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OCR for page 139
~pCDd~ ~
Nag louse Industda1 Sumac
List of Selected Substances (gable 1)
Selected Substance Report Quesdonnsire
and Instructions
*SOURCE: JEEP, 198~
139
OCR for page 140
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OCR for page 141
APPENDIX G
141
Folm COM 021
Rev. 2180
.___
~_
OfFICE or ~Hs CO - ISSIONEFI
PART I - Gen~ol Plont Informotlon
;in=:~_
_.~
Stat. ot Hew Jer - y
Depu~t d En'6ro~te. Protectlon ~· ·
Raturn forms to:
INDUSTRIAL SURVEY PROJECT
P.O. BOX 251
TRENTON, NEW JERSEY 08602
SELECTED SUBSTANCE REPORT
CO~PLETE ONE REPORT FOR EACII PLANT 51TE OR fACILITY LOCATION
1. Compeny NU~
I
2. Dl~lshn ~ Plant N~
3. Maillog Addrose (Str~t)
tCltyJ7a~n) County State Zlp Code
4. Plant Locatlon Add - " (Str~t) ---
(It no' as sbove)
tClty/Ta - ~, C - nty State Zlp Code.
5. Dato Plant B - - Operations At Tl~is Locatlon
6. Porson to Contact Rogarding th,iS Report.
7. Phone Numt~or (Ar~ Codo)
Tl~le
8. ~IC C - o (Four Dl'lt) S=ndard InduarW Cl~itic~ion (if evulabb)
9. Natus d Busi - "
10. Number ot Pr~tu:tlon Employoes at this Plant Site
11. Doos this plant mantJacture, process, tc~m, repackage, relea - , use, dispose ot a. store "y ot the selected subetances
st~own on Table I of the anclosod Instructlons? (Check Or - ) YES C NO C
It your answ. to nwobor 1t ;s "YES", comPlate the Entire Rep~t lor yow facility, sign and ret~n.
It your answo~r to n~r 11 is "NO", con~letc ~stion 1S, sign and retun.
1, HEREBY, CERTIFY TttAT AEL STATEMENTS MAOE eY ME iN TFtlS REP - T ARE TRUE, COMPLETE ANO CORRECT
TO ThiE BEST OF ~ KNOWL~E A~ THAT ESTIMATES WH~E US~ HAYE B~N ~OE IN G=O FAITH.
NAME (Prtnt)
Title
Signatu.
Dat ~-~
12A. Sketch (On tt. rever" side d this page) or anach a copy ot a map indicatinq thc exact location d the plant site.
t28. SUpply your Dun ~ eradatr~t numbor tt available.
FOR OFFICIAL USE ONLY
I
~ | | |
C ~
V o
s 1 1 1 ~ 1
o o
N
OA
l--T I I I I I I I 1
I ..
OCR for page 142
142
AL4SS BALANCE INFORMA TION
PART I - Gonoral Informat~on (continu.~)
13. List atl d t" select" s~t~os Included in this report along with their CAS Nu~ers (From
Table I of tl# Inetructlons) whid, u. manufactured, procossed, tornad, ropackag - , rele~ed,
u~d, dlepo~i ot or storm) at ths plant site:
14. W - t~ter Ol~rges-Compiete the toliowing in10rmatlon:
A. Ol~r" to publicly owned treatment works (POTW}:
1. Nams d Utillt~y (PO1~).
~dressI Location __
2. Estimatod Av~e Volun. d Wast~tor Oisc~rgod to POTW in ~ day
3. 13rlefly deacrlbe my ~retrostment mett~ods
fOR4 CEP
USE ONLY
-
4. tN"tewater conslets d: ( ) Procs" Water, ( ) Contact Coollng, ( ) Non-Contact
Cooli~, ( ) Oomnstic Sewago, ( ) Coniaminated Storm Water, ( ) washdown Water,
( ) Sc~Oer Water, ( ) Ot~r _
B t~i~rgo to Nevig~le W.t~y or Tributary Stream
1 N~ d Rscolving Strsam
2 Nf3OES Pormit l~umb~
3 Estim~ted av. - o volume d wast~ator dix~r~d to rocol~lag stream in a "y
-- ga' ions
Brle11y doscri" any tr atment msthmis
Wast~ter consists d ( ) Process v~ter, ( ) Contact Cooling, ( ) Non-Contact
Cooilnl, ( ) Domestic Ssw go, ( ) Contam' - ted Stcrm "ter, ( ) Wssmown Wator,
~ ~ ~ ~ ( ) Ot - ;
t~ ~lous oIsposal practicff (19~19~ Has this plant previously d15=S-i ot ~stes contain~ng ~y ot _ select=
su~tu= - at my )and dispmal SltO (1 s by 1and spr~ding or buri~, landtililng, lagoon or s - Pago Pit) sit~r on or
ott site?
