Page 6 
1i!::J UUJ 

PMN Page 6 ; Page 15 of 36 

3. Impurities 

(a) - Identify eacb impurity that may be rea11onably anticipated to be present in the chemical substance a5 manufactured for commercial purpose. Provide 

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

Estimate the max.imum · eaeb . If there are unidentified estimate their o/o. 

Impurity aod CAS Registry Number Maximwn Confi· 

percent dentia1 

none 

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

5. Trade identification - List trade names for the oew chemical substance identified in subsection 1 cr 2. 

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

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

the specific chemical identity of the new chemical substance to the maximum extent poss:ble. Refer to the 

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

Treated Silica 

attach a continuation sheet. 

% 

% 

% 

~;. 

% 

% 

o;. 

D 

D 

D 

D 

D 

D 

D 

Confi· 

dcntial 

D 

Describe any byproducts resulting from the manufacrure, pro::essiog, use, or disposal of lbe new chemical substance. Provide the CAS Registry 

Number if available. 

CAS 

none 

EPA FORM 7710-25 (Rev. S-95) Page 6 1 

Number Confidential 

D 

D 

D 

D 
UJ/U~/04 lti:41 FAX 517 496 5595 HLTH & E~V SCI ~004 

P~N Page 6 ; Page 16 of 36 

3. Impurities 1 

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

none 

lh.e CAS Registry Number if available. If then: are unidentified impurities. enter ''unidentified." 

Estimarc the maximum wei % of c:ach · ' If there are unideolified · estimate their total 

Impurity and CAS Registry Number 

I 

i 

4. Synonyms- Enter a.oy chemical synonyms for the new chemical identified in subsection 1 or 2. 

0 Mark (X) this box if you anach a continuation shcel 

5. Trade identification- List trade names far the new cbemjcal substance identified in subsection 1 or 2. 

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

Vo. 

Maximum 

percent 

6. Generic chemical name • If you claim chemical idenrity as confidential, you must prov1de a geoeric name for your substance that re\'eals 

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

TSCA Chemical Sub:rtam;e Inventory, 1985 Edition, Appendix B for guidance on developing generic names. 

Treated Silica 

attach a continuation sheet 

% 

% 

o/o 

ii 

% 

% 

% 

Confi· 

deotial 

D 

D 

D 

D 

D 

D 

D 

Contideotial 

D 

resulting from the manufacture, processing, usc, or disposal of the new chemical substance. Provide the CAS Registry 

CAS 

Am~ania 7664-41-7 

EPA FORM 7710-25 (Rev. 5-95) Page 6 2 

Number Confidential 

D 

D 

D 
03/09/04 16:41 FAX 517 496 5595 HLTH & Ei\V SCI ~005 

PMN Page 6 ; Page 17 of 36 

3. Impurities 

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

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

the max.imu.m % o each· fthere are · · estimate their total %. 

[mpurity and CAS Registry Number Mnxir:mm 

pcn;:ent 

none 

4. Synonyms· Enter any chemical synonyms for the new chemical identified in subsectwn 1 or 2. 

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

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

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

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

the specific chemical identity of the new chemical sub5tance to the maximum extent possible. Refer to the 

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

Treated Silica 

th1s box if you attach a continuation sheet 

% 

% 

% 

% 

% 

% 

% 

Confidential 

D 

D 

D 

D 

D 

D 

D 

Conf1· 

dcntial 

D 

7. Byproduch · Describe any byproducts resulting fiom the manufachm:, processing, use, or disposal of the new chemical substance. Provide the CAS Registry 

Number jf available. 

