Document ID: EPA-HQ-TRI-2005-0073-0012
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2005-09-20T17:01:29Z

Activity
Time
(
min)
first
yr
Time
(
min)
subs
yr
paper*
Time
(
min)
subs
yr
electronic**
Proofread
one
field
of
known
information
(
such
as
facility
name)
0.08
0.08
0.00
Conduct
management
review
of
data
elements
requiring
release
or
other
waste
management
estimates
when
technical
time
takes
less
than
one
hour
1.00
0.83
0.83
Conduct
management
review
of
data
elements
requiring
release
or
other
waste
management
estimates
when
technical
time
takes
approximately
one
hour
2.00
1.67
1.67
Conduct
management
review
of
data
elements
requiring
release
or
other
waste
management
estimates
when
technical
time
takes
greater
than
one
hour
3.00
2.50
2.50
Activity
Time
(
min)
first
yr
Time
(
min)
subs
yr
paper
Time
(
min)
subs
yr
electronic*
Check
a
box
or
type
a
simple
code
into
one
field
(
5
sec)
0.08
0.08
0.00
Type
needed
characters
into
one
field
(
15
sec)
0.25
0.25
0.00
Conduct
short
information
look­
up
(
such
as
I.
d.
number)
and
enter
in
field
10.00
0.15
0.00
Determine
annual
chemical
usage
quantity
30.00
30.00
30.00
Determine
chemical
concentration
in
waste
streams
without
monitoring
data
30.00
25.00
25.00
Locate
and
review
monitoring
data
to
identify
chemical
concentration
35.00
25.00
25.00
Identify
release
points
for
the
chemical
30.00
5.00
5.00
Identify
waste
streams
containing
the
chemical
30.00
5.00
5.00
Sum
together
relevant
quantities
estimated
for
Sections
5
and
6
for
reporting
in
Sections
8.1
­
8.7
5.00
5.00
5.00
TABLE
2
COMPLETION
TIMES
FOR
STANDARD
MANAGEMENT
AND
TECHNICAL
ACTIVITIES
*
First
year
times
for
paper
and
electronic
are
the
same
because
none
of
the
electronic
forms
are
prepopulated
**
Subsequent
year
estimates
of
zero
indicate
that
this
information
is
prepopulated
into
TRI­
ME
by
loading
last
year's
forms.
Management
Technical
PBT
Reports
Highest
C
E
M
O
Section
5.1:
Fugitive
or
non­
point
air
emissions
O
8.83
32.54
5.56
52.96
Section
5.2:
Stack
or
point
air
emissions
E
8.28
55.14
9.34
27.19
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
M
6.57
11.54
50.33
31.52
5.4.1:
Underground
injection
onsite
to
Class
I
wells
M
4.00
4.00
56.00
36.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
M
30.77
0.00
57.69
11.54
5.5.1A:
RCRA
Subtitle
C
landfills
O
36.68
5.53
13.07
44.72
5.5.1B:
Other
landfills
O
30.38
24.22
14.18
31.05
5.5.2:
Land
treatment/
application
farming
O
17.48
21.36
29.13
31.55
5.5.3:
Surface
impoundment
C
50.13
10.70
8.49
30.68
5.5.4:
Other
disposal
O
20.12
11.39
10.92
57.41
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
M
7.61
1.95
67.24
23.16
Section
6.2:
Transfers
to
other
off­
site
locations
O
26.78
3.09
29.43
40.66
Non­
PBT
Reports
Section
5.1:
Fugitive
or
non­
point
air
emissions
O
14.01
29.13
4.88
51.93
Section
5.2:
Stack
or
point
air
emissions
O
17.22
31.53
8.58
42.64
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
M
6.26
6.18
52.86
34.68
5.4.1:
Underground
injection
onsite
to
Class
I
wells
M
9.75
1.82
53.72
34.71
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
M
10.53
0.00
66.66
22.81
5.5.1A:
RCRA
Subtitle
C
landfills
O
25.29
1.82
14.05
58.84
5.5.1B:
Other
landfills
O
35.74
14.26
13.78
36.19
5.5.2:
Land
treatment/
application
farming
M
25.50
9.12
33.76
31.62
5.5.3:
Surface
impoundment
C
54.85
5.94
9.75
29.45
5.5.4:
Other
disposal
O
11.98
2.25
8.32
77.46
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
M
15.91
1.54
46.56
35.88
Section
6.2:
Transfers
to
other
off­
site
locations
O
22.38
1.13
28.90
47.56
O:
Estimate
based
on
other
approaches
Prevalence
of
code
[%]
FORM
R
BASIS
OF
ESTIMATE
CODES
TABLE
3
C:
Estimate
based
on
mass
balance
calculations
E:
Estimate
based
on
published
emission
factors
M:
Estimate
based
on
monitoring
data
or
measurements
Proposed
Item
Management
Technical
Total
Time
Incidence
Rate
(%)
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.17
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Facility
or
establishment
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Street
0.08
0.25
0.33
100.00
0.08
0.25
0.33
City/
county/
state/
zip
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Mailing
address
0.08
0.25
0.33
100.00
0.08
0.25
0.33
City/
state/
zip
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Country
(
non­
US)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
4.3:
Technical
contact
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Telephone
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Email
address
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.4:
Public
contact
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Telephone
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.5:
SIC
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.6:
Latitude
Degrees
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Minutes
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Seconds
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Section
4.6:
Longitude
Degrees
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Minutes
0.08
0.75
0.83
100.00
0.08
0.75
0.83
TABLE
5
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
FIRST
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
PBT
CHEMICAL
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Seconds
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
10.00
10.08
83.47
0.07
8.35
8.42
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
10.00
10.08
80.47
0.07
8.05
8.11
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
10.00
10.08
45.97
0.04
4.60
4.64
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
10.00
10.08
0.59
0.00
0.06
0.06
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
10.00
10.08
100.00
0.08
10.00
10.08
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
0.08
10.00
10.08
100.00
0.08
10.00
10.08
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
1.3:
Generic
chemical
name
0.08
0.50
0.58
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
0.58
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
0.17
46.98
0.04
0.04
0.08
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
0.17
63.81
0.05
0.05
0.11
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
0.17
34.60
0.03
0.03
0.06
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
1.00
30.00
31.00
100.00
1.00
30.00
31.00
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.17
48.21
0.04
0.04
0.08
A.
Total
release
3.00
195.00
198.00
51.79
1.55
100.99
102.54
B.
Basis
of
estimate
0.08
0.25
0.33
51.72
0.04
0.13
0.17
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.17
25.44
0.02
0.02
0.04
A.
Total
release
3.00
86.00
89.00
74.56
2.24
64.12
66.36
B.
Basis
of
estimate
0.08
0.25
0.33
74.43
0.06
0.19
0.25
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.17
71.42
0.06
0.06
0.12
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.33
28.58
0.02
0.07
0.10
A.
Total
release
2.00
75.00
77.00
28.58
0.57
21.44
22.01
B.
Basis
of
estimate
0.08
0.25
0.33
28.56
0.02
0.07
0.10
C.
%
from
stormwater
3.00
107.00
110.00
18.45
0.55
19.74
20.30
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.17
99.69
0.08
0.08
0.17
A.
Total
release
2.00
73.00
75.00
0.32
0.01
0.23
0.24
B.
Basis
of
estimate
0.08
0.25
0.33
0.31
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.17
99.73
0.08
0.08
0.17
A.
Total
release
2.00
73.00
75.00
0.27
0.01
0.20
0.20
B.
Basis
of
estimate
0.08
0.25
0.33
0.26
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.17
98.26
0.08
0.08
0.16
A.
Total
release
3.00
96.00
99.00
1.74
0.05
1.67
1.72
B.
Basis
of
estimate
0.08
0.25
0.33
1.74
0.00
0.00
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.17
90.54
0.08
0.08
0.15
A.
Total
release
3.00
96.00
99.00
9.46
0.28
9.08
9.37
B.
Basis
of
estimate
0.08
0.25
0.33
9.45
0.01
0.02
0.03
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.17
97.95
0.08
0.08
0.16
A.
Total
release
3.00
96.00
99.00
2.05
0.06
1.97
2.03
B.
Basis
of
estimate
0.08
0.25
0.33
2.05
0.00
0.01
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.17
46.03
0.04
0.04
0.08
A.
Total
release
3.00
96.00
99.00
3.98
0.12
3.82
3.94
B.
Basis
of
estimate
0.08
0.25
0.33
3.98
0.00
0.01
0.01
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.17
46.03
0.04
0.04
0.08
A.
Total
release
3.00
96.00
99.00
3.98
0.12
3.82
3.94
B.
Basis
of
estimate
0.08
0.25
0.33
3.98
0.00
0.01
0.01
5.5.4:
Other
disposal
NA
0.08
0.08
0.17
86.71
0.07
0.07
0.14
A.
Total
release
1.00
35.00
36.00
13.29
0.13
4.65
4.78
B.
Basis
of
estimate
0.08
0.25
0.33
13.25
0.01
0.03
0.04
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
2.00
73.00
75.00
19.01
0.38
13.88
14.26
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.33
18.89
0.02
0.05
0.06
6.1.
B
POTW
name
0.08
0.25
0.33
18.90
0.02
0.05
0.06
POTW
address
0.08
0.25
0.33
18.90
0.02
0.05
0.06
City
0.08
0.25
0.33
18.90
0.02
0.05
0.06
State
0.08
0.25
0.33
18.90
0.02
0.05
0.06
County
0.08
0.25
0.33
18.90
0.02
0.05
0.06
Zip
0.08
0.25
0.33
18.90
0.02
0.05
0.06
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Off­
site
location
name
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Off­
site
address
0.17
0.50
0.67
100.00
0.17
0.50
0.67
City
0.17
0.50
0.67
100.00
0.17
0.50
0.67
State
0.17
0.50
0.67
100.00
0.17
0.50
0.67
County
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Zip
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Country
(
non­
US)
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
0.33
100.00
0.17
0.17
0.33
A:
Total
transfers
3.00
107.00
110.00
100.00
3.00
107.00
110.00
B:
Basis
of
estimate
0.17
0.50
0.67
99.90
0.17
0.50
0.67
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
0.17
0.50
0.67
99.83
0.17
0.50
0.67
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.17
66.44
0.06
0.06
0.11
7A.
1a:
General
waste
stream
(
enter
code)
1.00
10.00
11.00
33.56
0.34
3.36
3.69
7A.
1b:
Waste
treatment
method(
s)
sequence
1.00
25.00
26.00
33.56
0.34
8.39
8.73
7A.
1c:
Range
of
influent
concentration
2.00
60.00
62.00
33.56
0.67
20.14
20.81
7A.
1d:
Waste
treatment
efficiency
estimate
1.00
30.00
31.00
33.56
0.34
10.07
10.40
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.33
33.56
0.06
0.06
0.11
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.17
98.90
0.08
0.08
0.16
Energy
recovery
methods
1.00
32.00
33.00
1.10
0.01
0.35
0.36
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.17
93.77
0.08
0.08
0.16
Energy
recovery
methods
1.00
38.00
39.00
6.23
0.06
2.37
2.43
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
1.96
0.00
0.00
0.01
Column
B:
Current
reporting
year
1.00
30.00
31.00
1.96
0.02
0.59
0.61
Column
C:
Following
year
0.08
1.00
1.08
1.96
0.00
0.02
0.02
Column
D:
Second
following
year
0.08
1.00
1.08
1.96
0.00
0.02
0.02
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
2.95
0.00
0.01
0.01
Column
B:
Current
reporting
year
0.25
5.00
5.25
2.95
0.01
0.15
0.15
Column
C:
Following
year
0.08
1.00
1.08
2.95
0.00
0.03
0.03
Column
D:
Second
following
year
0.08
1.00
1.08
2.95
0.00
0.03
0.03
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
7.17
0.01
0.02
0.02
Column
B:
Current
reporting
year
1.00
30.00
31.00
7.17
0.07
2.15
2.22
Column
C:
Following
year
0.08
1.00
1.08
7.17
0.01
0.07
0.08
Column
D:
Second
following
year
0.08
1.00
1.08
7.17
0.01
0.07
0.08
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
30.21
0.03
0.08
0.10
Column
B:
Current
reporting
year
0.25
5.00
5.25
30.21
0.08
1.51
1.59
Column
C:
Following
year
0.08
1.00
1.08
30.21
0.03
0.30
0.33
Column
D:
Second
following
year
0.08
1.00
1.08
30.21
0.03
0.30
0.33
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
6.36
0.01
0.02
0.02
Column
B:
Current
reporting
year
1.00
30.00
31.00
6.36
0.06
1.91
1.97
Column
C:
Following
year
0.08
1.00
1.08
6.36
0.01
0.06
0.07
Column
D:
Second
following
year
0.08
1.00
1.08
6.36
0.01
0.06
0.07
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
5.86
0.00
0.01
0.02
Column
B:
Current
reporting
year
0.25
5.00
5.25
5.86
0.01
0.29
0.31
Column
C:
Following
year
0.08
1.00
1.08
5.86
0.00
0.06
0.06
Column
D:
Second
following
year
0.08
1.00
1.08
5.86
0.00
0.06
0.06
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
5.25
24.37
0.06
1.22
1.28
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
36.83
100.00
0.83
36.00
36.83
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
1.00
35.00
36.00
8.32
0.08
2.91
3.00
Methods
to
identify
activity
0.08
0.25
0.33
8.29
0.01
0.02
0.03
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
61.33
1834.25
1895.83
20.76
559.50
580.26
TOTAL
(
hr)
1.02
30.57
31.60
0.35
9.32
9.67
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.
Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Proposed
Item
Management
Technical
Total
Time
Incidence
Rate
(%)
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.17
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Facility
or
establishment
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Street
0.08
0.25
0.33
100.00
0.08
0.25
0.33
City/
county/
state/
zip
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Mailing
address
0.08
0.25
0.33
100.00
0.08
0.25
0.33
City/
state/
zip
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Country
(
non­
US)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
4.3:
Technical
contact
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Telephone
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Email
address
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.4:
Public
contact
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Telephone
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.5:
SIC
code
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
4.6:
Latitude
Degrees
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Minutes
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Seconds
0.08
0.75
0.83
100.00
0.08
0.75
0.83
TABLE
6
FIRST
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
NON­
PBT
CHEMICAL
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Section
4.6:
Longitude
Degrees
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Minutes
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Seconds
0.08
0.75
0.83
100.00
0.08
0.75
0.83
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
10.00
10.08
83.47
0.07
8.35
8.42
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
10.00
10.08
80.47
0.07
8.05
8.11
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
10.00
10.08
45.97
0.04
4.60
4.64
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
10.00
10.08
0.59
0.00
0.06
0.06
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
10.00
10.08
100.00
0.08
10.00
10.08
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
0.08
10.00
10.08
100.00
0.08
10.00
10.08
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
0.33
100.00
0.08
0.25
0.33
Section
1.3:
Generic
chemical
name
0.08
0.50
0.58
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
0.33
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
0.17
33.06
0.03
0.03
0.06
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
0.17
59.84
0.05
0.05
0.10
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
0.17
39.97
0.03
0.03
0.07
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
1.00
30.00
31.00
100.00
1.00
30.00
31.00
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.17
28.32
0.02
0.02
0.05
A.
Total
release
3.00
195.00
198.00
71.68
2.15
139.78
141.93
B.
Basis
of
estimate
0.08
0.25
0.33
71.61
0.06
0.18
0.24
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.17
26.15
0.02
0.02
0.04
A.
Total
release
3.00
106.00
109.00
73.85
2.22
78.28
80.50
B.
Basis
of
estimate
0.08
0.25
0.33
73.78
0.06
0.18
0.25
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.17
73.56
0.06
0.06
0.12
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.33
26.44
0.02
0.07
0.09
A.
Total
release
3.00
111.58
114.58
26.44
0.79
29.50
30.29
B.
Basis
of
estimate
0.08
0.25
0.33
26.42
0.02
0.07
0.09
C.
%
from
stormwater
0.25
2.00
2.25
16.64
0.04
0.33
0.37
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.17
98.76
0.08
0.08
0.16
A.
Total
release
2.00
73.00
75.00
1.24
0.02
0.91
0.93
B.
Basis
of
estimate
0.08
0.25
0.33
1.21
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.17
99.76
0.08
0.08
0.17
A.
Total
release
2.00
73.00
75.00
0.24
0.00
0.18
0.18
B.
Basis
of
estimate
0.08
0.25
0.33
0.23
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.17
98.48
0.08
0.08
0.16
A.
Total
release
3.00
96.00
99.00
1.52
0.05
1.46
1.50
B.
Basis
of
estimate
0.08
0.25
0.33
1.51
0.00
0.00
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.17
94.51
0.08
0.08
0.16
A.
Total
release
3.00
96.00
99.00
5.49
0.16
5.27
5.44
B.
Basis
of
estimate
0.08
0.25
0.33
5.47
0.00
0.01
0.02
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.17
98.33
0.08
0.08
0.16
A.
Total
release
2.00
73.00
75.00
1.67
0.03
1.22
1.25
B.
Basis
of
estimate
0.08
0.25
0.33
1.65
0.00
0.00
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.17
47.92
0.04
0.04
0.08
A.
Total
release
3.00
96.00
99.00
2.09
0.06
2.00
2.06
B.
Basis
of
estimate
0.08
0.25
0.33
2.09
0.00
0.01
0.01
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.17
47.92
0.04
0.04
0.08
A.
Total
release
3.00
96.00
99.00
2.09
0.06
2.00
2.06
B.
Basis
of
estimate
0.08
0.25
0.33
2.09
0.00
0.01
0.01
5.5.4:
Other
disposal
NA
0.08
0.08
0.17
90.45
0.08
0.08
0.15
A.
Total
release
1.00
35.00
36.00
9.55
0.10
3.34
3.44
B.
Basis
of
estimate
0.08
0.25
0.33
9.48
0.01
0.02
0.03
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
2.00
73.00
75.00
23.97
0.48
17.50
17.98
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.33
23.93
0.02
0.06
0.08
6.1.
B
POTW
name
0.08
0.25
0.33
23.92
0.02
0.06
0.08
POTW
address
0.08
0.25
0.33
23.92
0.02
0.06
0.08
City
0.08
0.25
0.33
23.92
0.02
0.06
0.08
State
0.08
0.25
0.33
23.92
0.02
0.06
0.08
County
0.08
0.25
0.33
23.92
0.02
0.06
0.08
Zip
0.08
0.25
0.33
23.92
0.02
0.06
0.08
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Off­
site
location
name
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Off­
site
address
0.17
0.50
0.67
100.00
0.17
0.50
0.67
City
0.17
0.50
0.67
100.00
0.17
0.50
0.67
State
0.17
0.50
0.67
100.00
0.17
0.50
0.67
County
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Zip
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Country
(
non­
US)
0.17
0.50
0.67
100.00
0.17
0.50
0.67
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
0.33
100.00
0.17
0.17
0.33
A:
Total
transfers
3.00
107.00
110.00
100.00
3.00
107.00
110.00
B:
Basis
of
estimate
0.17
0.50
0.67
99.99
0.17
0.50
0.67
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
0.17
0.50
0.67
99.97
0.17
0.50
0.67
ITEMS
PERTAINING
TO
SECTION
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.17
51.48
0.04
0.04
0.09
7A.
1a:
General
waste
stream
(
enter
code)
1.00
10.00
11.00
48.52
0.49
4.85
5.34
7A.
1b:
Waste
treatment
method(
s)
sequence
1.00
25.00
26.00
48.52
0.49
12.13
12.62
7A.
1c:
Range
of
influent
concentration
2.00
60.00
62.00
48.52
0.97
29.11
30.08
7A.
1d:
Waste
treatment
efficiency
estimate
1.00
30.00
31.00
48.52
0.49
14.56
15.04
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.33
48.52
0.08
0.08
0.16
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.17
95.60
0.08
0.08
0.16
Energy
recovery
methods
1.00
32.00
33.00
4.40
0.04
1.41
1.45
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.17
90.18
0.08
0.08
0.15
Energy
recovery
methods
1.00
38.00
39.00
9.82
0.10
3.73
3.83
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
5.42
0.00
0.01
0.02
Column
B:
Current
reporting
year
1.00
30.00
31.00
5.42
0.05
1.63
1.68
Column
C:
Following
year
0.08
1.00
1.08
5.42
0.00
0.05
0.06
Column
D:
Second
following
year
0.08
1.00
1.08
5.42
0.00
0.05
0.06
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
18.52
0.02
0.05
0.06
Column
B:
Current
reporting
year
0.25
5.00
5.25
18.52
0.05
0.93
0.97
Column
C:
Following
year
0.08
1.00
1.08
18.52
0.02
0.19
0.20
Column
D:
Second
following
year
0.08
1.00
1.08
18.52
0.02
0.19
0.20
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
10.83
0.01
0.03
0.04
Column
B:
Current
reporting
year
1.00
30.00
31.00
10.83
0.11
3.25
3.36
Column
C:
Following
year
0.08
1.00
1.08
10.83
0.01
0.11
0.12
Column
D:
Second
following
year
0.08
1.00
1.08
10.83
0.01
0.11
0.12
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
22.68
0.02
0.06
0.08
Column
B:
Current
reporting
year
0.25
5.00
5.25
22.68
0.06
1.13
1.19
Column
C:
Following
year
0.08
1.00
1.08
22.68
0.02