CAS 

Ammonia 7664-41-7 

EPA FORM 7710-25 (Rev. S-95) Page 6 3 

,, 

Number Confi· 

dential 

D 

D 

D 
PMN Page 7 ; Page 18 of 36 

Part I -- GENERAL INFORMATION- Continued 

Section C --PRODUCTION, IMPORT, AND USE INF0~1ATION: 

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 of production. Also estimate the maximum 

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

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

10,000 k!!lvr, specifv the volume and mark (x) in the binding box. If granted, vou are bound to this volume 

Maximum first 12-month production (kg/yr) Maximum 12-month production (kg/yr) Conti- Bindmg 

dcntial Option 

(I 00% new chemical substance basis) (100% new chemical substance basis) Mark (X) 

[KJ D 

2. Usc Information- You must make separate confidentiality claims for the description of the category of usc, the percent of production volume devoted to each 

category, the fom1ulation of the new substance, and other usc information. Mark (X) the "Confidential" Box next to any item you claim as confidential. 

a. ( 1) --Describe each intended category of usc of the new chemical substance by function and application. (2) --Mark (X) this column if entry column (I) is 

onfidcntial business infoml:ltion (CBI). (3) --Indicate your willingness to have the information provided in column (I) binding. (4) --Estimate the percent of total 

rroduction for the first three years devoted to each category of use. (5) --Mark (X) this column if entry in column (4) is confidential business infom1ation (CBI). (6) --

':stimate 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 usc. (7) -Mark (X) this column if entry in column (6) is confidential business information (CBI). (8) --Indicate% of 

product volume expected for the listed "usc" sectors. Mark more than one box if appropriate. Mark (X) to indicate your willingness to have the usc type provided in (8) 

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

Category of usc (I) (by function and application i.e. a CBI Bmdmg Prod- CBI %in CBI % of substance expected per usc CBJ 

dispersive dye for finishing polyester fibers) Opt .on uction Fonnu (8) Mark % lation (xl 

(2) (3) (4) (5) (6) (7) SIIC· Cons- lndu~- Com- Bmdmg (9) hm1tcd umcr mal OICfCI3i Opt ton 

Filler D D ~0 

~ % 

~ D ~ 

D D olo D ~0 D D D 

D D % D % D D D 

D D 0/0 D o/o D D D 

D D 0' i'o D ~0 D D D 

D D 0

t0 D ~0 D D D 

D D o• lo D 0 /0 D D D • If you have identified a "consumer" usc, please provide on a continuation sheet a detailed dcscnptton of the usc(s) ofth1s 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 whtch this 

substance loses its identity in the consumer product. 

Or--lark (X) this box if you attach a continuation sheet. 

b. Generic usc If you claim any category of usc description in subsccuon 2a as con fidcntial, enter a generic description of that category. Read the InstructiOn 

description Manual for examples of generic usc descriptions. 

l 

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

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

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

the safe handing. transpon. usc, or disposal of the new substance. List in part Ill hazard information you include. !'.brk(x) 

[K] Mark (X) this box if you anach hazard information. CD 

EPA FORM 7710-25 (Rev. 5-95) Page 7 
PMN Page 7 ; Page 19 of 36 

Part I -- GENERAL INFORMATION - Continued 

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

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

I. 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 I 00% 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, specifv the volume and mark (x) in the binding box. If granted, vou are bound to this volume 

Maximum first 12-month production (kglyr) Maximum 12-month production (kglyr) Conti- Bindmg 

( 100% new chemical substance basis) ( 1 00% new chemical substance basis) dcntial Option 

Mark (x) 

0 D 

2. Use Information - You must make separate confidentiality claims for the description of the category of usc. the percent of production volume devoted to each 

category, the formulation of the new substance, and other usc information. Mark (X) the "Confidential'' Box next to any item you claim as confidential. 

a. ( 1) --Describe each intended category of usc of the new chemical substance by function and application. (2) --Mark (X) this column if entry column (I) is 

·onfidcntial business information (CBI). (3) --Indicate your willingness to have the information provided in column (I) binding. (4) --Estimate the percent of total 

production for the first three years devoted to each category of usc. (5) --Mark (X) this column if entry in column (4) is confidential business infom1ation (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 

our control associated with each category of usc. (7) -Mark (X) this column if entry in column (6) is confidential business information (CBI). (8) --Indicate% of 

product volume expected for the listed "usc" sectors. Mark more than one box if appropriate. Mark (X) to indicate your willingness to have the usc type provided in (8) 

binding. (9} --Mark (X) this column if cntry(ics) in column (8) is (arc) confidential business information (CBI). 

Category of usc (I) (by function and application i.e. a CBI Btndtng Prod- CBI 0

/u in CBI %of substance expected per usc CBI 

dispersive dye for finishing polyester fibers) Opt1on uction Forrnu (8) Mark % I at ion (x) 

(2) (3) (4) (5) (6) (7) S1tc- Cons· lndu>· Com· Btndtng (9) limned umcr tnal mercia! Option 

Filler D D % 

~ % 

~ D ~ 

D D 0' i'o D % D D D 

D D % D % D D D 

D D o/o D o/o D D D 

D D ~lo D 0' IO D D D 

D D 0' D 0 D D D /0 •O 

D D % D o• D D D /0 

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

In addition mcludc csttmatcs of the concentration of the new chemical substance as expected m consumer products and describe the chemical reactions by which this 

substance loses its identity in the consumer product. 

DMJrk (X) this box 1fyou attach a continuation sheet. 

b. Gcncnc usc If you claim any category of usc descriptiOn in subsection 2a as confidential. enter a generic description of that category. Read the Instruction 

dcscriptton Manual for examples of generic usc dcscnptions. 

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

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

information which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective equipment or practices for Opt10n 

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

~ Mark (X) this box if you attach hazard infom1ation. ){ 

EPA FORM 7710-25 (Rev. 5-95) Page 7 I 
PMN Page 7 ; Page 20 of 36 

Part I-- GENERAL INFOM1ATION -Continued 

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

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

I. Production Yolume --Estimate the maximum production volume during the first 12 months of production. Also estimate the maximum 

productio~ volume for any consecutive 12-month period during the first three years of production. Estimates should be on I 00% new chemical 

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

I 0.000 k!!lvr. specify the volume and mark (x) in the bindine box. If granted, you are bound to this volume 

Maximum first 12-month production (kglyr) Maximum 12-month production (kg/yr) Conti- 13inJmg 

(I 00% new chemical substance basis) ( 1 00% new chemical substance basis) dcntial Option 

Mark (x) 

01 

2. Use Information - You must make separate confidentiality claims for the description of the category of usc. the percent of production volume devoted to each 

category. the formulation of the new substance, and other usc information. Mark (X) the "Confidential" Box next to any item you claim as confidential. 

a. (I) --Describe each intended category of usc of the new chemical substance by function and application. (2) --Mark (X) this column if entry column (I) is 

onfidential business information (CBI). (3) --Indicate your willingness to have the information provided in column (I) binding. (4) --Estimate the percent of total 

production for the first three years devoted to each category of usc. (5) --Mark (X) this column if entry in column (4) is confidential business infom1ation (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 

our control associated with each category of usc. (7) -Mark (X) this column if entry in column (6) is confidential business information (CBI). (8) --Indicate% of 

product volume expected for the listed "usc" sectors. Mark more than one box if appropriate. Mark (X) to indicate your willingness to have the usc type provided in {8) 

bindinl!. (9) --Mark (X) this column if entrv{ics) in column (8) is (arc) confidential business information (CBl). 

Category of usc (I) (by function and application i.e. a CBI Bmdmg Prod- CBI %in CBI % of substance expected per usc CBI 

dispersive dye for finishing polyester fibers) Opnon uction Formu (8) MaO: % I at ion (x) 

(2) (3) (4) (5) (6) (7) Sttc- Cons- lndu:>- Com· Bmdmg (9) hmitcd umcr tnal mercia! Ort•on 

D D % ~ % ~ -~ Filler 

-

D D % D ~0 D D D 

D D 0' i'O D % D D D 

D D % D ~0 D D D 

D D 0' i'o D 0' lo D D D 

D D % D ~0 D D D 

D D 0' D 0 D D D 10 '0 

. If you have identi ficd a "consumer'' usc, please provide on a continuation sheet a detailed description of the usc(s) of this chemical substance in consumer products . 