0.23
0.25
Column
D:
Second
following
year
0.08
1.00
1.08
22.68
0.02
0.23
0.25
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
24.58
0.02
0.06
0.08
Column
B:
Current
reporting
year
1.00
30.00
31.00
24.58
0.25
7.37
7.62
Column
C:
Following
year
0.08
1.00
1.08
24.58
0.02
0.25
0.27
Column
D:
Second
following
year
0.08
1.00
1.08
24.58
0.02
0.25
0.27
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
28.76
0.02
0.07
0.10
Column
B:
Current
reporting
year
0.25
5.00
5.25
28.76
0.07
1.44
1.51
Column
C:
Following
year
0.08
1.00
1.08
28.76
0.02
0.29
0.31
Column
D:
Second
following
year
0.08
1.00
1.08
28.76
0.02
0.29
0.31
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
5.25
27.65
0.07
1.38
1.45
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
36.83
100.00
0.83
36.00
36.83
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
1.00
35.00
36.00
13.25
0.13
4.64
4.77
Methods
to
identify
activity
0.08
0.25
0.33
13.25
0.01
0.03
0.04
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
58.58
1762.83
1821.41
22.25
629.49
651.74
TOTAL
(
hr)
0.98
29.38
30.36
0.37
10.49
10.86
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.
Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Total
Time
Incidence
Rate
(%)
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.17
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Facility
or
establishment
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Street
0.08
0.00
0.08
100.00
0.08
0.00
0.08
City/
county/
state/
zip
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Mailing
address
0.08
0.00
0.08
100.00
0.08
0.00
0.08
City/
state/
zip
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Country
(
non­
US)
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
4.3:
Technical
contact
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Telephone
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Email
address
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.4:
Public
contact
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Telephone
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.5:
SIC
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.6:
Latitude
Degrees
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Minutes
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Seconds
0.08
0.00
0.08
100.00
0.08
0.00
0.08
SUBSEQUENT
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
PBT
CHEMICAL
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
TABLE
7
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Section
4.6:
Longitude
Degrees
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Minutes
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Seconds
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
0.00
0.08
83.47
0.07
0.00
0.07
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
0.00
0.08
80.47
0.07
0.00
0.07
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
0.00
0.08
45.97
0.04
0.00
0.04
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
0.00
0.08
0.59
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
1.3:
Generic
chemical
name
0.08
0.00
0.08
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.00
0.08
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.00
0.08
46.98
0.04
0.00
0.04
Section
3.2:
Process
the
toxic
chemical
0.08
0.00
0.08
63.81
0.05
0.00
0.05
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.00
0.08
34.60
0.03
0.00
0.03
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
0.83
30.00
30.83
100.00
0.83
30.00
30.83
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.17
48.21
0.04
0.04
0.08
A.
Total
release
2.50
115.00
117.50
51.79
1.29
59.56
60.85
B.
Basis
of
estimate
0.08
0.25
0.33
51.72
0.04
0.13
0.17
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.17
25.44
0.02
0.02
0.04
A.
Total
release
1.67
60.00
61.67
74.56
1.24
44.74
45.98
B.
Basis
of
estimate
0.08
0.25
0.33
74.43
0.06
0.19
0.25
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.17
71.42
0.06
0.06
0.12
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.33
28.58
0.02
0.07
0.10
A.
Total
release
2.50
85.09
87.59
28.58
0.71
24.32
25.03
B.
Basis
of
estimate
0.08
0.25
0.33
28.56
0.02
0.07
0.10
C.
%
from
stormwater
0.25
2.00
2.25
18.45
0.05
0.37
0.42
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.17
99.69
0.08
0.08
0.17
A.
Total
release
1.67
63.00
64.67
0.32
0.01
0.20
0.21
B.
Basis
of
estimate
0.08
0.25
0.33
0.31
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.17
99.73
0.08
0.08
0.17
A.
Total
release
1.67
63.00
64.67
0.27
0.00
0.17
0.17
B.
Basis
of
estimate
0.08
0.25
0.33
0.26
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.17
98.26
0.08
0.08
0.16
A.
Total
release
1.67
66.00
67.67
1.74
0.03
1.15
1.18
B.
Basis
of
estimate
0.08
0.25
0.33
1.74
0.00
0.00
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.17
90.54
0.08
0.08
0.15
A.
Total
release
1.67
66.00
67.67
9.46
0.16
6.24
6.40
B.
Basis
of
estimate
0.08
0.25
0.33
9.45
0.01
0.02
0.03
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.17
97.95
0.08
0.08
0.16
A.
Total
release
1.67
66.00
67.67
2.05
0.03
1.35
1.39
B.
Basis
of
estimate
0.08
0.25
0.33
2.05
0.00
0.01
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.17
46.03
0.04
0.04
0.08
A.
Total
release
1.67
66.00
67.67
3.98
0.07
2.62
2.69
B.
Basis
of
estimate
0.08
0.25
0.33
3.98
0.00
0.01
0.01
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.17
46.03
0.04
0.04
0.08
A.
Total
release
1.67
66.00
67.67
3.98
0.07
2.62
2.69
B.
Basis
of
estimate
0.08
0.25
0.33
3.98
0.00
0.01
0.01
5.5.4:
Other
disposal
NA
0.08
0.08
0.17
86.71
0.07
0.07
0.14
A.
Total
release
0.83
35.00
35.83
13.29
0.11
4.65
4.76
B.
Basis
of
estimate
0.08
0.25
0.33
13.25
0.01
0.03
0.04
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
1.67
58.00
59.67
19.01
0.32
11.03
11.34
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.33
18.89
0.02
0.05
0.06
6.1.
B
POTW
name
0.08
0.00
0.08
18.90
0.02
0.00
0.02
POTW
address
0.08
0.00
0.08
18.90
0.02
0.00
0.02
City
0.08
0.00
0.08
18.90
0.02
0.00
0.02
State
0.08
0.00
0.08
18.90
0.02
0.00
0.02
County
0.08
0.00
0.08
18.90
0.02
0.00
0.02
Zip
0.08
0.00
0.08
18.90
0.02
0.00
0.02
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Off­
site
location
name
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Off­
site
address
0.17
0.25
0.42
100.00
0.17
0.25
0.42
City
0.17
0.25
0.42
100.00
0.17
0.25
0.42
State
0.17
0.25
0.42
100.00
0.17
0.25
0.42
County
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Zip
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Country
(
non­
US)
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.08
0.25
100.00
0.17
0.08
0.25
A:
Total
transfers
2.50
82.00
84.50
100.00
2.50
82.00
84.50
B:
Basis
of
estimate
0.17
0.25
0.42
99.90
0.17
0.25
0.42
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
0.17
0.25
0.42
99.83
0.17
0.25
0.42
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.17
66.44
0.06
0.06
0.11
7A.
1a:
General
waste
stream
(
enter
code)
0.83
5.00
5.83
33.56
0.28
1.68
1.96
7A.
1b:
Waste
treatment
method(
s)
sequence
0.83
7.00
7.83
33.56
0.28
2.35
2.63
7A.
1c:
Range
of
influent
concentration
0.83
30.00
30.83
33.56
0.28
10.07
10.35
7A.
1d:
Waste
treatment
efficiency
estimate
0.83
10.00
10.83
33.56
0.28
3.36
3.64
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.33
33.56
0.06
0.06
0.11
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.17
98.90
0.08
0.08
0.16
Energy
recovery
methods
0.83
24.00
24.83
1.10
0.01
0.26
0.27
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.17
93.77
0.08
0.08
0.16
Energy
recovery
methods
0.83
27.00
27.83
6.23
0.05
1.68
1.73
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
92.85
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
92.85
0.23
4.64
4.87
Column
C:
Following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Column
D:
Second
following
year
0.08
1.00
1.08
92.85
0.08
0.93
1.01
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
1.96
0.00
0.00
0.01
Column
B:
Current
reporting
year
0.83
30.00
30.83
1.96
0.02
0.59
0.60
Column
C:
Following
year
0.08
1.00
1.08
1.96
0.00
0.02
0.02
Column
D:
Second
following
year
0.08
1.00
1.08
1.96
0.00
0.02
0.02
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
1.00
1.08
2.95
0.00
0.03
0.03
Column
B:
Current
reporting
year
0.25
5.00
5.25
2.95
0.01
0.15
0.15
Column
C:
Following
year
0.08
1.00
1.08
2.95
0.00
0.03
0.03
Column
D:
Second
following
year
0.08
1.00
1.08
2.95
0.00
0.03
0.03
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
7.17
0.01
0.02
0.02
Column
B:
Current
reporting
year
0.83
30.00
30.83
7.17
0.06
2.15
2.21
Column
C:
Following
year
0.08
1.00
1.08
7.17
0.01
0.07
0.08
Column
D:
Second
following
year
0.08
1.00
1.08
7.17
0.01
0.07
0.08
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
30.21
0.03
0.08
0.10
Column
B:
Current
reporting
year
0.25
5.00
5.25
30.21
0.08
1.51
1.59
Column
C:
Following
year
0.08
1.00
1.08
30.21
0.03
0.30
0.33
Column
D:
Second
following
year
0.08
1.00
1.08
30.21
0.03
0.30
0.33
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
6.36
0.01
0.02
0.02
Column
B:
Current
reporting
year
0.83
30.00
30.83
6.36
0.05
1.91
1.96
Column
C:
Following
year
0.08
1.00
1.08
6.36
0.01
0.06
0.07
Column
D:
Second
following
year
0.08
1.00
1.08
6.36
0.01
0.06
0.07
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
5.86
0.00
0.01
0.02
Column
B:
Current
reporting
year
0.25
5.00
5.25
5.86
0.01
0.29
0.31
Column
C:
Following
year
0.08
1.00
1.08
5.86
0.00
0.06
0.06
Column
D:
Second
following
year
0.08
1.00
1.08
5.86
0.00
0.06
0.06
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
5.25
24.37
0.06
1.22
1.28
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
36.83
100.00
0.83
36.00
36.83
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
0.83
35.00
35.83
8.32
0.07
2.91
2.98
Methods
to
identify
activity
0.08
0.25
0.33
8.29
0.01
0.02
0.03
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
46.08
1258.51
1304.59
17.49
370.13
387.63
TOTAL
(
hr)
0.77
20.98
21.74
0.29
6.17
6.46
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.
Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Proposed
Item
Management
Technical
Total
Time
Incidence
Rate
(%)
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.33
100.00
0.08
0.25
0.33
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.17
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Facility
or
establishment
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Street
0.08
0.00
0.08
100.00
0.08
0.00
0.08
City/
county/
state/
zip
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Mailing
address
0.08
0.00
0.08
100.00
0.08
0.00
0.08
City/
state/
zip
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Country
(
non­
US)
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.17
100.00
0.08
0.08
0.17
Section
4.3:
Technical
contact
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Telephone
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Email
address
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.4:
Public
contact
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Telephone
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.5:
SIC
code
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.6:
Latitude
Degrees
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Minutes
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Seconds
0.08
0.00
0.08
100.00
0.08
0.00
0.08
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
TABLE
8
SUBSEQUENT
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
NON­
PBT
CHEMICAL
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Section
4.6:
Longitude
Degrees
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Minutes
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Seconds
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
0.00
0.08
83.47
0.07
0.00
0.07
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
0.00
0.08
80.47
0.07
0.00
0.07
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
0.00
0.08
45.97
0.04
0.00
0.04
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
0.00
0.08
0.59
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.00
0.08
100.00
0.08
0.00
0.08
Section
1.3:
Generic
chemical
name
0.08
0.00
0.08
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.00
0.08
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.00
0.08
33.06
0.03
0.00
0.03
Section
3.2:
Process
the
toxic
chemical
0.08
0.00
0.08
59.84
0.05
0.00
0.05
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.00
0.08
39.97
0.03
0.00
0.03
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
0.83
30.00
30.83
100.00
0.83
30.00
30.83
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.33
100.00
0.08
0.25
0.33
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.17
28.32
0.02
0.02
0.05
A.
Total
release
2.50
115.00
117.50
71.68
1.79
82.43
84.22
B.
Basis
of
estimate
0.08
0.25
0.33
71.61
0.06
0.18
0.24
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.17
26.15
0.02
0.02
0.04
A.
Total
release
1.67
66.00
67.67
73.85
1.23
48.74
49.97
B.
Basis
of
estimate
0.08
0.25
0.33
73.78
0.06
0.18
0.25
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.17
73.56
0.06
0.06
0.12
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.33
26.44
0.02
0.07
0.09
A.
Total
release
2.50
82.44
84.94
26.44
0.66
21.80
22.46
B.
Basis
of
estimate
0.08
0.25
0.33
26.42
0.02
0.07
0.09
C.
%
from
stormwater
0.25
2.00
2.25
16.64
0.04
0.33
0.37
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.17
98.76
0.08
0.08
0.16
A.
Total
release
1.67
63.00
64.67
1.24
0.02
0.78
0.80
B.
Basis
of
estimate
0.08
0.25
0.33
1.21
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.17
99.76
0.08
0.08
0.17
A.
Total
release
1.67
63.00
64.67
0.24
0.00
0.15
0.16
B.
Basis
of
estimate
0.08
0.25
0.33
0.23
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.17
98.48
0.08
0.08
0.16
A.
Total
release
1.67
66.00
67.67
1.52
0.03
1.00
1.03
B.
Basis
of
estimate
0.08
0.25
0.33
1.51
0.00
0.00
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.17
94.51
0.08
0.08
0.16
A.
Total
release
1.67
66.00
67.67
5.49
0.09
3.62
3.71
B.
Basis
of
estimate
0.08
0.25
0.33
5.47
0.00
0.01
0.02
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.17
98.33
0.08
0.08
0.16
A.
Total
release
1.67
63.00
64.67
1.67
0.03
1.05
1.08
B.
Basis
of
estimate
0.08
0.25
0.33
1.65
0.00
0.00
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.17
47.92
0.04
0.04
0.08
A.
Total
release
1.67
66.00
67.67
2.09
0.03
1.38
1.41
B.
Basis
of
estimate
0.08
0.25
0.33
2.09
0.00
0.01
0.01
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.17
47.92
0.04
0.04
0.08
A.
Total
release
1.67
66.00
67.67
2.09
0.03
1.38
1.41
B.
Basis
of
estimate
0.08
0.25
0.33
2.09
0.00
0.01
0.01
5.5.4:
Other
disposal
NA
0.08
0.08
0.17
90.45
0.08
0.08
0.15
A.
Total
release
0.83
35.00
35.83
9.55
0.08
3.34
3.42
B.
Basis
of
estimate
0.08
0.25
0.33
9.48
0.01
0.02
0.03
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
1.67
58.00
59.67
23.97
0.40
13.90
14.30
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.33
23.93
0.02
0.06
0.08
6.1.
B
POTW
name
0.08
0.00
0.08
23.92
0.02
0.00
0.02
POTW
address
0.08
0.00
0.08
23.92
0.02
0.00
0.02
City
0.08
0.00
0.08
23.92
0.02
0.00
0.02
State
0.08
0.00
0.08
23.92
0.02
0.00
0.02
County
0.08
0.00
0.08
23.92
0.02
0.00
0.02
Zip
0.08
0.00
0.08
23.92
0.02
0.00
0.02
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Off­
site
location
name
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Off­
site
address
0.17
0.25
0.42
100.00
0.17
0.25
0.42
City
0.17
0.25
0.42
100.00
0.17
0.25
0.42
State
0.17
0.25
0.42
100.00
0.17
0.25
0.42
County
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Zip
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Country
(
non­
US)
0.17
0.25
0.42
100.00
0.17
0.25
0.42
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.08
0.25
100.00
0.17
0.08
0.25
A:
Total
transfers
2.50
82.00
84.50
100.00
2.50
82.00
84.50
B:
Basis
of
estimate
0.17
0.25
0.42
99.99
0.17
0.25
0.42
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
0.17
0.25
0.42
99.97
0.17
0.25
0.42
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.17
51.48
0.04
0.04
0.09
7A.
1a:
General
waste
stream
(
enter
code)
0.83
5.00
5.83
48.52
0.40
2.43
2.83
7A.
1b:
Waste
treatment
method(
s)
sequence
0.83
7.00
7.83
48.52
0.40
3.40
3.80
7A.
1c:
Range
of
influent
concentration
0.83
30.00
30.83
48.52
0.40
14.56
14.96
7A.
1d:
Waste
treatment
efficiency
estimate
0.83
10.00
10.83
48.52
0.40
4.85
5.26
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.33
48.52
0.08
0.08
0.16
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.17
95.60
0.08
0.08
0.16
Energy
recovery
methods
0.83
24.00
24.83
4.40
0.04
1.06
1.09
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.17
90.18
0.08
0.08
0.15
Energy
recovery
methods
0.83
27.00
27.83
9.82
0.08
2.65
2.73
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.33
93.89
0.08
0.23
0.31
Column
B:
Current
reporting
year
0.25
5.00
5.25
93.89
0.23
4.69
4.93
Column
C:
Following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Column
D:
Second
following
year
0.08
1.00
1.08
93.89
0.08
0.94
1.02
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
5.42
0.00
0.01
0.02
Column
B:
Current
reporting
year
0.83
30.00
30.83
5.42
0.05
1.63
1.67
Column
C:
Following
year
0.08
1.00
1.08
5.42
0.00
0.05
0.06
Column
D:
Second
following
year
0.08
1.00
1.08
5.42
0.00
0.05
0.06
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
18.52
0.02
0.05
0.06
Column
B:
Current
reporting
year
0.25
5.00
5.25
18.52
0.05
0.93
0.97
Column
C:
Following
year
0.08
1.00
1.08
18.52
0.02
0.19
0.20
Column
D:
Second
following
year
0.08
1.00
1.08
18.52
0.02
0.19
0.20
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
10.83
0.01
0.03
0.04
Column
B:
Current
reporting
year
0.83
30.00
30.83
10.83
0.09
3.25
3.34
Column
C:
Following
year
0.08
1.00
1.08
10.83
0.01
0.11
0.12
Column
D:
Second
following
year
0.08
1.00
1.08
10.83
0.01
0.11
0.12
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
22.68
0.02
0.06
0.08
Column
B:
Current
reporting
year
0.25
5.00
5.25
22.68
0.06
1.13
1.19
Column
C:
Following
year
0.08
1.00
1.08
22.68
0.02
0.23
0.25
Column
D:
Second
following
year
0.08
1.00
1.08
22.68
0.02
0.23
0.25
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.33
24.58
0.02
0.06
0.08
Column
B:
Current
reporting
year
0.83
30.00
30.83
24.58
0.20
7.37
7.58
Column
C:
Following
year
0.08
1.00
1.08
24.58
0.02
0.25
0.27
Column
D:
Second
following
year
0.08
1.00
1.08
24.58
0.02
0.25
0.27
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.33
28.76
0.02
0.07
0.10
Column
B:
Current
reporting
year
0.25
5.00
5.25
28.76
0.07
1.44
1.51
Column
C:
Following
year
0.08
1.00
1.08
28.76
0.02
0.29
0.31
Column
D:
Second
following
year
0.08
1.00
1.08
28.76
0.02
0.29
0.31
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
5.25
27.65
0.07
1.38
1.45
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
36.83
100.00
0.83
36.00
36.83
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
0.83
35.00
35.83
13.25
0.11
4.64
4.75
Methods
to
identify
activity
0.08
0.25
0.33
13.25
0.01
0.03
0.04
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
46.08
1258.11
1304.19
18.93
413.18
432.12
TOTAL
(
hr)
0.77
20.97
21.74
0.32
6.89
7.20
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.
Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Clerical
Total
Time
Incidence
Rate
(%)
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
1.18
1.34
100.00
0.08
0.08
1.18
1.34
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
1.18
1.34
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Signature
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Date
signed
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Facility
or
establishment
name
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Street
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
City/
county/
state/
zip
code
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Mailing
address
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
City/
state/
zip
code
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Country
(
non­
US)
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
1.18
1.34
100.00
0.08
0.08
1.18
1.34
Section
4.3:
Technical
contact
name
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Telephone
number
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Email
address
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Section
4.4:

Public
contact
name
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Telephone
number
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
FIRST
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
PBT
CHEMICAL
TABLE
10
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Section
4.5:
SIC
code
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Section
4.6:
Latitude
Degrees
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Minutes
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Seconds
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Section
4.6:
Longitude
Degrees
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Minutes
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Seconds
0.08
0.75
1.18
2.01
100.00
0.08
0.75
1.18
2.01
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
10.00
1.18
11.26
83.47
0.07
8.35
0.98
9.40
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
10.00
1.18
11.26
80.47
0.07
8.05
0.95
9.06
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
10.00
1.18
11.26
45.97
0.04
4.60
0.54
5.18
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
10.00
1.18
11.26
0.59
0.00
0.06
0.01
0.07
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
10.00
1.18
11.26
100.00
0.08
10.00
1.18
11.26
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
0.08
10.00
1.18
11.26
100.00
0.08
10.00
1.18
11.26
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
Section
1.3:
Generic
chemical
name
0.08
0.50
1.18
1.76
0.00
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
1.18
1.51
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
1.18
1.34
46.98
0.04
0.04
0.55
0.63
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
1.18
1.34
63.81
0.05
0.05
0.75
0.86
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
1.18
1.34
34.60
0.03
0.03
0.41
0.46
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
1.00
30.00
1.18
32.18
100.00
1.00
30.00
1.18
32.18
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
1.18
1.51
100.00
0.08
0.25
1.18
1.51
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
1.18
1.34
48.21
0.04
0.04
0.57
0.65
A.
Total
release
3.00
195.00
1.18
199.18
51.79
1.55
100.99
0.61
103.15
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
51.72
0.04
0.13
0.61
0.78
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
1.18
1.34
25.44
0.02
0.02
0.30
0.34
A.
Total
release
3.00
86.00
1.18
90.18
74.56
2.24
64.12
0.88
67.23
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
74.43
0.06
0.19
0.88
1.12
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
1.18
1.34
71.42
0.06
0.06
0.84
0.96
5.3.1:
Stream
or
water
body
name
0.08
0.25
1.18
1.51
28.58
0.02
0.07
0.34
0.43
A.
Total
release
3.00
116.07
1.18
120.25
28.58
0.86
33.17
0.34
34.37
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
28.56
0.02
0.07
0.34
0.43
C.
%
from
stormwater
0.25
2.00
1.18
3.43
18.45
0.05
0.37
0.22
0.63
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
1.18
1.34
99.69
0.08
0.08
1.17
1.34
A.
Total
release
2.00
73.00
1.18
76.18
0.32
0.01
0.23
0.00
0.24
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
0.31
0.00
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
1.18
1.34
99.73
0.08
0.08
1.17
1.34
A.
Total
release
2.00
73.00
1.18
76.18
0.27
0.01
0.20
0.00
0.21
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
0.26
0.00
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
1.18
1.34
98.26
0.08
0.08
1.16
1.32
A.
Total
release
3.00
96.00
1.18
100.18
1.74
0.05
1.67
0.02
1.74
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
1.74
0.00
0.00
0.02
0.03
5.5.1B:
Other
landfills
NA
0.08
0.08
1.18
1.34
90.54
0.08
0.08
1.06
1.22
A.
Total
release
3.00
96.00
1.18
100.18
9.46
0.28
9.08
0.11
9.48
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
9.45
0.01
0.02
0.11
0.14
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
1.18
1.34
97.95
0.08
0.08
1.15
1.31
A.
Total
release
3.00
96.00
1.18
100.18
2.05
0.06
1.97
0.02
2.05
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
2.05
0.00
0.01
0.02
0.03
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
1.18
1.34
46.03
0.04
0.04
0.54
0.62
A.
Total
release
3.00
96.00
1.18
100.18
3.98
0.12
3.82
0.05
3.98
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
3.98
0.00
0.01
0.05
0.06
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
1.18
1.34
46.03
0.04
0.04
0.54
0.62
A.
Total
release
3.00
96.00
1.18
100.18
3.98
0.12
3.82
0.05
3.98
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
3.98
0.00
0.01
0.05
0.06
5.5.4:
Other
disposal
NA
0.08
0.08
1.18
1.34
86.71
0.07
0.07
1.02
1.16
A.
Total
release
1.00
35.00
1.18
37.18
13.29
0.13
4.65
0.16
4.94
B.
Basis
of
estimate
0.08
0.25
1.18
1.51
13.25
0.01
0.03
0.16
0.20
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
2.00
73.00
1.18
76.18
19.01
0.38
13.88
0.22
14.48
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
1.18
1.51
18.89
0.02
0.05
0.22
0.29
6.1.
B
POTW
name
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
POTW
address
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
City
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
State
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
County
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
Zip
0.08
0.25
1.18
1.51
18.90
0.02
0.05
0.22
0.29
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
Off­
site
location
name
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
Off­
site
address
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
City
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
State
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
County
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
Zip
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
Country
(
non­
US)
0.17
0.50
1.18
1.84
100.00
0.17
0.50
1.18
1.84
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
1.18
1.51
100.00
0.17
0.17
1.18
1.51
A:
Total
transfers
3.00
107.00
1.18
111.18
100.00
3.00
107.00
1.18
111.18
B:
Basis
of
estimate
0.17
0.50
1.18
1.84
99.90
0.17
0.50
1.17
1.84
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
0.17
0.50
1.18
1.84
99.83
0.17
0.50
1.17
1.84
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
1.18
1.34
66.44
0.06
0.06
0.78
0.89
7A.
1a:
General
waste
stream
(
enter
code)
1.00
10.00
1.18
12.18
33.56
0.34
3.36
0.39
4.09
7A.
1b:
Waste
treatment
method(
s)

sequence
1.00
25.00
1.18
27.18
33.56
0.34
8.39
0.39
9.12
7A.
1c:
Range
of
influent
concentration
2.00
60.00
1.18
63.18
33.56
0.67
20.14
0.39
21.20
7A.
1d:
Waste
treatment
efficiency
estimate
1.00
30.00
1.18
32.18
33.56
0.34
10.07
0.39
10.80
7A.
1e:
Based
on
operating
data?
0.17
0.17
1.18
1.51
33.56
0.06
0.06
0.39
0.51
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
1.18
1.34
98.90
0.08
0.08
1.16
1.33
Energy
recovery
methods
1.00
32.00
1.18
34.18
1.10
0.01
0.35
0.01
0.38
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
1.18
1.34
93.77
0.08
0.08
1.10
1.26
Energy
recovery
methods
1.00
38.00
1.18
40.18
6.23
0.06
2.37
0.07
2.50
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
1.18
1.51
92.85
0.08
0.23
1.09
1.40
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
92.85
0.23
4.64
1.09
5.97
Column
C:
Following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
1.18
1.51
92.85
0.08
0.23
1.09
1.40
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
92.85
0.23
4.64
1.09
5.97
Column
C:
Following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
1.18
1.51
92.85
0.08
0.23
1.09
1.40
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
92.85
0.23
4.64
1.09
5.97
Column
C:
Following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
1.18
1.51
92.85
0.08
0.23
1.09
1.40
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
92.85
0.23
4.64
1.09
5.97
Column
C:
Following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
92.85
0.08
0.93
1.09
2.10
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
1.96
0.00
0.00
0.02
0.03
Column
B:
Current
reporting
year
1.00
30.00
1.18
32.18
1.96
0.02
0.59
0.02
0.63
Column
C:
Following
year
0.08
1.00
1.18
2.26
1.96
0.00
0.02
0.02
0.04
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
1.96
0.00
0.02
0.02
0.04
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
2.95
0.00
0.01
0.03
0.04
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
2.95
0.01
0.15
0.03
0.19
Column
C:
Following
year
0.08
1.00
1.18
2.26
2.95
0.00
0.03
0.03
0.07
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
2.95
0.00
0.03
0.03
0.07
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
7.17
0.01
0.02
0.08
0.11
Column
B:
Current
reporting
year
1.00
30.00
1.18
32.18
7.17
0.07
2.15
0.08
2.31
Column
C:
Following
year
0.08
1.00
1.18
2.26
7.17
0.01
0.07
0.08
0.16
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
7.17
0.01
0.07
0.08
0.16
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
30.21
0.03
0.08
0.36
0.46
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
30.21
0.08
1.51
0.36
1.94
Column
C:
Following
year
0.08
1.00
1.18
2.26
30.21
0.03
0.30
0.36
0.68
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
30.21
0.03
0.30
0.36
0.68
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
6.36
0.01
0.02
0.07
0.10
Column
B:
Current
reporting
year
1.00
30.00
1.18
32.18
6.36
0.06
1.91
0.07
2.05
Column
C:
Following
year
0.08
1.00
1.18
2.26
6.36
0.01
0.06
0.07
0.14
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
6.36
0.01
0.06
0.07
0.14
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
1.18
1.51
5.86
0.00
0.01
0.07
0.09
Column
B:
Current
reporting
year
0.25
5.00
1.18
6.43
5.86
0.01
0.29
0.07
0.38
Column
C:
Following
year
0.08
1.00
1.18
2.26
5.86
0.00
0.06
0.07
0.13
Column
D:
Second
following
year
0.08
1.00
1.18
2.26
5.86
0.00
0.06
0.07
0.13
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
1.18
6.43
24.37
0.06
1.22
0.29
1.57
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
1.18
38.01
100.00
0.83
36.00
1.18
38.01
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
1.00
35.00
1.18
37.18
8.32
0.08
2.91
0.10
3.09
Methods
to
identify
activity
0.08
0.25
1.18
1.51
8.29
0.01
0.02
0.10
0.13
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
60.33
1770.32
174.00
2004.65
21.29
551.86
95.49
668.65
TOTAL
(
hr)
1.01
29.51
2.90
33.41
0.35
9.20
1.59
11.14
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.

Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Clerical
Total
Time
Incidence
Rate
(%)
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.66
0.82
100.00
0.08
0.08
0.66
0.82
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.66
0.82
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Signature
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Date
signed
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Facility
or
establishment
name
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Street
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
City/
county/
state/
zip
code
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Mailing
address
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
City/
state/
zip
code
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Country
(
non­
US)
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.66
0.82
100.00
0.08
0.08
0.66
0.82
Section
4.3:
Technical
contact
name
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Telephone
number
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Email
address
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Section
4.4:

Public
contact
name
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Telephone
number
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
TABLE
11
FIRST
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
NON­
PBT
CHEMICAL
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Section
4.5:
SIC
code
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Section
4.6:
Latitude
Degrees
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Minutes
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Seconds
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Section
4.6:
Longitude
Degrees
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Minutes
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Seconds
0.08
0.75
0.66
1.49
100.00
0.08
0.75
0.66
1.49
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
10.00
0.66
10.74
83.47
0.07
8.35
0.55
8.96
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
10.00
0.66
10.74
80.47
0.07
8.05
0.53
8.64
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
10.00
0.66
10.74
45.97
0.04
4.60
0.30
4.94
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
10.00
0.66
10.74
0.59
0.00
0.06
0.00
0.06
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
10.00
0.66
10.74
100.00
0.08
10.00
0.66
10.74
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
0.08
10.00
0.66
10.74
100.00
0.08
10.00
0.66
10.74
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
Section
1.3:
Generic
chemical
name
0.08
0.50
0.66
1.24
0.00
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
0.66
0.99
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
0.66
0.82
33.06
0.03
0.03
0.22
0.27
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
0.66
0.82
59.84
0.05
0.05
0.39
0.49
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
0.66
0.82
39.97
0.03
0.03
0.26
0.33
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
1.00
30.00
0.66
31.66
100.00
1.00
30.00
0.66
31.66
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.66
0.99
100.00
0.08
0.25
0.66
0.99
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.66
0.82
28.32
0.02
0.02
0.19
0.23
A.
Total
release
3.00
195.00
0.66
198.66
71.68
2.15
139.78
0.47
142.40
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
71.61
0.06
0.18
0.47
0.71
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.66
0.82
26.15
0.02
0.02
0.17
0.22
A.
Total
release
3.00
106.00
0.66
109.66
73.85
2.22
78.28
0.48
80.98
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
73.78
0.06
0.18
0.48
0.73
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.66
0.82
73.56
0.06
0.06
0.48
0.60
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.66
0.99
26.44
0.02
0.07
0.17
0.26
A.
Total
release
3.00
111.58
0.66
115.24
26.44
0.79
29.50
0.17
30.47
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
26.42
0.02
0.07
0.17
0.26
C.
%
from
stormwater
0.25
2.00
0.66
2.91
16.64
0.04
0.33
0.11
0.48
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.66
0.82
98.76
0.08
0.08
0.65
0.81
A.
Total
release
2.00
73.00
0.66
75.66
1.24
0.02
0.91
0.01
0.94
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
1.21
0.00
0.00
0.01
0.01
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.66
0.82
99.76
0.08
0.08
0.65
0.82
A.
Total
release
2.00
73.00
0.66
75.66
0.24
0.00
0.18
0.00
0.18
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
0.23
0.00
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.66
0.82
98.48
0.08
0.08
0.65
0.81
A.
Total
release
3.00
96.00
0.66
99.66
1.52
0.05
1.46
0.01
1.51
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
1.51
0.00
0.00
0.01
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.66
0.82
94.51
0.08
0.08
0.62
0.78
A.
Total
release
3.00
96.00
0.66
99.66
5.49
0.16
5.27
0.04
5.47
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
5.47
0.00
0.01
0.04
0.05
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.66
0.82
98.33
0.08
0.08
0.64
0.81
A.
Total
release
2.00
73.00
0.66
75.66
1.67
0.03
1.22
0.01
1.26
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
1.65
0.00
0.00
0.01
0.02
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.66
0.82
47.92
0.04
0.04
0.31
0.39
A.
Total
release
3.00
96.00
0.66
99.66
2.09
0.06
2.00
0.01
2.08
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
2.09
0.00
0.01
0.01
0.02
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.66
0.82
47.92
0.04
0.04
0.31
0.39
A.
Total
release
3.00
96.00
0.66
99.66
2.09
0.06
2.00
0.01
2.08
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
2.09
0.00
0.01
0.01
0.02
5.5.4:
Other
disposal
NA
0.08
0.08
0.66
0.82
90.45
0.08
0.08
0.59
0.74
A.
Total
release
1.00
35.00
0.66
36.66
9.55
0.10
3.34
0.06
3.50
B.
Basis
of
estimate
0.08
0.25
0.66
0.99
9.48
0.01
0.02
0.06
0.09
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
2.00
73.00
0.66
75.66
23.97
0.48
17.50
0.16
18.13
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.66
0.99
23.93
0.02
0.06
0.16
0.24
6.1.
B
POTW
name
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
POTW
address
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
City
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
State
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
County
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
Zip
0.08
0.25
0.66
0.99
23.92
0.02
0.06
0.16
0.24
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
Off­
site
location
name
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
Off­
site
address
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
City
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
State
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
County
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
Zip
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
Country
(
non­
US)
0.17
0.50
0.66
1.32
100.00
0.17
0.50
0.66
1.32
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
0.66
0.99
100.00
0.17
0.17
0.66
0.99
A:
Total
transfers
3.00
107.00
0.66
110.66
100.00
3.00
107.00
0.66
110.66
B:
Basis
of
estimate
0.17
0.50
0.66
1.32
99.99
0.17
0.50
0.66
1.32
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
0.17
0.50
0.66
1.32
99.97
0.17
0.50
0.66
1.32
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.66
0.82
51.48
0.04
0.04
0.34
0.42
7A.
1a:
General
waste
stream
(
enter
code)
1.00
10.00
0.66
11.66
48.52
0.49
4.85
0.32
5.66
7A.
1b:
Waste
treatment
method(
s)

sequence
1.00
25.00
0.66
26.66
48.52
0.49
12.13
0.32
12.93
7A.
1c:
Range
of
influent
concentration
2.00
60.00
0.66
62.66
48.52
0.97
29.11
0.32
30.40
7A.
1d:
Waste
treatment
efficiency
estimate
1.00
30.00
0.66
31.66
48.52
0.49
14.56
0.32
15.36
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.66
0.99
48.52
0.08
0.08
0.32
0.48
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.66
0.82
95.60
0.08
0.08
0.63
0.79
Energy
recovery
methods
1.00
32.00
0.66
33.66
4.40
0.04
1.41
0.03
1.48
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.66
0.82
90.18
0.08
0.08
0.59
0.74
Energy
recovery
methods
1.00
38.00
0.66
39.66
9.82
0.10
3.73
0.06
3.89
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.66
0.99
93.89
0.08
0.23
0.62
0.93
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
93.89
0.23
4.69
0.62
5.54
Column
C:
Following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.66
0.99
93.89
0.08
0.23
0.62
0.93
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
93.89
0.23
4.69
0.62
5.54
Column
C:
Following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.66
0.99
93.89
0.08
0.23
0.62
0.93
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
93.89
0.23
4.69
0.62
5.54
Column
C:
Following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.66
0.99
93.89
0.08
0.23
0.62
0.93
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
93.89
0.23
4.69
0.62
5.54
Column
C:
Following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
93.89
0.08
0.94
0.62
1.63
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
5.42
0.00
0.01
0.04
0.05
Column
B:
Current
reporting
year
1.00
30.00
0.66
31.66
5.42
0.05
1.63
0.04
1.72
Column
C:
Following
year
0.08
1.00
0.66
1.74
5.42
0.00
0.05
0.04
0.09
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
5.42
0.00
0.05
0.04
0.09
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
18.52
0.02
0.05
0.12
0.18
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
18.52
0.05
0.93
0.12
1.09
Column
C:
Following
year
0.08
1.00
0.66
1.74
18.52
0.02
0.19
0.12
0.32
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
18.52
0.02
0.19
0.12
0.32
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
10.83
0.01
0.03
0.07
0.11
Column
B:
Current
reporting
year
1.00
30.00
0.66
31.66
10.83
0.11
3.25
0.07
3.43
Column
C:
Following
year
0.08
1.00
0.66
1.74
10.83
0.01
0.11
0.07
0.19
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
10.83
0.01
0.11
0.07
0.19
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
22.68
0.02
0.06
0.15
0.22
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
22.68
0.06
1.13
0.15
1.34
Column
C:
Following
year
0.08
1.00
0.66
1.74
22.68
0.02
0.23
0.15
0.39
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
22.68
0.02
0.23
0.15
0.39
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
24.58
0.02
0.06
0.16
0.24
Column
B:
Current
reporting
year
1.00
30.00
0.66
31.66
24.58
0.25
7.37
0.16
7.78
Column
C:
Following
year
0.08
1.00
0.66
1.74
24.58
0.02
0.25
0.16
0.43
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
24.58
0.02
0.25
0.16
0.43
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.66
0.99
28.76
0.02
0.07
0.19
0.28
Column
B:
Current
reporting
year
0.25
5.00
0.66
5.91
28.76
0.07
1.44
0.19
1.70
Column
C:
Following
year
0.08
1.00
0.66
1.74
28.76
0.02
0.29
0.19
0.50
Column
D:
Second
following
year
0.08
1.00
0.66
1.74
28.76
0.02
0.29
0.19
0.50
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
0.66
5.91
27.65
0.07
1.38
0.18
1.63
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
0.66
37.49
100.00
0.83
36.00
0.66
37.49
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
1.00
35.00
0.66
36.66
13.25
0.13
4.64
0.09
4.86
Methods
to
identify
activity
0.08
0.25
0.66
0.99
13.25
0.01
0.03
0.09
0.13
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
59.33
1762.83
97.02
1919.18
23.00
629.49
55.50
708.00
TOTAL
(
hr)
0.99
29.38
1.62
31.99
0.38
10.49
0.93
11.80
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.

Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Clerical
Total
Time
Incidence
Rate
(%)
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.81
0.98
100.00
0.08
0.08
0.81
0.98
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.81
0.98
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Signature
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Date
signed
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Facility
or
establishment
name
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Street
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
City/
county/
state/
zip
code
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Mailing
address
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
City/
state/
zip
code
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Country
(
non­
US)
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.81
0.98
100.00
0.08
0.08
0.81
0.98
Section
4.3:
Technical
contact
name
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Telephone
number
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Email
address
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
4.4:

Public
contact
name
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Telephone
number
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
TABLE
12
SUBSEQUENT
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
PBT
CHEMICAL
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Section
4.5:
SIC
code
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
4.6:
Latitude
Degrees
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Minutes
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Seconds
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
4.6:
Longitude
Degrees
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Minutes
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Seconds
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
0.25
0.81
1.14
83.47
0.07
0.21
0.68
0.96
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
0.25
0.81
1.14
80.47
0.07
0.20
0.65
0.92
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
0.25
0.81
1.14
45.97
0.04
0.11
0.37
0.53
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
0.25
0.81
1.14
0.59
0.00
0.00
0.00
0.01
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
Section
1.3:
Generic
chemical
name
0.08
0.25
0.81
1.14
0.00
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
0.81
1.14
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
0.81
0.98
46.98
0.04
0.04
0.38
0.46
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
0.81
0.98
63.81
0.05
0.05
0.52
0.62
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
0.81
0.98
34.60
0.03
0.03
0.28
0.34
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
0.83
30.00
0.81
31.64
100.00
0.83
30.00
0.81
31.64
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.81
1.14
100.00
0.08
0.25
0.81
1.14
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.81
0.98
48.21
0.04
0.04
0.39
0.47
A.
Total
release
2.50
115.00
0.81
118.31
51.79
1.29
59.56
0.42
61.27
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
51.72
0.04
0.13
0.42
0.59
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.81
0.98
25.44
0.02
0.02
0.21
0.25
A.
Total
release
1.67
60.00
0.81
62.48
74.56
1.24
44.74
0.60
46.58
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
74.43
0.06
0.19
0.60
0.85
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.81
0.98
71.42
0.06
0.06
0.58
0.70
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.81
1.14
28.58
0.02
0.07
0.23
0.33
A.
Total
release
2.50
85.09
0.81
88.40
28.58
0.71
24.32
0.23
25.26
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
28.56
0.02
0.07
0.23
0.33
C.
%
from
stormwater
0.25
2.00
0.81
3.06
18.45
0.05
0.37
0.15
0.56
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.81
0.98
99.69
0.08
0.08
0.81
0.97
A.
Total
release
1.67
63.00
0.81
65.48
0.32
0.01
0.20
0.00
0.21
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
0.31
0.00
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.81
0.98
99.73
0.08
0.08
0.81
0.97
A.
Total
release
1.67
63.00
0.81
65.48
0.27
0.00
0.17
0.00
0.18
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
0.26
0.00
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.81
0.98
98.26
0.08
0.08
0.80
0.96
A.
Total
release
1.67
66.00
0.81
68.48
1.74
0.03
1.15
0.01
1.19
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
1.74
0.00
0.00
0.01
0.02
5.5.1B:
Other
landfills
NA
0.08
0.08
0.81
0.98
90.54
0.08
0.08
0.73
0.89
A.
Total
release
1.67
66.00
0.81
68.48
9.46
0.16
6.24
0.08
6.48
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
9.45
0.01
0.02
0.08
0.11
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.81
0.98
97.95
0.08
0.08
0.79
0.96
A.
Total
release
1.67
66.00
0.81
68.48
2.05
0.03
1.35
0.02
1.40
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
2.05
0.00
0.01
0.02
0.02
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.81
0.98
46.03
0.04
0.04
0.37
0.45
A.
Total
release
1.67
66.00
0.81
68.48
3.98
0.07
2.62
0.03
2.72
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
3.98
0.00
0.01
0.03
0.05
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.81
0.98
46.03
0.04
0.04
0.37
0.45
A.
Total
release
1.67
66.00
0.81
68.48
3.98
0.07
2.62
0.03
2.72
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
3.98
0.00
0.01
0.03
0.05
5.5.4:
Other
disposal
NA
0.08
0.08
0.81
0.98
86.71
0.07
0.07
0.70
0.85
A.
Total
release
0.83
35.00
0.81
36.64
13.29
0.11
4.65
0.11
4.87
B.
Basis
of
estimate
0.08
0.25
0.81
1.14
13.25
0.01
0.03
0.11
0.15
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
1.67
58.00
0.81
60.48
19.01
0.32
11.03
0.15
11.50
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.81
1.14
18.89
0.02
0.05
0.15
0.22
6.1.
B
POTW
name
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
POTW
address
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
City
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
State
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
County
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
Zip
0.08
0.25
0.81
1.14
18.90
0.02
0.05
0.15
0.22
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
Off­
site
location
name
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
Off­
site
address
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
City
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
State
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
County
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
Zip
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
Country
(
non­
US)
0.17
0.50
0.81
1.48
100.00
0.17
0.50
0.81
1.48
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
0.81
1.14
100.00
0.17
0.17
0.81
1.14
A:
Total
transfers
2.50
82.00
0.81
85.31
100.00
2.50
82.00
0.81
85.31
B:
Basis
of
estimate
0.08
0.50
0.81
1.39
99.90
0.08
0.50
0.81
1.39
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
0.17
0.50
0.81
1.48
99.83
0.17
0.50
0.81
1.47
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.81
0.98
66.44
0.06
0.06
0.54
0.65
7A.
1a:
General
waste
stream
(
enter
code)
0.83
5.00
0.81
6.64
33.56
0.28
1.68
0.27
2.23
7A.
1b:
Waste
treatment
method(
s)

sequence
0.83
7.00
0.81
8.64
33.56
0.28
2.35
0.27
2.90
7A.
1c:
Range
of
influent
concentration
0.83
30.00
0.81
31.64
33.56
0.28
10.07
0.27
10.62
7A.
1d:
Waste
treatment
efficiency
estimate
0.83
10.00
0.81
11.64
33.56
0.28
3.36
0.27
3.91
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.81
1.14
33.56
0.06
0.06
0.27
0.38
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.81
0.98
98.90
0.08
0.08
0.80
0.97
Energy
recovery
methods
0.83
24.00
0.81
25.64
1.10
0.01
0.26
0.01
0.28
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.81
0.98
93.77
0.08
0.08
0.76
0.92
Energy
recovery
methods
0.83
27.00
0.81
28.64
6.23
0.05
1.68
0.05
1.78
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.81
1.14
92.85
0.08
0.23
0.75
1.06
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
92.85
0.23
4.64
0.75
5.63
Column
C:
Following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.81
1.14
92.85
0.08
0.23
0.75
1.06
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
92.85
0.23
4.64
0.75
5.63
Column
C:
Following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.81
1.14
92.85
0.08
0.23
0.75
1.06
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
92.85
0.23
4.64
0.75
5.63
Column
C:
Following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.81
1.14
92.85
0.08
0.23
0.75
1.06
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
92.85
0.23
4.64
0.75
5.63
Column
C:
Following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
92.85
0.08
0.93
0.75
1.76
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.81
1.14
1.96
0.00
0.00
0.02
0.02
Column
B:
Current
reporting
year
0.83
30.00
0.81
31.64
1.96
0.02
0.59
0.02
0.62
Column
C:
Following
year
0.08
1.00
0.81
1.89
1.96
0.00
0.02
0.02
0.04
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
1.96
0.00
0.02
0.02
0.04
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
1.00
0.81
1.89
2.95
0.00
0.03
0.02
0.06
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
2.95
0.01
0.15
0.02
0.18
Column
C:
Following
year
0.08
1.00
0.81
1.89
2.95
0.00
0.03
0.02
0.06
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
2.95
0.00
0.03
0.02
0.06
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.81
1.14
7.17
0.01
0.02
0.06
0.08
Column
B:
Current
reporting
year
0.83
30.00
0.81
31.64
7.17
0.06
2.15
0.06
2.27
Column
C:
Following
year
0.08
1.00
0.81
1.89
7.17
0.01
0.07
0.06
0.14
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
7.17
0.01
0.07
0.06
0.14
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.81
1.14
30.21
0.03
0.08
0.24
0.35
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
30.21
0.08
1.51
0.24
1.83
Column
C:
Following
year
0.08
1.00
0.81
1.89
30.21
0.03
0.30
0.24
0.57
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
30.21
0.03
0.30
0.24
0.57
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.81
1.14
6.36
0.01
0.02
0.05
0.07
Column
B:
Current
reporting
year
0.83
30.00
0.81
31.64
6.36
0.05
1.91
0.05
2.01
Column
C:
Following
year
0.08
1.00
0.81
1.89
6.36
0.01
0.06
0.05
0.12
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
6.36
0.01
0.06
0.05
0.12
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.81
1.14
5.86
0.00
0.01
0.05
0.07
Column
B:
Current
reporting
year
0.25
5.00
0.81
6.06
5.86
0.01
0.29
0.05
0.36
Column
C:
Following
year
0.08
1.00
0.81
1.89
5.86
0.00
0.06
0.05
0.11
Column
D:
Second
following
year
0.08
1.00
0.81
1.89
5.86
0.00
0.06
0.05
0.11
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
0.81
6.06
24.37
0.06
1.22
0.20
1.48
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
0.81
37.64
100.00
0.83
36.00
0.81
37.64
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
0.83
35.00
0.81
36.64
8.32
0.07
2.91
0.07
3.05
Methods
to
identify
activity
0.08
0.25
0.81
1.14
8.29
0.01
0.02
0.07
0.09
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
46.75
1270.34
120.00
1437.09
18.16
379.65
65.86
463.67
TOTAL
(
hr)
0.78
21.17
2.00
23.95
0.30
6.33
1.10
7.73
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.

Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Proposed
Item
Management
Technical
Clerical
Total
Time
Incidence
Rate
(%)
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
0.08
0.08
0.45
0.61
100.00
0.08
0.08
0.45
0.61
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
0.08
0.08
0.45
0.61
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Signature
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
Date
signed
0.25
0.00
0.00
0.25
100.00
0.25
0.00
0.00
0.25
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Facility
or
establishment
name
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Street
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
City/
county/
state/
zip
code
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Mailing
address
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
City/
state/
zip
code
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Country
(
non­
US)
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
0.08
0.08
0.45
0.61
100.00
0.08
0.08
0.45
0.61
Section
4.3:
Technical
contact
name
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Telephone
number
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Email
address
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
4.4:

Public
contact
name
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Telephone
number
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
TABLE
13
SUBSEQUENT
YEAR
REALISTIC
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
NON­
PBT
CHEMICAL
Realistic
reporting
burden
per
Form
R
(
min)
Estimated
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Section
4.5:
SIC
code
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
4.6:
Latitude
Degrees
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Minutes
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Seconds
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
4.6:
Longitude
Degrees
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Minutes
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Seconds
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
4.7:
Dun
&
Bradstreet
number(
s)
0.08
0.25
0.45
0.78
83.47
0.07
0.21
0.37
0.65
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
0.08
0.25
0.45
0.78
80.47
0.07
0.20
0.36
0.63
Section
4.9:
Facility
NPDES
permit
number(
s)
0.08
0.25
0.45
0.78
45.97
0.04
0.11
0.21
0.36
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
0.08
0.25
0.45
0.78
0.59
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
1.2:
Toxic
chemical
or
chemical
category
name
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
Section
1.3:
Generic
chemical
name
0.08
0.25
0.45
0.78
0.00
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
0.08
0.25
0.45
0.78
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
0.08
0.08
0.45
0.61
33.06
0.03
0.03
0.15
0.20
Section
3.2:
Process
the
toxic
chemical
0.08
0.08
0.45
0.61
59.84
0.05
0.05
0.27
0.37
Section
3.3:
Otherwise
use
the
toxic
chemical
0.08
0.08
0.45
0.61
39.97
0.03
0.03
0.18
0.24
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
0.83
30.00
0.45
31.28
100.00
0.83
30.00
0.45
31.28
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
0.08
0.25
0.45
0.78
100.00
0.08
0.25
0.45
0.78
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
0.08
0.08
0.45
0.61
28.32
0.02
0.02
0.13
0.17
A.
Total
release
2.50
115.00
0.45
117.95
71.68
1.79
82.43
0.32
84.54
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
71.61
0.06
0.18
0.32
0.56
Section
5.2:
Stack
or
point
air
emissions
NA
0.08
0.08
0.45
0.61
26.15
0.02
0.02
0.12
0.16
A.
Total
release
1.67
66.00
0.45
68.11
73.85
1.23
48.74
0.33
50.30
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
73.78
0.06
0.18
0.33
0.57
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
0.08
0.08
0.45
0.61
73.56
0.06
0.06
0.33
0.45
5.3.1:
Stream
or
water
body
name
0.08
0.25
0.45
0.78
26.44
0.02
0.07
0.12
0.21
A.
Total
release
2.50
82.44
0.45
85.39
26.44
0.66
21.80
0.12
22.58
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
26.42
0.02
0.07
0.12
0.21
C.
%
from
stormwater
0.25
2.00
0.45
2.70
16.64
0.04
0.33
0.07
0.45
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
0.08
0.08
0.45
0.61
98.76
0.08
0.08
0.44
0.61
A.
Total
release
1.67
63.00
0.45
65.11
1.24
0.02
0.78
0.01
0.81
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
1.21
0.00
0.00
0.01
0.01
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
0.08
0.08
0.45
0.61
99.76
0.08
0.08
0.44
0.61
A.
Total
release
1.67
63.00
0.45
65.11
0.24
0.00
0.15
0.00
0.16
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
0.23
0.00
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
0.08
0.08
0.45
0.61
98.48
0.08
0.08
0.44
0.60
A.
Total
release
1.67
66.00
0.45
68.11
1.52
0.03
1.00
0.01
1.04
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
1.51
0.00
0.00
0.01
0.01
5.5.1B:
Other
landfills
NA
0.08
0.08
0.45
0.61
94.51
0.08
0.08
0.42
0.58
A.
Total
release
1.67
66.00
0.45
68.11
5.49
0.09
3.62
0.02
3.74
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
5.47
0.00
0.01
0.02
0.04
5.5.2:
Land
treatment/
application
farming
NA
0.08
0.08
0.45
0.61
98.33
0.08
0.08
0.44
0.60
A.
Total
release
1.67
63.00
0.45
65.11
1.67
0.03
1.05
0.01
1.09
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
1.65
0.00
0.00
0.01
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
0.08
0.08
0.45
0.61
47.92
0.04
0.04
0.21
0.29
A.
Total
release
1.67
66.00
0.45
68.11
2.09
0.03
1.38
0.01
1.42
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
2.09
0.00
0.01
0.01
0.02
5.5.3B:
Other
surface
impoundments
NA
0.08
0.08
0.45
0.61
47.92
0.04
0.04
0.21
0.29
A.
Total
release
1.67
66.00
0.45
68.11
2.09
0.03
1.38
0.01
1.42
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
2.09
0.00
0.01
0.01
0.02
5.5.4:
Other
disposal
NA
0.08
0.08
0.45
0.61
90.45
0.08
0.08
0.40
0.55
A.
Total
release
0.83
35.00
0.45
36.28
9.55
0.08
3.34
0.04
3.46
B.
Basis
of
estimate
0.08
0.25
0.45
0.78
9.48
0.01
0.02
0.04
0.07
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
1.67
58.00
0.45
60.11
23.97
0.40
13.90
0.11
14.41
6.1.
A.
2:
Basis
of
estimate
0.08
0.25
0.45
0.78
23.93
0.02
0.06
0.11
0.19
6.1.
B
POTW
name
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
POTW
address
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
City
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
State
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
County
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
Zip
0.08
0.25
0.45
0.78
23.92
0.02
0.06
0.11
0.19
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
Off­
site
location
name
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
Off­
site
address
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
City
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
State
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
County
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
Zip
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
Country
(
non­
US)
0.17
0.50
0.45
1.11
100.00
0.17
0.50
0.45
1.11
Is
location
under
control
of
reporting
facility
or
parent
company?
0.17
0.17
0.45
0.78
100.00
0.17
0.17
0.45
0.78
A:
Total
transfers
2.50
82.00
0.45
84.95
100.00
2.50
82.00
0.45
84.95
B:
Basis
of
estimate
0.17
0.50
0.45
1.11
99.99
0.17
0.50
0.45
1.11
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
0.17
0.50
0.45
1.11
99.97
0.17
0.50
0.45
1.11
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
0.08
0.08
0.45
0.61
51.48
0.04
0.04
0.23
0.32
7A.
1a:
General
waste
stream
(
enter
code)
0.83
5.00
0.45
6.28
48.52
0.40
2.43
0.22
3.05
7A.
1b:
Waste
treatment
method(
s)