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

d~bstance loses its identity in the consumer product 

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

b. Generic usc lf you claim any category of usc description in subscctwn 2a as confidential. enter a generic description of that category. Read the Instruction 

dcscript1on Manual for examples of generic usc descriptions. 

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

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

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

the safe handing. transport, usc. or disposal of the new substance. List in part Ill hazard information you include. Mark(xl 

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

EPA FORl\1 7710-25 (Rev. 5-95) Page 7 2 
PMN Page 7 ; Page 21 of 36 

Part I --GENERAL INFORMATION- Continued 

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

Mark (X) the "Confidential" box next to anv item vou claim as confidential. 

1. Production Yolume --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 I 00% 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/vr, specify the volume and mark (x) in the binding box. If granted. vou 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) dcntial Optiun 

!\.lark (x) 

[KJ D 

2. Use Information- You must make separate confidentiality claims for the description of the category of usc. the percent of production volume devoted to each 

category. the formulation of the new substance. and other usc information. Mark (X) the "Confidential" Box next to any item you claim as confidentiaL 

a. ( 1) --Describe each intended category of usc of the new chemical substance by function and application. (2) --Mark (X) this column if entry column ( l) is 

confidential business information (CBI). (3) --Indicate your willingness to have the information provided in column (I) binding. (4) --Estimate the percent of total 

production for the first three years devoted to each category of usc. (5) --Mark (X) this column if entry in column (4) is confidential business infom1ation (CBI). (6) --

':stimatc the percent of the new substance as formulated in mixtures. suspensions, emulsions. solutions. or gels as manufactured for commercial purposes at sites under 

our control associated with each category of usc. (7) --Mark (X) this column if entry in column (6) is confidential busmcss information (CBI). (8) --Indicate% of 

product volume expected for the listed "usc" sectors. Mark more than one box if appropriate. Mark (X) to indicate your willingness to have the usc type provided in (8) 

bindine. (9) --Mark (X) this column if entrv(ics) in column (8) is (arc) confidential business information (CBI). 

Category of usc (I) (by function and application i.e. a CBI Bmdmg Prod- CBI ~0 in CBI '% of substance expected per usc CBI 

dispersive dye for finishing polyester fibers) Opnon uction Formu (8) Mark '}'U lation (x) 

(2) (3) (4) (5) (6) (7) Sue- Con>· Indus- Com- Bmdtng (9) llm1tcd umcr tnal OH."tt:taJ Ortion 

D D % ~ ~'(, ,-- D ~ Filler K 

-

D D O;Q D % -

D D 

D D ~0 D o• 

10 D D D 

D D o• /0 D 0/0 D D D 

D D % D '}0 D D D 

D D '}o D o• D D D .o 

D D 0• 

10 D O• IO D D D 

* If you have idcnti ficd a "consumer" usc, please provide on a continuation sheet a dctai led dcscnption of the usc( s) of this chemical substance in consumer products. 

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

d~bstancc loses its identity in the consumer product. 

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

b. Generic usc If you claim any category of usc descnption in subsection 2a as confidential. enter a generic dc$cription of that catcgOI)'. Read the Instruction 

dcscnption Manual for examples of generic usc descriptions. 

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

3. Hazard Information- Include in the notice a copy of reasonable facsimile of any hazard warning statement. label. material safety data sheet. or other H1ndwg 

information which will be provided to any person who is reasonably likely to be exposed to this substance regarding protective equtpmcnt or practices for Op!lon 

the safe handing. transpon. usc, or disposal of the new substance. List in pan Ill hazard information you include. Mark IX) 

[E) Mark (X) this box if you attach hazard information. ){ 

EPA FORM 7710-25 (Rev. 5-95) Page 7 3 

2! 
PMN Page 8 ; Page 22 of 36 

Section A _ INDUSTRIAL SITES CONTROLLED BY THE SUBMITTER Mark (X) the "Confidential" box next to any nem 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 roce · erations after · . You must describe these ions. See instructions manual 

of the site at which the ion will occur. 

Name 

State. ZIP code 

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

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

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

sites as attachments. 

I. Batch 

2. Continuous 

Maximum kg/day ( 100% new chem•cal Hours/day substance) 

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

Use 

Batches/year 

Days/year 

dential 

D 

(I) Diagram the major unit operation steps and chemical conversions. Include interim storage and transport contamers (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 I 00% new chemical substance basis). and entry point of all starting materials and 

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

used daily or per batch.). 

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

at the same step. assign a second release number for the second medium. 

~~ter text here. There is space on the next page for a separate file name and/or 

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

EPA FORM 7710-25 (Rev. 5-95) Page 8 
PMN Page Sa ; Page 23 of 36 

Confidential 

EPA FORM i'710-25 (Rev. 5-95) Page 8a 
PMN Page 8 ; Page 24 of 36 

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

claim as confidential 

Cqmplete se<;:tion 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 rations after · You must describe these · ons. See instructions manual 

I. 

a. of the site at which the · n will occur. 

Name 

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

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

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

sites as attachments. 

I. Batch 

2. Continuous 

Hours/batch 

Maximum kg/day ( 100'\. nc"' chcmtcal Hours/day 

substance I 

Use 

Batches/year 

Dayst:ycar 

Confidential 

D 

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 contamers !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 IOO~o new chemical substance basis). and entry point of all starting materials and 

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

used daily or per batch.). 

(3l Identify by number the points of release, including small or intcm1ittent releases. to the environment of the new chemical substance. If releasing to two media 

at the same step. assign a second release number for the second medium. 

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

EPA FORM 7710-25 (Rev. 5-95) Page 8 1 
PMN Page Sa ; Page 25 of 36 

Confidential 

EPA FORM 7710-25 (Rev. 5-95) Page 8a 1 
PMN Page 8 ; Page 26 of 36 

Section A-- lf'DUSTRJAL SITES COf'TROLLED 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 

co~trol. 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 i . You must describe these ons. See instructions manual 

a. of the site at which the tion will occur. 

Name 

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

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

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

sites as attachments. 

I. Batch 

::!. Continuous 

Hourstbatch 

Maximum kg/day ( 100"'0 new chcmtcal Hours/day 

£ubsrancc) 

d Process description t-.tark (X) to indicate your willingness to have your process description binding. 

Use 

Batches/year 

Days/year 

dential 

D 

(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.). 

(::!) Provide the identity • the approximate weight (by kg'day or kg batch on a I 00% new chemical substance basis). and entl)' point of all starting materials and 

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

used daily or per batch.). 

( 3) Identify by number the points of release, including small or intem1ittcnt releases. to the environment of the new chem1cal substance. If releasing to two media 

at the same step. ass1gn a second release number for the second medium. 

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

EPA FORM 7710-25 (Rev. 5-95) Page 8 2 
PMN Page Sa ; Page 27 of 36 

Confidential 

EPA FOR~t 7710-25 (Rev. 5-95) Page 8a 2 
PMN Page 8 ; Page 28 of 36 

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 

c~ntrol. 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 rocessi or use · s after i You must describe these · See instructions manual 

a. of the site at which the will occur. 

Name 

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

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

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

sites as attachments. 

I. Batch 

2. Continuous 

Hoursibatch 

Maximum kg/day ( IQQ",. new chcmtcal Hours/day substance) 

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

Use 

Batches year 

Days1year 

dential 

D 

(I) Diagram the major unit operation steps and chemical convers10ns. Include intcnm storage and transport contamers (specify- e.g. 5 gallon pails. 55 gallon 

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

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

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

used daily or per batch.). 