sequence
0.83
7.00
0.45
8.28
48.52
0.40
3.40
0.22
4.02
7A.
1c:
Range
of
influent
concentration
0.83
30.00
0.45
31.28
48.52
0.40
14.56
0.22
15.18
7A.
1d:
Waste
treatment
efficiency
estimate
0.83
10.00
0.45
11.28
48.52
0.40
4.85
0.22
5.47
7A.
1e:
Based
on
operating
data?
0.17
0.17
0.45
0.78
48.52
0.08
0.08
0.22
0.38
Section
7B:
On­
site
energy
recovery
processes
NA
0.08
0.08
0.45
0.61
95.60
0.08
0.08
0.43
0.59
Energy
recovery
methods
0.83
24.00
0.45
25.28
4.40
0.04
1.06
0.02
1.11
Section
7C:
On­
site
recycling
processes
NA
0.08
0.08
0.45
0.61
90.18
0.08
0.08
0.40
0.55
Energy
recovery
methods
0.83
27.00
0.45
28.28
9.82
0.08
2.65
0.04
2.78
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.45
0.78
93.89
0.08
0.23
0.42
0.73
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
93.89
0.23
4.69
0.42
5.35
Column
C:
Following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.45
0.78
93.89
0.08
0.23
0.42
0.73
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
93.89
0.23
4.69
0.42
5.35
Column
C:
Following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
0.08
0.25
0.45
0.78
93.89
0.08
0.23
0.42
0.73
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
93.89
0.23
4.69
0.42
5.35
Column
C:
Following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
0.08
0.25
0.45
0.78
93.89
0.08
0.23
0.42
0.73
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
93.89
0.23
4.69
0.42
5.35
Column
C:
Following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
93.89
0.08
0.94
0.42
1.44
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
5.42
0.00
0.01
0.02
0.04
Column
B:
Current
reporting
year
0.83
30.00
0.45
31.28
5.42
0.05
1.63
0.02
1.70
Column
C:
Following
year
0.08
1.00
0.45
1.53
5.42
0.00
0.05
0.02
0.08
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
5.42
0.00
0.05
0.02
0.08
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
18.52
0.02
0.05
0.08
0.14
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
18.52
0.05
0.93
0.08
1.05
Column
C:
Following
year
0.08
1.00
0.45
1.53
18.52
0.02
0.19
0.08
0.28
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
18.52
0.02
0.19
0.08
0.28
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
10.83
0.01
0.03
0.05
0.08
Column
B:
Current
reporting
year
0.83
30.00
0.45
31.28
10.83
0.09
3.25
0.05
3.39
Column
C:
Following
year
0.08
1.00
0.45
1.53
10.83
0.01
0.11
0.05
0.17
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
10.83
0.01
0.11
0.05
0.17
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
22.68
0.02
0.06
0.10
0.18
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
22.68
0.06
1.13
0.10
1.29
Column
C:
Following
year
0.08
1.00
0.45
1.53
22.68
0.02
0.23
0.10
0.35
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
22.68
0.02
0.23
0.10
0.35
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
24.58
0.02
0.06
0.11
0.19
Column
B:
Current
reporting
year
0.83
30.00
0.45
31.28
24.58
0.20
7.37
0.11
7.69
Column
C:
Following
year
0.08
1.00
0.45
1.53
24.58
0.02
0.25
0.11
0.38
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
24.58
0.02
0.25
0.11
0.38
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
0.08
0.25
0.45
0.78
28.76
0.02
0.07
0.13
0.22
Column
B:
Current
reporting
year
0.25
5.00
0.45
5.70
28.76
0.07
1.44
0.13
1.64
Column
C:
Following
year
0.08
1.00
0.45
1.53
28.76
0.02
0.29
0.13
0.44
Column
D:
Second
following
year
0.08
1.00
0.45
1.53
28.76
0.02
0.29
0.13
0.44
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
0.25
5.00
0.45
5.70
27.65
0.07
1.38
0.12
1.57
Section
8.9:
Production
ratio
or
activity
index
0.83
36.00
0.45
37.28
100.00
0.83
36.00
0.45
37.28
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
0.83
35.00
0.45
36.28
13.25
0.11
4.64
0.06
4.81
Methods
to
identify
activity
0.08
0.25
0.45
0.78
13.25
0.01
0.03
0.06
0.10
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
0.00
TOTAL
(
min)
46.83
1269.94
66.00
1382.77
19.68
422.76
37.76
480.20
TOTAL
(
hr)
0.78
21.17
1.10
23.05
0.33
7.05
0.63
8.00
Section
5.5.3B
is
a
new
data
element
field
for
RY
2003.
The
incidence
rate
was
split
between
5.5.3A
and
5.5.3B
because
it
is
assumed
half
of
the
facilities
will
file
for
RCRA
Subtitle
C
impoundments
and
half
of
the
facilities
will
file
for
other
surface
impoundments.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.

Section
6.2:
Technical
burdens
for
typing
and
management
review
burdens
are
doubled
for
all
data
elements
in
this
section,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Proposed
Item
Management
Technical
Total
Time
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
yes
0.12
0.25
0.37
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
yes
0.04
0.08
0.12
0.04
0.08
0.12
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
yes
0.04
0.08
0.12
0.04
0.08
0.12
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Facility
or
establishment
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Street
yes
0.12
0.25
0.37
0.00
0.00
0.00
City/
county/
state/
zip
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
yes
0.12
0.25
0.37
0.00
0.00
0.00
Mailing
address
yes
0.12
0.25
0.37
0.00
0.00
0.00
City/
state/
zip
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Country
(
non­
US)
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
yes
0.04
0.08
0.12
0.04
0.08
0.12
Section
4.3:
Technical
contact
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Telephone
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Email
address
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.4:
Public
contact
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Telephone
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.5:
SIC
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.6:
Latitude
Degrees
yes
0.35
0.75
1.10
0.00
0.00
0.00
Minutes
yes
0.35
0.75
1.10
0.00
0.00
0.00
Seconds
yes
0.35
0.75
1.10
0.00
0.00
0.00
Section
4.6:
Longitude
Degrees
yes
0.35
0.75
1.10
0.00
0.00
0.00
Minutes
yes
0.35
0.75
1.10
0.00
0.00
0.00
TABLE
14
FIRST
AND
SUBSEQUENT
YEAR
SCALED
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
PBT
CHEMICAL
(
INCIDENCE
RATE
NOT
Scaled
reporting
burden
per
Form
R
(
min)

FIRST
YEAR
SUBSEQUENT
YEARS
Static
field*
yes/
no
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Scaled
reporting
burden
per
Form
R
(
min)
Seconds
yes
0.35
0.75
1.10
0.00
0.00
0.00
Section
4.7:
Dun
&
Bradstreet
number(
s)
yes
4.62
10.00
14.62
0.00
0.00
0.00
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
yes
4.62
10.00
14.62
0.00
0.00
0.00
Section
4.9:
Facility
NPDES
permit
number(
s)
yes
4.62
10.00
14.62
0.00
0.00
0.00
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
yes
4.62
10.00
14.62
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
yes
4.62
10.00
14.62
0.00
0.00
0.00
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
yes
4.62
10.00
14.62
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
1.2:
Toxic
chemical
or
chemical
category
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
1.3:
Generic
chemical
name
yes
0.23
0.50
0.73
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
yes
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
yes
0.12
0.25
0.37
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
yes
0.04
0.08
0.12
0.00
0.00
0.00
Section
3.2:
Process
the
toxic
chemical
yes
0.04
0.08
0.12
0.00
0.00
0.00
Section
3.3:
Otherwise
use
the
toxic
chemical
yes
0.04
0.08
0.12
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
no
21.63
46.78
68.40
20.52
44.20
64.73
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
yes
0.12
0.25
0.37
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
140.58
304.04
444.62
78.67
169.45
248.12
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
Section
5.2:
Stack
or
point
air
emissions
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
62.00
134.09
196.09
41.05
88.41
129.45
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
5.3.1:
Stream
or
water
body
name
yes
0.12
0.25
0.37
0.12
0.25
0.37
A.
Total
release
no
83.68
180.97
264.65
58.21
125.38
183.59
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
C.
%
from
stormwater
yes
0.92
2.00
2.92
0.93
2.00
2.93
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
52.63
113.82
166.45
43.10
92.83
135.93
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
52.63
113.82
166.45
43.10
92.83
135.93
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
69.21
149.68
218.89
45.15
97.25
142.40
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
5.5.1B:
Other
landfills
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
69.21
149.68
218.89
45.15
97.25
142.40
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
5.5.2:
Land
treatment/
application
farming
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
69.21
149.68
218.89
45.15
97.25
142.40
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
69.21
149.68
218.89
45.15
97.25
142.40
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
5.5.3B:
Other
surface
impoundments
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
69.21
149.68
218.89
45.15
97.25
142.40
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
5.5.4:
Other
disposal
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
25.23
54.57
79.80
23.94
51.57
75.51
B.
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
no
52.63
113.82
166.45
39.68
85.46
125.14
6.1.
A.
2:
Basis
of
estimate
yes
0.12
0.25
0.37
0.12
0.25
0.37
6.1.
B
POTW
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
POTW
address
yes
0.12
0.25
0.37
0.00
0.00
0.00
City
yes
0.12
0.25
0.37
0.00
0.00
0.00
State
yes
0.12
0.25
0.37
0.00
0.00
0.00
County
yes
0.12
0.25
0.37
0.00
0.00
0.00
Zip
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
yes
0.23
0.50
0.73
0.12
0.25
0.37
Off­
site
location
name
yes
0.23
0.50
0.73
0.12
0.25
0.37
Off­
site
address
yes
0.23
0.50
0.73
0.12
0.25
0.37
City
yes
0.23
0.50
0.73
0.12
0.25
0.37
State
yes
0.23
0.50
0.73
0.12
0.25
0.37
County
yes
0.23
0.50
0.73
0.12
0.25
0.37
Zip
yes
0.23
0.50
0.73
0.12
0.25
0.37
Country
(
non­
US)
yes
0.23
0.50
0.73
0.12
0.25
0.37
Is
location
under
control
of
reporting
facility
or
parent
company?
yes
0.08
0.17
0.24
0.04
0.08
0.12
A:
Total
transfers
no
77.14
166.83
243.97
56.10
120.82
176.92
B:
Basis
of
estimate
yes
0.23
0.50
0.73
0.12
0.25
0.37
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
yes
0.23
0.50
0.73
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
7A.
1a:
General
waste
stream
(
enter
code)
no
7.21
15.59
22.80
3.42
7.37
10.79
7A.
1b:
Waste
treatment
method(
s)
sequence
no
18.02
38.98
57.00
4.79
10.31
15.10
7A.
1c:
Range
of
influent
concentration
no
43.26
93.55
136.81
20.52
44.20
64.73
7A.
1d:
Waste
treatment
efficiency
estimate
no
21.63
46.78
68.40
6.84
14.73
21.58
7A.
1e:
Based
on
operating
data?
yes
0.08
0.17
0.24
0.08
0.17
0.24
Section
7B:
On­
site
energy
recovery
processes
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
Energy
recovery
methods
no
23.07
49.89
72.96
16.42
35.36
51.78
Section
7C:
On­
site
recycling
processes
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
Energy
recovery
methods
no
27.40
59.25
86.64
18.47
39.78
58.25
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
21.63
46.78
68.40
20.52
44.20
64.73
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.46
1.00
1.46
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
21.63
46.78
68.40
20.52
44.20
64.73
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
21.63
46.78
68.40
20.52
44.20
64.73
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
yes
0.12
0.25
0.37
0.12
0.25
0.37
Column
B:
Current
reporting
year
no
3.60
7.80
11.40
3.42
7.37
10.79
Column
C:
Following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Column
D:
Second
following
year
no
0.72
1.56
2.28
0.68
1.47
2.16
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
no
3.60
7.80
11.40
3.42
7.37
10.79
Section
8.9:
Production
ratio
or
activity
index
no
25.95
56.13
82.08
24.63
53.04
77.67
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
no
25.23
54.57
79.80
23.94
51.57
75.51
Methods
to
identify
activity
yes
0.12
0.25
0.37
0.12
0.25
0.37
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
TOTAL
(
min)
1254.00
2712.00
3966.00
858.00
1848.00
2706.00
TOTAL
(
hr)
20.90
45.20
66.10
14.30
30.80
45.10
*
A
static
field
is
one
that
only
requires
typing
or
a
quick
information
look
up
by
technical
staff.
Static
fields
are
not
scaled
up.
Section
6.2:
Technical
burdens
for
typing
are
doubled
for
all
data
elements
in
this
section
for
first
year
filers,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Clerical
Total
Time
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Signature
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Date
signed
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Facility
or
establishment
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Street
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
City/
county/
state/
zip
code
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Mailing
address
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
City/
state/
zip
code
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Country
(
non­
US)
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Section
4.3:
Technical
contact
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Telephone
number
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Email
address
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
4.4:

Public
contact
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
TABLE
15
FIRST
AND
SUBSEQUENT
YEAR
SCALED
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
PBT
CHEMICAL
(
INCIDENCE
RATE
NOT
INCLUDED)

FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Static
field*

yes/
no
FIRST
YEAR
SUBSEQUENT
YEARS
Scaled
reporting
burden
per
Form
R
(
min)
Scaled
reporting
burden
per
Form
R
(
min)
Telephone
number
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
4.5:
SIC
code
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
4.6:
Latitude
Degrees
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Minutes
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Seconds
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Section
4.6:
Longitude
Degrees
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Minutes
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Seconds
yes
0.35
0.75
1.18
2.27
0.12
0.25
0.81
1.18
Section
4.7:
Dun
&
Bradstreet
number(
s)
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
Section
4.9:
Facility
NPDES
permit
number(
s)
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
yes
4.62
10.00
1.18
15.80
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
1.2:
Toxic
chemical
or
chemical
category
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
1.3:
Generic
chemical
name
yes
0.23
0.50
1.18
1.91
0.12
0.25
0.81
1.18
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Section
3.2:
Process
the
toxic
chemical
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Section
3.3:
Otherwise
use
the
toxic
chemical
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
no
21.63
46.78
1.18
69.58
20.39
43.92
0.81
65.12
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
140.58
304.04
1.18
445.80
78.16
168.35
0.81
247.33
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
5.2:
Stack
or
point
air
emissions
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
62.00
134.09
1.18
197.27
40.78
87.84
0.81
129.43
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
5.3.1:
Stream
or
water
body
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
A.
Total
release
no
83.68
180.97
1.18
265.83
57.83
124.57
0.81
183.21
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
C.
%
from
stormwater
yes
0.92
2.00
1.18
4.10
0.93
2.00
0.81
3.74
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
52.63
113.82
1.18
167.62
42.82
92.23
0.81
135.86
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
52.63
113.82
1.18
167.62
42.82
92.23
0.81
135.86
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
69.21
149.68
1.18
220.07
44.86
96.62
0.81
142.29
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
5.5.1B:
Other
landfills
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
69.21
149.68
1.18
220.07
44.86
96.62
0.81
142.29
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
5.5.2:
Land
treatment/
application
farming
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
69.21
149.68
1.18
220.07
44.86
96.62
0.81
142.29
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
69.21
149.68
1.18
220.07
44.86
96.62
0.81
142.29
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
5.5.3B:
Other
surface
impoundments
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
69.21
149.68
1.18
220.07
44.86
96.62
0.81
142.29
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
5.5.4:
Other
disposal
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
A.
Total
release
no
25.23
54.57
1.18
80.98
23.79
51.24
0.81
75.84
B.
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
no
52.63
113.82
1.18
167.62
39.42
84.91
0.81
125.14
6.1.
A.
2:
Basis
of
estimate
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
6.1.
B
POTW
name
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
POTW
address
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
City
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
State
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
County
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Zip
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
Off­
site
location
name
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
Off­
site
address
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
City
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
State
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
County
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
Zip
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
Country
(
non­
US)
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
Is
location
under
control
of
reporting
facility
or
parent
company?
yes
0.08
0.17
1.18
1.42
0.08
0.17
0.81
1.05
A:
Total
transfers
no
77.14
166.83
1.18
245.15
55.73
120.04
0.81
176.59
B:
Basis
of
estimate
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
yes
0.23
0.50
1.18
1.91
0.23
0.50
0.81
1.54
ITEMS
PERTAINING
TO
SECTION
7
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
7A.
1a:
General
waste
stream
(
enter
code)
no
7.21
15.59
1.18
23.98
3.40
7.32
0.81
11.53
7A.
1b:
Waste
treatment
method(
s)

sequence
no
18.02
38.98
1.18
58.18
4.76
10.25
0.81
15.82
7A.
1c:
Range
of
influent
concentration
no
43.26
93.55
1.18
137.98
20.39
43.92
0.81
65.12
7A.
1d:
Waste
treatment
efficiency
estimate
no
21.63
46.78
1.18
69.58
6.80
14.64
0.81
22.25
7A.
1e:
Based
on
operating
data?
yes
0.08
0.17
1.18
1.42
0.08
0.17
0.81
1.05
Section
7B:
On­
site
energy
recovery
processes
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Energy
recovery
methods
no
23.07
49.89
1.18
74.14
16.31
35.13
0.81
52.26
Section
7C:
On­
site
recycling
processes
NA
yes
0.04
0.08
1.18
1.30
0.04
0.08
0.81
0.93
Energy
recovery
methods
no
27.40
59.25
1.18
87.82
18.35
39.53
0.81
58.69
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
21.63
46.78
1.18
69.58
20.39
43.92
0.81
65.12
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.46
1.00
0.81
2.28
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
21.63
46.78
1.18
69.58
20.39
43.92
0.81
65.12
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
21.63
46.78
1.18
69.58
20.39
43.92
0.81
65.12
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Column
B:
Current
reporting
year
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Column
C:
Following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Column
D:
Second
following
year
no
0.72
1.56
1.18
3.46
0.68
1.46
0.81
2.95
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
no
3.60
7.80
1.18
12.58
3.40
7.32
0.81
11.53
Section
8.9:
Production
ratio
or
activity
index
no
25.95
56.13
1.18
83.26
24.47
52.70
0.81
77.98
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
no
25.23
54.57
1.18
80.98
23.79
51.24
0.81
75.84
Methods
to
identify
activity
yes
0.12
0.25
1.18
1.54
0.12
0.25
0.81
1.18
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
TOTAL
(
min)
1254.00
2712.00
174.00
4140.00
858.00
1848.00
120.00
2826.00
TOTAL
(
hr)
20.90
45.20
2.90
69.00
14.30
30.80
2.00
47.10
*
A
static
field
is
one
that
only
requires
typing
or
a
quick
information
look
up
by
technical
staff.
Static
fields
are
not
scaled
up.