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

at the same step. assign a second release number for the second medmm. 

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

EPA FORM 7710-25 (Rev. 5-95) Page 8 3 
PMN Page Sa ; Page 29 of 36 

Confidential 

EPA FORM 7710<:!5 (Rt:v. 5-95) Page !Sa 3 
PMN Page 9 ; Page 30 of 36 

Part II-- HU1\IAN EXPOSURE AND ENVIRON1\IENT AL RELEASE -- Continued 

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

2. Occupationai Exposure- You must make separate confidentiality claims for the description of worker activity, phystcal form of the nev.· chemtcal substance. number of 

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

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

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

(3) --Describe any protective 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: Cl)Stal. granule, powder. or dust) and% new chemical substance (If pan of a mixture) at the 

time of exposure. 

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

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

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

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

( 121 --Mark (X) this column if entries in columns (10) and (II) arc confidential business information (CBI). 

Worker activity CBI Protective Equipment' Bmdmg Phys1cal Bmdmg CBI #of CBI l\1axm1Um duration CHI 

forms(s) 

(i.e .. bag dumping. filling drums) Engineering Controls Opuon and% ne\\. OptiOn Workers Hr.; Jay Daysyr MJrk{x) substance Mark (x) Exposed 

(I) (2) (3) (4) (5) (6) (7) (8) (9) (!OJ !Ill (12) 

1.._ 

-

K D D ~ -

K ~ 

L---

K D ...___ ~ -K ~ 

~ D D ~ L---

K ~ 

- D D D - D 

D D D D D 

D D D D -

- D 

D D D D -

'--- D 

D D D D ..____ D 

D D D D -

- D 

D D D D - ,..---

- '---

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

EPA FORM 7710-25 (Rev. 5-95) 9 
PMN Page 9a; Page 31 of 36 

3. En\'ironmcntal Release and Disposal -- You must make separate confidentiality claims for the release number and the amount of the new chcmtcal substance 

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

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

121-- 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) arc confidential business information (CBI). 

{4) Identify the medta (stack air. fugitive air (optional-sec 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 

d1sposcd of on land. characterize the disposal method and state whether it is approved for disposal of RCRA hazardous waste. On a contmuat10n 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 h. Estimate the 

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

( (i) --Mark (X) this column if entries in columns (4) and (5) arc confidential business mformauon (CBI). 

(7 1 --ldenti fy the dcsttnation(s) of releases to water. Please supply NPDES (National Pollutant Discharge Elimination System) numbers for direct d1scharges or 

:-.JPDES numbers of the POTW (Publiclv Owned Treatment \\'arks). Mark (X) if the POTW name or NPDES #is confidential business infonnation (CBI). 

Release 

I 

.-\mount of new CBI Medmm of Control technology and efficiency (you may wish to optionally attach CBI 

:-.;umber substance released release cfficiencv data} 

(I) {2a) (2b) c,; ~•d.tl.f ® Bmdm).! 

(3) (4) {5a) l\1Jrl. (5b) (6) iXI 

~ D ~ 

~ D ~ 

~ D ~ 

D D D 

D D D 

D D D 

D D D 

D D D 

D D D 

(7) \lark (X) the dcstination(s) ofrclcases to water. NPDES # CBI 

r D POTW --prO\ ide 

I D namctsl 

I 

0 :-.;;l\ !!,!ahk watcrwa:-- D prmidc namc(s) 

D Other--Spec if: 

i D I 

D Mark !X) this box if you attach a contmuat10n sheet. 

EPA FORM 7710-25 (Rev. 5-95) Page 9a 
PMN Page 10; Page 32 of 36 

Part II- HUJ\.IAN EXPOSURE AND ENVIRONMENTAL RELEASE -- Continued 

Section B --INDUSTRIAL SITES CONTROLLED BY OTHERS 

Complete sectiOn 8 for typtcal processing or usc operations involving the ncv.: chemical substance at s1tes you do not controL Importers do not have to complete th1s scct1on for 

operations outside the U.S.: however, you must report any processing or usc activities after tmpon. Sec the Instructions Manual. Complete a separate secrion B!in· t•ach t)pc of 

processing or usc opcrarion im·olving the new chemical substance. If the same operation is performed at more than one site describe the typical operation common to these 

sites. ldentifv additional sites on a continuation sheet. 

J(a). Operation Description-- To claim information in this section as confidential, circle or bracket the specific infom1ation that you clatm as confidentiaL 

( 1) -- D1agram the major unit operation steps and chemical conversions, including interim storage and transport containers (specify- e.g. 5 gallon pails, 55 gallon drums, rat! 

cars. tank trucks. etc). On the diagram. identify by letter and briefly describe each worker acuvity. (2) --Either in the diagram or m the text field I( h) below, provide the 

identity. the approximate weight (by kg/day or kg:batch. on an I 00% new chemical substance basis), and entry point of all feedstocks ( includmg 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) --En her m the diagram or in the 

text field ](bl below. identify by number the points of release, including small or mtcrmittcnt releases. to the environment of the new chemical substance. (41 Please enter 

CBI the= of sites (remember to identify the locations of these sites on a continuation sheet): 

#of sites 

1R] 

..____ 

((b). (0ptwnal) TillS sract.: ~~ f(l[ a text descnpllon to clan fy the diagram ahO\ C. 

I 0 Mark (XI this box if you ;.lttach a continuation sheet. 

EP:\ FOR~1 7710-25 (Rev. 5-95) Page 10 
PMN Page 1 Oa ; Page 33 of 36 

2. Worker Exposure/Environmental Release 

( 1) --From Complete 2-8 for each worker activity described. the di:~gmm above. provide the letter for each worker activity. 

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

( ..t) •• Estimate the typical duration of exposure per worker m (a) hours per day and (b) days per year. . . . . ~ 

(6) Describe physical form of exposure and% new chcmJcal substance (If m mixture). and any protective equipment and engmeenng controls. it any. used to protect 

workers. 

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

(9) •• From the process diagram abo-..·e, 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 k!,C batch). 

( 12) __ Describe media of release i.e. stack air. fugitive air (optional-sec Instructions Manu:~ I). surface water. on-site or off-site land or incineratlon. POT\\'. or other (specify) 

and control technology. if any. that will be used to limit the release of the new substance to the environment. 

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

(3 ). ( 5), (8). (II). ( 131 and ( 15) -- Mark (X) this column if anv of the proccedmg cntncs arc confidential business information 1 CBil. 

Letter ;: of CBI Duration Of CBI Protective Equip. /Engineering Controls/Physical Form and/% new substance ~.in CBl 

of Workers Exposure FonnAct!· ExposeJ ulation 

\'!l~ 

(1) (:!I (3) (4:1) (4b) (5) (6) (7) (!<) 

~ 00 00 ~ 00 00 ~ 00 00 

D D D 

D D D Release Amount of CBl Media of Release & Control Technology CHI 

Number Nev. 

Substam:e 

RdeaseJ 

(9) t ltL1l ( lObl (I!) (I~ I ( IJl 

00 00 

00 00 

00 00 

D D 

D D 

14) Ryproducts: (15) 

D 

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

OPTIONAL POLLUTION PREVENTION INFORl\1ATION 

To claim infonnation in the followin!! section as confidential circle or bracket the specific infom1ation that vou claim as conlidential. 