Section
6.2:
Technical
burdens
for
typing
are
doubled
for
all
data
elements
in
this
section
for
first
and
subsequent
year
filers,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Proposed
Item
Management
Technical
Total
Time
Management
Technical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
yes
0.12
0.25
0.37
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
yes
0.04
0.08
0.12
0.04
0.08
0.12
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
yes
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
NA
NA
NA
NA
NA
NA
Signature
NA
NA
NA
NA
NA
NA
Date
signed
NA
NA
NA
NA
NA
NA
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Facility
or
establishment
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Street
yes
0.12
0.25
0.37
0.00
0.00
0.00
City/
county/
state/
zip
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
yes
0.12
0.25
0.37
0.00
0.00
0.00
Mailing
address
yes
0.12
0.25
0.37
0.00
0.00
0.00
City/
state/
zip
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Country
(
non­
US)
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
yes
0.04
0.08
0.12
0.04
0.08
0.12
Section
4.3:
Technical
contact
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Telephone
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Email
address
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.4:
Public
contact
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Telephone
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.5:
SIC
code
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
4.6:
Latitude
Degrees
yes
0.35
0.75
1.10
0.00
0.00
0.00
Minutes
yes
0.35
0.75
1.10
0.00
0.00
0.00
Seconds
yes
0.35
0.75
1.10
0.00
0.00
0.00
Section
4.6:
Longitude
Degrees
yes
0.35
0.75
1.10
0.00
0.00
0.00
Minutes
yes
0.35
0.75
1.10
0.00
0.00
0.00
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
TABLE
16
FIRST
AND
SUBSEQUENT
YEAR
SCALED
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
FORM
R
ELECTRONICALLY
FOR
A
NON­
PBT
CHEMICAL
(
INCIDENCE
RATE
Static
field*
yes/
no
Scaled
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Scaled
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FIRST
YEAR
SUBSEQUENT
YEARS
Seconds
yes
0.35
0.75
1.10
0.00
0.00
0.00
Section
4.7:
Dun
&
Bradstreet
number(
s)
yes
3.92
8.35
12.27
0.00
0.00
0.00
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
yes
3.78
8.05
11.83
0.00
0.00
0.00
Section
4.9:
Facility
NPDES
permit
number(
s)
yes
2.16
4.60
6.76
0.00
0.00
0.00
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
yes
0.03
0.06
0.09
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
yes
4.70
10.00
14.70
0.00
0.00
0.00
Section
5.2:
Parent
company's
Dun
&
Bradstreet
number
yes
4.70
10.00
14.70
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
1.2:
Toxic
chemical
or
chemical
category
name
yes
0.12
0.25
0.37
0.00
0.00
0.00
Section
1.3:
Generic
chemical
name
yes
0.00
0.00
0.00
0.00
0.00
0.00
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
yes
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
yes
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
yes
0.01
0.03
0.04
0.00
0.00
0.00
Section
3.2:
Process
the
toxic
chemical
yes
0.02
0.05
0.07
0.00
0.00
0.00
Section
3.3:
Otherwise
use
the
toxic
chemical
yes
0.02
0.03
0.05
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
no
34.26
72.96
107.22
33.85
72.10
105.95
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
yes
0.12
0.25
0.37
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
yes
0.01
0.02
0.03
0.01
0.02
0.03
A.
Total
release
no
159.61
339.95
499.55
93.01
198.10
291.11
B.
Basis
of
estimate
yes
0.08
0.18
0.26
0.08
0.18
0.26
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
Section
5.2:
Stack
or
point
air
emissions
NA
yes
0.01
0.02
0.03
0.01
0.02
0.03
A.
Total
release
no
89.39
190.39
279.77
55.00
117.14
172.13
B.
Basis
of
estimate
yes
0.09
0.18
0.27
0.09
0.18
0.27
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
yes
0.03
0.06
0.09
0.03
0.06
0.09
5.3.1:
Stream
or
water
body
name
yes
0.03
0.07
0.10
0.03
0.07
0.10
A.
Total
release
no
33.69
71.75
105.44
24.59
52.38
76.98
B.
Basis
of
estimate
yes
0.03
0.07
0.10
0.03
0.07
0.10
C.
%
from
stormwater
yes
0.16
0.33
0.49
0.16
0.33
0.49
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
1.03
2.20
3.24
0.88
1.88
2.76
B.
Basis
of
estimate
yes
0.00
0.00
0.00
0.00
0.00
0.00
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
0.20
0.43
0.63
0.17
0.36
0.53
B.
Basis
of
estimate
yes
0.00
0.00
0.00
0.00
0.00
0.00
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
1.67
3.55
5.22
1.13
2.41
3.54
B.
Basis
of
estimate
yes
0.00
0.00
0.01
0.00
0.00
0.01
5.5.1B:
Other
landfills
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
6.02
12.82
18.84
4.09
8.71
12.80
B.
Basis
of
estimate
yes
0.01
0.01
0.02
0.01
0.01
0.02
5.5.2:
Land
treatment/
application
farming
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
A.
Total
release
no
1.39
2.96
4.36
1.19
2.53
3.72
B.
Basis
of
estimate
yes
0.00
0.00
0.01
0.00
0.00
0.01
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
yes
0.02
0.04
0.06
0.02
0.04
0.06
A.
Total
release
no
2.29
4.87
7.15
1.55
3.31
4.86
B.
Basis
of
estimate
yes
0.00
0.01
0.01
0.00
0.01
0.01
5.5.3B:
Other
surface
impoundments
NA
yes
0.02
0.04
0.06
0.02
0.04
0.06
A.
Total
release
no
2.29
4.87
7.15
1.55
3.31
4.86
B.
Basis
of
estimate
yes
0.00
0.01
0.01
0.00
0.01
0.01
5.5.4:
Other
disposal
NA
yes
0.04
0.08
0.11
0.04
0.08
0.11
A.
Total
release
no
3.82
8.13
11.95
3.77
8.03
11.80
B.
Basis
of
estimate
yes
0.01
0.02
0.03
0.01
0.02
0.03
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)
6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
no
19.98
42.56
62.54
15.69
33.41
49.10
6.1.
A.
2:
Basis
of
estimate
yes
0.03
0.06
0.09
0.03
0.06
0.09
6.1.
B
POTW
name
yes
0.03
0.06
0.09
0.00
0.00
0.00
POTW
address
yes
0.03
0.06
0.09
0.00
0.00
0.00
City
yes
0.03
0.06
0.09
0.00
0.00
0.00
State
yes
0.03
0.06
0.09
0.00
0.00
0.00
County
yes
0.03
0.06
0.09
0.00
0.00
0.00
Zip
yes
0.03
0.06
0.09
0.00
0.00
0.00
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
yes
0.23
0.50
0.73
0.12
0.25
0.37
Off­
site
location
name
yes
0.23
0.50
0.73
0.12
0.25
0.37
Off­
site
address
yes
0.23
0.50
0.73
0.12
0.25
0.37
City
yes
0.23
0.50
0.73
0.12
0.25
0.37
State
yes
0.23
0.50
0.73
0.12
0.25
0.37
County
yes
0.23
0.50
0.73
0.12
0.25
0.37
Zip
yes
0.23
0.50
0.73
0.12
0.25
0.37
Country
(
non­
US)
yes
0.23
0.50
0.73
0.12
0.25
0.37
Is
location
under
control
of
reporting
facility
or
parent
company?
yes
0.08
0.17
0.24
0.04
0.08
0.12
A:
Total
transfers
no
122.18
260.23
382.41
92.52
197.06
289.59
B:
Basis
of
estimate
yes
0.23
0.50
0.73
0.12
0.25
0.37
C:
Type
of
waste
treatment/
disposal/
recycling/
energy
recovery
yes
0.23
0.50
0.73
0.12
0.25
0.37
ITEMS
PERTAINING
TO
SECTION
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
yes
0.02
0.04
0.06
0.02
0.04
0.06
7A.
1a:
General
waste
stream
(
enter
code)
no
5.54
11.80
17.34
2.74
5.83
8.57
7A.
1b:
Waste
treatment
method(
s)
sequence
no
13.85
29.50
43.35
3.83
8.16
11.99
7A.
1c:
Range
of
influent
concentration
no
33.24
70.80
104.05
16.42
34.98
51.41
7A.
1d:
Waste
treatment
efficiency
estimate
no
16.62
35.40
52.02
5.47
11.66
17.14
7A.
1e:
Based
on
operating
data?
yes
0.04
0.08
0.12
0.04
0.08
0.12
Section
7B:
On­
site
energy
recovery
processes
NA
yes
0.04
0.08
0.12
0.04
0.08
0.12
Energy
recovery
methods
no
1.61
3.42
5.03
1.19
2.54
3.73
Section
7C:
On­
site
recycling
processes
NA
yes
0.04
0.08
0.11
0.04
0.08
0.11
Energy
recovery
methods
no
4.26
9.08
13.34
2.99
6.37
9.36
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.11
0.23
0.34
0.11
0.23
0.34
Column
B:
Current
reporting
year
no
5.36
11.42
16.78
5.30
11.28
16.58
Column
C:
Following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Column
D:
Second
following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.11
0.23
0.34
0.11
0.23
0.34
Column
B:
Current
reporting
year
no
5.36
11.42
16.78
5.30
11.28
16.58
Column
C:
Following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Column
D:
Second
following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,
RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.11
0.23
0.34
0.11
0.23
0.34
Column
B:
Current
reporting
year
no
5.36
11.42
16.78
5.30
11.28
16.58
Column
C:
Following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Column
D:
Second
following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.11
0.23
0.34
0.11
0.23
0.34
Column
B:
Current
reporting
year
no
5.36
11.42
16.78
5.30
11.28
16.58
Column
C:
Following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Column
D:
Second
following
year
no
1.07
2.28
3.36
1.06
2.26
3.32
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
yes
0.01
0.01
0.02
0.01
0.01
0.02
Column
B:
Current
reporting
year
no
1.86
3.95
5.81
1.83
3.91
5.74
Column
C:
Following
year
no
0.06
0.13
0.19
0.06
0.13
0.19
Column
D:
Second
following
year
no
0.06
0.13
0.19
0.06
0.13
0.19
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
yes
0.02
0.05
0.07
0.02
0.05
0.07
Column
B:
Current
reporting
year
no
1.06
2.25
3.31
1.04
2.23
3.27
Column
C:
Following
year
no
0.21
0.45
0.66
0.21
0.45
0.65
Column
D:
Second
following
year
no
0.21
0.45
0.66
0.21
0.45
0.65
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
yes
0.01
0.03
0.04
0.01
0.03
0.04
Column
B:
Current
reporting
year
no
3.71
7.90
11.61
3.67
7.81
11.47
Column
C:
Following
year
no
0.12
0.26
0.39
0.12
0.26
0.38
Column
D:
Second
following
year
no
0.12
0.26
0.39
0.12
0.26
0.38
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
yes
0.03
0.06
0.08
0.03
0.06
0.08
Column
B:
Current
reporting
year
no
1.29
2.76
4.05
1.28
2.73
4.00
Column
C:
Following
year
no
0.26
0.55
0.81
0.26
0.55
0.80
Column
D:
Second
following
year
no
0.26
0.55
0.81
0.26
0.55
0.80
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
yes
0.03
0.06
0.09
0.03
0.06
0.09
Column
B:
Current
reporting
year
no
8.42
17.93
26.35
8.32
17.72
26.04
Column
C:
Following
year
no
0.28
0.60
0.88
0.28
0.59
0.87
Column
D:
Second
following
year
no
0.28
0.60
0.88
0.28
0.59
0.87
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
yes
0.03
0.07
0.11
0.03
0.07
0.11
Column
B:
Current
reporting
year
no
1.64
3.50
5.14
1.62
3.46
5.08
Column
C:
Following
year
no
0.33
0.70
1.03
0.32
0.69
1.02
Column
D:
Second
following
year
no
0.33
0.70
1.03
0.32
0.69
1.02
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
no
1.58
3.36
4.94
1.56
3.32
4.88
Section
8.9:
Production
ratio
or
activity
index
no
41.11
87.55
128.66
40.62
86.52
127.14
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?
8.10.1
Source
reduction
activities
no
5.30
11.28
16.57
5.23
11.14
16.38
Methods
to
identify
activity
yes
0.02
0.03
0.05
0.02
0.03
0.05
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
TOTAL
(
min)
679.14
1446.48
2125.62
462.00
984.00
1446.00
TOTAL
(
hr)
11.32
24.11
35.43
7.70
16.40
24.10
*
A
static
field
is
one
that
only
requires
typing
or
a
quick
information
look
up
by
technical
staff.
Static
fields
are
not
scaled
up.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.
Section
6.2:
Technical
burdens
for
typing
are
doubled
for
all
data
elements
in
this
section
for
first
year
filers,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.
Proposed
Item
Management
Technical
Clerical
Total
Time
Management
Technical
Clerical
Total
Time
ITEMS
PERTAINING
TO
SECTION
1:
Reporting
Year
Section
1:
Reporting
Year
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
ITEMS
PERTAINING
TO
SECTION
2:
Trade
Secret
Information
Section
2.1:
Are
you
claiming
the
toxic
chemical
identified
on
page
2
trade
secret?
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
Section
2.2:
Is
this
copy
sanitized
or
unsanitized?
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
ITEMS
PERTAINING
TO
SECTION
3:
Certification
Name
and
official
title
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Signature
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Date
signed
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
4:
Facility
Identification
Section
4.1
TRI
facility
ID
number
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Facility
or
establishment
name
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Street
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
City/
county/
state/
zip
code
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Facility
or
establishment
name
or
mailing
address
(
if
different
from
street
address)
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Mailing
address
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
City/
state/
zip
code
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Country
(
non­
US)
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
4.2:
This
report
contains
information
for
(
check
a
or
b;
check
c
or
d
if
applicable)
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
Section
4.3:
Technical
contact
name
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Telephone
number
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Email
address
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
4.4:

Public
contact
name
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
TABLE
17
FIRST
AND
SUBSEQUENT
YEAR
SCALED
DATA
ELEMENT
SPECIFIC
TRI
REPORTING
BURDEN
ESTIMATES
ASSOCIATED
WITH
FILING
A
PAPER
FORM
R
FOR
A
NON­
PBT
CHEMICAL
(
INCIDENCE
RATE
INCLUDED)

Static
field*

yes/
no
Scaled
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)
Scaled
reporting
burden
per
Form
R
weighted
by
the
incidence
rate
(
min)