In this section you may provide infom1ation not reported elsewhere in this form regarding your efforts to reduce or minimize potential risks 

associated with activities surrounding manufacturing. processing. usc and disposal of the PMN substance. Please include new infonnation 

pertinent to pollution pre\·cntion. including source reduction, recycling activities and safer processes or products available due to the new 

chemical substance. Source reduction includes the reduction in the amount or toxicity of chemical wastes by technological modification, 

process and procedure modification, product refom1Ulation, raw materials substitution. and/or inventory control. Recycling refers to the 

reclamation of useful chemical components from wastes that would otherwise be treated or released as air emissions or water discharges, or 

land disposal. Descriptions of pollution prevention, source reduction and recycling should emphasize potential risk reduction subsequent to 

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

assess overall net reductions in toxicity or environmental releases and exposures, not the shifting of risks to other environmental media or nonenvironmental areas (e.g .. occupational or consumer exposure). In addition, infonnation on the relative cost or pcrfonnance characteristics of 

the Pl\'1N substance to potential alternatives may be provided. 

All information provided in this section will be taken into consideration during the review of this substance. Sec Pl\1~ Instructions 

l\lanual and Pollution Prevention Guidance manual for _guidance and examples. 

EP:\ FORM 7710-2.:" (Re\ . .:"-95) Page lOa 
PMN Page 11 ; Page 34 of 36 

Optional Pollution Prevention Information (Continued) Describe the expected net benefits. such as ( 1) an overall reduction in risk to 

human health or the environment; (2) a reduction in the volume manufactured; {3) a reduction in the generation of waste materials 

thro•1gh recycling. source reduction or other means; ( 4) a reduction in potential toxicity or human exposure and/or environmental 

release; (5) an increase in product performance, a decrease in the cost of production and/or improved operation efficiency of the nc\v 

chemical substance in comparison to existing chemical substances used in similar application; or (6) the extent to which the new 

chemical substance mav be a substitute for an existing substance that poses a ereater overall risk to human health or the environment. 

CBI 

00 

r 1 Mark (X) this box if YOU attach a continuation sheet. 

EPA FORM 7710-25 (Rc\. 5-95) Page II 
PMN Page 12 ; Page 35 of 36 

Part III-- LIST OF ATTACHMENTS 

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

stnictureiacti·vity information), and optional information after this page. Clearly identify the attachment and the section of the form to 

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

numbers of each attachment. Electronic attachments can be identified by filename. 

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 vou claim information as confidential. 

# Attachment name Attachment Filename Attachment Contipage nurnbcr(s\ dcntial 

1 0 

2 0 

3 0 

4 0 

5 0 

6 0 

7 0 

8 0 

9 0 

10 0 

11 0 

12 Explanation of Mn Estimation 76 D 

D 

D 

D 

D 

D 

D 

D 

D 

D 

D 

D 

D 0 t>.L!rl-. l X) th1s box if you attach a continuation shcct. Enter thc attachment name and number 

EPA FORt-.1 7710-25 (Rev. 5-95) Page 12 
PMN Page 13 ; Page 36 of 36 

PHYSICAL AND CHEMICAL PROPERTIES WORKSHEET 

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

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

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

arc i.:iectronic, give the attachment number (found on page 12) at (b). The physical state of the 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 of test data. This worksheet is not a substitute for submission of test data. 

Property Marie (X Page Value Measured 01 Confl· 

if number Estimate dential 

(a) provided Mark(X) 

(b) (c) (MorE) (d) 

Physical state of neat substance D D (s) Do> D(g) E 0 

Vapor pressure 

@, D D Temperature oc Torr 

Density/relative density D g/cm3 D 

Solubility 

D @ Temperature oc D 

Solvent giL 

Solubility in water @J Temperature oc 'o 0% giL D 

Melting temperature D oc D 

Boiling I sublimation temperature(a! torr pressure D oc D 

Spectra D D 

Dissociation constant D D 

Particle size distribution D D 

Octanol/ water partition coefficient D D 

Henry's Law constant D D 

Volatilization from water D D 

Volatilization from soil D D 

pH ~ concentration D D 

Flammability D D 

Explodability D D 

Adsorption I coefficient D D 

Other - Specify D D 

Other - Specify D D 

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

ATTACHMENT 

PAGE 13