FIRST
YEAR
SUBSEQUENT
YEARS
FORM
R
PART
I:
FACILITY
IDENTIFICATION
INFORMATION
Telephone
number
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
4.5:
SIC
code
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
4.6:
Latitude
Degrees
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Minutes
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Seconds
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Section
4.6:
Longitude
Degrees
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Minutes
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Seconds
yes
0.35
0.75
0.66
1.76
0.12
0.25
0.45
0.81
Section
4.7:
Dun
&
Bradstreet
number(
s)
yes
3.92
8.35
0.66
12.92
0.10
0.21
0.45
0.75
Section
4.8:
EPA
identification
number
(
RCRA
I.
D.
No.)
yes
3.78
8.05
0.66
12.48
0.09
0.20
0.45
0.74
Section
4.9:
Facility
NPDES
permit
number(
s)
yes
2.16
4.60
0.66
7.41
0.05
0.11
0.45
0.61
Section
4.10:
Underground
injection
well
code
(
UIC)
I.
D.
number(
s)
yes
0.03
0.06
0.66
0.74
0.00
0.00
0.45
0.45
ITEMS
PERTAINING
TO
SECTION
5:
Parent
Company
Information
Section
5.1:
Name
of
parent
company
yes
4.70
10.00
0.66
15.35
0.12
0.25
0.45
0.81
Section
5.2:
Parent
company's
Dun
&

Bradstreet
number
yes
4.70
10.00
0.66
15.35
0.12
0.25
0.45
0.81
ITEMS
PERTAINING
TO
SECTION
1:
Toxic
Chemical
Identity
Section
1.1:
CAS
number
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
1.2:
Toxic
chemical
or
chemical
category
name
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
Section
1.3:
Generic
chemical
name
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
Section
1.4:
Distribution
of
each
member
of
the
dioxin
and
dioxin­
like
compounds
category
yes
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
ITEMS
PERTAINING
TO
SECTION
2:
Mixture
Component
Identity
Section
2.1:
Generic
chemical
name
provided
by
supplier
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
ITEMS
PERTAINING
TO
SECTION
3:
Activities
and
Uses
of
the
Toxic
Chemical
at
the
Facility
Section
3.1:
Manufacture
the
toxic
chemical
yes
0.01
0.03
0.66
0.70
0.01
0.03
0.45
0.49
Section
3.2:
Process
the
toxic
chemical
yes
0.02
0.05
0.66
0.73
0.02
0.05
0.45
0.52
Section
3.3:
Otherwise
use
the
toxic
chemical
yes
0.02
0.03
0.66
0.70
0.02
0.03
0.45
0.49
FORM
R
PART
II:
CHEMICAL­
SPECIFIC
INFORMATION
ITEMS
PERTAINING
TO
SECTION
4:
Maximum
Amount
of
the
Toxic
Chemical
On­
Site
at
any
Time
During
the
Calendar
Year
Section
4.1:
Determine
maximum
quantity
on­
site
no
34.26
72.96
0.66
107.87
33.52
71.39
0.45
105.35
Section
4.1:
(
Enter
two­
digit
code
from
instruction
package)
yes
0.12
0.25
0.66
1.02
0.12
0.25
0.45
0.81
ITEMS
PERTAINING
TO
SECTION
5:
Quantity
of
the
Toxic
Chemical
Entering
each
Environmental
Medium
On­
Site
Section
5.1:
Fugitive
or
non­
point
air
emissions
NA
yes
0.01
0.02
0.66
0.69
0.01
0.02
0.45
0.48
A.
Total
release
no
159.61
339.95
0.66
500.21
92.10
196.16
0.45
288.71
B.
Basis
of
estimate
yes
0.08
0.18
0.66
0.92
0.08
0.18
0.45
0.71
Section
5.2:
Stack
or
point
air
emissions
NA
yes
0.01
0.02
0.66
0.69
0.01
0.02
0.45
0.48
A.
Total
release
no
89.39
190.39
0.66
280.43
54.46
115.99
0.45
170.89
B.
Basis
of
estimate
yes
0.09
0.18
0.66
0.93
0.09
0.18
0.45
0.72
Section
5.3:
Discharges
to
receiving
streams
or
water
bodies
NA
yes
0.03
0.06
0.66
0.75
0.03
0.06
0.45
0.54
5.3.1:
Stream
or
water
body
name
yes
0.03
0.07
0.66
0.75
0.03
0.07
0.45
0.54
A.
Total
release
no
33.69
71.75
0.66
106.09
24.35
51.87
0.45
76.67
B.
Basis
of
estimate
yes
0.03
0.07
0.66
0.75
0.03
0.07
0.45
0.54
C.
%
from
stormwater
yes
0.16
0.33
0.66
1.14
0.16
0.33
0.45
0.93
5.4.1:
Underground
injection
onsite
to
Class
I
wells
NA
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
A.
Total
release
no
1.03
2.20
0.66
3.89
0.87
1.86
0.45
3.18
B.
Basis
of
estimate
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
Section
5.4.2:
Underground
injection
onsite
to
Class
II­
V
wells
NA
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
A.
Total
release
no
0.20
0.43
0.66
1.28
0.17
0.36
0.45
0.97
B.
Basis
of
estimate
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
Section
5.5:
Disposal
to
land
on­
site
5.5.1A:
RCRA
Subtitle
C
landfills
NA
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
A.
Total
release
no
1.67
3.55
0.66
5.87
1.12
2.39
0.45
3.95
B.
Basis
of
estimate
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
5.5.1B:
Other
landfills
NA
yes
0.04
0.08
0.66
0.77
0.04
0.08
0.45
0.56
A.
Total
release
no
6.02
12.82
0.66
19.49
4.05
8.62
0.45
13.12
B.
Basis
of
estimate
yes
0.01
0.01
0.66
0.68
0.01
0.01
0.45
0.47
5.5.2:
Land
treatment/
application
farming
NA
yes
0.04
0.08
0.66
0.78
0.04
0.08
0.45
0.57
A.
Total
release
no
1.39
2.96
0.66
5.01
1.18
2.50
0.45
4.13
B.
Basis
of
estimate
yes
0.00
0.00
0.66
0.66
0.00
0.00
0.45
0.45
5.5.3A:
RCRA
Subtitle
C
surface
impoundments
NA
yes
0.02
0.04
0.66
0.71
0.02
0.04
0.45
0.50
A.
Total
release
no
2.29
4.87
0.66
7.81
1.54
3.27
0.45
5.26
B.
Basis
of
estimate
yes
0.00
0.01
0.66
0.66
0.00
0.01
0.45
0.45
5.5.3B:
Other
surface
impoundments
NA
yes
0.02
0.04
0.66
0.71
0.02
0.04
0.45
0.50
A.
Total
release
no
2.29
4.87
0.66
7.81
1.54
3.27
0.45
5.26
B.
Basis
of
estimate
yes
0.00
0.01
0.66
0.66
0.00
0.01
0.45
0.45
5.5.4:
Other
disposal
NA
yes
0.04
0.08
0.66
0.77
0.04
0.08
0.45
0.56
A.
Total
release
no
3.82
8.13
0.66
12.60
3.73
7.95
0.45
12.13
B.
Basis
of
estimate
yes
0.01
0.02
0.66
0.69
0.01
0.02
0.45
0.48
ITEMS
PERTAINING
TO
SECTION
6:
Transfers
of
the
Toxic
Chemical
in
Wastes
to
Off­
Site
Locations
Section
6.1:
Discharges
to
publicly
owned
treatment
works
(
POTWs)

6.1.
A:
Total
quantity
transferred
to
POTWs
and
basis
of
estimate
6.1.
A.
1:
Total
transfers
no
19.98
42.56
0.66
63.19
15.53
33.08
0.45
49.06
6.1.
A.
2:
Basis
of
estimate
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
6.1.
B
POTW
name
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
POTW
address
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
City
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
State
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
County
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
Zip
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
Section
6.2:
Transfers
to
other
off­
site
locations
Off­
site
EPA
identification
number
(
RCRA
ID
No.)
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
Off­
site
location
name
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
Off­
site
address
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
City
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
State
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
County
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
Zip
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
Country
(
non­
US)
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
Is
location
under
control
of
reporting
facility
or
parent
company?
yes
0.08
0.17
0.66
0.90
0.08
0.17
0.45
0.69
A:
Total
transfers
no
122.18
260.23
0.66
383.07
91.62
195.13
0.45
287.20
B:
Basis
of
estimate
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
C:
Type
of
waste
treatment/

disposal/
recycling/
energy
recovery
yes
0.23
0.50
0.66
1.39
0.23
0.50
0.45
1.18
ITEMS
PERTAINING
TO
SECTION
Section
7A:
On­
site
waste
treatment
methods
and
efficiency
NA
yes
0.02
0.04
0.66
0.72
0.02
0.04
0.45
0.51
7A.
1a:
General
waste
stream
(
enter
code)
no
5.54
11.80
0.66
18.00
2.71
5.77
0.45
8.93
7A.
1b:
Waste
treatment
method(
s)

sequence
no
13.85
29.50
0.66
44.01
3.79
8.08
0.45
12.32
7A.
1c:
Range
of
influent
concentration
no
33.24
70.80
0.66
104.70
16.26
34.64
0.45
51.35
7A.
1d:
Waste
treatment
efficiency
estimate
no
16.62
35.40
0.66
52.68
5.42
11.55
0.45
17.41
7A.
1e:
Based
on
operating
data?
yes
0.04
0.08
0.66
0.77
0.04
0.08
0.45
0.56
Section
7B:
On­
site
energy
recovery
processes
NA
yes
0.04
0.08
0.66
0.77
0.04
0.08
0.45
0.56
Energy
recovery
methods
no
1.61
3.42
0.66
5.69
1.18
2.51
0.45
4.14
Section
7C:
On­
site
recycling
processes
NA
yes
0.04
0.08
0.66
0.77
0.04
0.08
0.45
0.56
Energy
recovery
methods
no
4.26
9.08
0.66
13.99
2.96
6.31
0.45
9.72
ITEMS
PERTAINING
TO
SECTION
8:
Source
Reduction
and
Recycling
Activities
Section
8.1a:
Total
on­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.11
0.23
0.66
1.00
0.11
0.23
0.45
0.79
Column
B:
Current
reporting
year
no
5.36
11.42
0.66
17.43
5.25
11.17
0.45
16.86
Column
C:
Following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Column
D:
Second
following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Section
8.1b:
Total
other
on­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.11
0.23
0.66
1.00
0.11
0.23
0.45
0.79
Column
B:
Current
reporting
year
no
5.36
11.42
0.66
17.43
5.25
11.17
0.45
16.86
Column
C:
Following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Column
D:
Second
following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Section
8.1c:
Total
off­
site
disposal
to
Class
I
Underground
Injection
Wells,

RCRA
Subtitle
C
landfills,
and
other
landfills
Column
A:
Prior
year
yes
0.11
0.23
0.66
1.00
0.11
0.23
0.45
0.79
Column
B:
Current
reporting
year
no
5.36
11.42
0.66
17.43
5.25
11.17
0.45
16.86
Column
C:
Following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Column
D:
Second
following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Section
8.1d:
Total
other
off­
site
disposal
or
other
releases
Column
A:
Prior
year
yes
0.11
0.23
0.66
1.00
0.11
0.23
0.45
0.79
Column
B:
Current
reporting
year
no
5.36
11.42
0.66
17.43
5.25
11.17
0.45
16.86
Column
C:
Following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Column
D:
Second
following
year
no
1.07
2.28
0.66
4.01
1.05
2.23
0.45
3.73
Section
8.2:
Quantity
used
for
energy
recovery
on­
site
Column
A:
Prior
year
yes
0.01
0.01
0.66
0.68
0.01
0.01
0.45
0.47
Column
B:
Current
reporting
year
no
1.86
3.95
0.66
6.47
1.82
3.87
0.45
6.13
Column
C:
Following
year
no
0.06
0.13
0.66
0.85
0.06
0.13
0.45
0.64
Column
D:
Second
following
year
no
0.06
0.13
0.66
0.85
0.06
0.13
0.45
0.64
Section
8.3:
Quantity
used
for
energy
recovery
off­
site
Column
A:
Prior
year
yes
0.02
0.05
0.66
0.72
0.02
0.05
0.45
0.51
Column
B:
Current
reporting
year
no
1.06
2.25
0.66
3.97
1.03
2.20
0.45
3.68
Column
C:
Following
year
no
0.21
0.45
0.66
1.32
0.21
0.44
0.45
1.09
Column
D:
Second
following
year
no
0.21
0.45
0.66
1.32
0.21
0.44
0.45
1.09
Section
8.4:
Quantity
recycled
on­
site
Column
A:
Prior
year
yes
0.01
0.03
0.66
0.70
0.01
0.03
0.45
0.49
Column
B:
Current
reporting
year
no
3.71
7.90
0.66
12.27
3.63
7.73
0.45
11.81
Column
C:
Following
year
no
0.12
0.26
0.66
1.04
0.12
0.26
0.45
0.82
Column
D:
Second
following
year
no
0.12
0.26
0.66
1.04
0.12
0.26
0.45
0.82
Section
8.5:
Quantity
recycled
off­
site
Column
A:
Prior
year
yes
0.03
0.06
0.66
0.74
0.03
0.06
0.45
0.53
Column
B:
Current
reporting
year
no
1.29
2.76
0.66
4.71
1.27
2.70
0.45
4.41
Column
C:
Following
year
no
0.26
0.55
0.66
1.47
0.25
0.54
0.45
1.24
Column
D:
Second
following
year
no
0.26
0.55
0.66
1.47
0.25
0.54
0.45
1.24
Section
8.6:
Quantity
treated
on­
site
Column
A:
Prior
year
yes
0.03
0.06
0.66
0.75
0.03
0.06
0.45
0.54
Column
B:
Current
reporting
year
no
8.42
17.93
0.66
27.01
8.24
17.55
0.45
26.23
Column
C:
Following
year
no
0.28
0.60
0.66
1.53
0.27
0.58
0.45
1.31
Column
D:
Second
following
year
no
0.28
0.60
0.66
1.53
0.27
0.58
0.45
1.31
Section
8.7:
Quantity
treated
off­
site
Column
A:
Prior
year
yes
0.03
0.07
0.66
0.76
0.03
0.07
0.45
0.55
Column
B:
Current
reporting
year
no
1.64
3.50
0.66
5.79
1.61
3.42
0.45
5.47
Column
C:
Following
year
no
0.33
0.70
0.66
1.68
0.32
0.68
0.45
1.45
Column
D:
Second
following
year
no
0.33
0.70
0.66
1.68
0.32
0.68
0.45
1.45
Section
8.8:
Quantity
released
to
the
environment
as
a
result
of
remedial
actions,
catastrophic
events,
or
one­
time
events
not
associated
with
production
processes
no
1.58
3.36
0.66
5.60
1.54
3.29
0.45
5.28
Section
8.9:
Production
ratio
or
activity
index
no
41.11
87.55
0.66
129.32
40.22
85.67
0.45
126.34
Section
8.10:
Did
your
facility
engage
in
any
source
reduction
activities?

8.10.1
Source
reduction
activities
no
5.30
11.28
0.66
17.23
5.18
11.04
0.45
16.66
Methods
to
identify
activity
yes
0.02
0.03
0.66
0.70
0.02
0.03
0.45
0.49
Section
8.11:
Is
additional
information
on
source
reduction,
recycling
or
pollution
control
activities
included
with
this
report?
0.00
0.00
TOTAL
(
min)
679.14
1446.48
97.02
2222.64
462.00
984.00
66.00
1512.00
TOTAL
(
hr)
11.32
24.11
1.62
37.04
7.70
16.40
1.10
25.20
Section
8.1
was
split
into
8.1
a,
b,
c,
and
d
for
RY
2003;
therefore,
data
for
8.1
in
RY
2002
were
applied
to
all
of
the
new
fields.

Section
6.2:
Technical
burdens
for
typing
are
doubled
for
all
data
elements
in
this
section
for
first
and
subsequent
year
filers,
except
total
transfers,
because
a
normal
facility
reports
two
off
site
transfer
locations.
The
total
transfers
field
burden
is
already
adjusted
for
the
additional
calculation
time
based
on
the
economy
of
scale
associated
with
reporting
two
transfers.

Section
7A.
1e:
The
technical
burden
for
typing
is
doubled
because
a
typical
facility
reports
two
waste
streams.

*
A
static
field
is
one
that
only
requires
typing
or
a
quick
information
look
up
by
technical
staff.
Static
fields
are
not
scaled
up.