rES = t4O _
It availablo provide the following into~tion tor each disP - aI sit. Use aCditional pages it necs~sary
N~ and ~tloll d Slto
nm. period sIte w" u~d
Nams ot selocted subst~es P~ysical Amount ot S6I6Ct~ SUOSt=C
dlep~d of at tnis ~ite atate di~cosed at 3'te ,Pounas)
.
OCR for page 143
APPENDIX G
' 3. CUANTtTY CONSUIUEC1 ON ~TE
7. CUANTITY S~IPP0 OFF SITE
AS tOR IN) P`OUCT I
Form CO~ 021 8
q - . ~ -
State ol New lereq
~tn~rn o' Environ~tal Proteetion
ART tI SELECTED SUBSTANCE REPORT
OMPLETE ONE FORM FOR EACH SE~£CTED SUBSTANCE
~ ar* _x~ton of Pl~t
I__
{r.~4
.'
F~R OEP USE
I.D.
Select" Subetance Nane
CAS
.
53ristly Ocacrio. Its Use Cn T:~e Site:
I CHECK ONE
=~=E =S R~ | ACT- I OTI-
fOR rHe PLANT B"~D ON 1978 ~ACE ~ ~ ES71 - tED AHOUN75 l=~St" UNITy UAL ! uAr':
l
I 4. CU - Tt~ PROOUC~ ON SITE ~
2Y
- ' S. =~ - BROU - T CNTO ~ITe
Its/y .
Ibstyr. I
j Ibe/yr. | j
I ~ T I
8. MAXI~-INV-TORY
I | Ib~
9. TOTAL STACX ~l=O~ 0F
SELECT~ = - T - CE
! mex lest~y l
n .' --- !
;~
_ ,
tO. TOT~L FUGITIVE e~tlSSIOP~I OF
SEt ECT0 SUBSTP~Cc
! 11, TOT~_ GISC~^PGE OF SEL=CTE!:
SlJBSTANCE INTO S1JRFACE WAT
1
l
1, Iba/yr. ~
,
| max Ibe/day
| tb~lyt. '
I max Ibs/d" i
_'2. 7OTAL ~ISC~AF:\GE CF SE' --CTED I
~:~BST~bJC-- INT~ °~ UC l_Y OWN
l~EAT iA-T 'NORKS
be/yr.
n~ It33'd"
i. 8tSPS)SAL OF VY~= CONTAINI~ - E SE=C I ~ ~8=A=£
LOC4nO~ 0# t~lN&
DIS~5&L Slr~
8 A~D AOOR
PHY~JCAL
SS&TE
TAOLE ~
OIWSAL
METHCO
sAaLE 8
CUANTITY Of SELECTED
SU8SS - C~ 01~"
tl - )
POR D~ USE
1 1 1 1
r~aLe ~
- ~C~ 57475
01 .so~ic
·~' L, Outd
H~ ~1~
\~ ;i - ~e
..~_09 ~ l~}
143
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-02 cv~- on
..~= "c~c~nq ? - K
'.:~l l~c~nwat~on
`~S In1cc:~ on .'JCI I
'A-26 _ - con
rAB~E a
~S~AL us=~=
.u~07 L~ Bur'al
U-OI! ~an~ Soreaalng
009 Neutratizatlen
t O ._CC - 1
u.t 1 p~'CIi~
' - 72 ;an1 t~ _~ti il
,d, ~ ~ye '.Y8tC,
.~4 Suosurtace ;ystem
S ?.,rolwe's
^~6 Saav Irr~geticn
\1.'7 it_t" Cn ;.~.
t.~?8 .~::`et ~acc: "
OCR for page 144
144
THOMAS BURKE, M.~.hl.
D I R E COO R
I . GENERAL I NFORMAT I ON
~45S BALANCE INFORMS TION
.~t' of N'm 31r rery
DEPARTMENT OF ENVIRONMENTAL PROTECTION
0 reach 0 F CANCER AN D
TO X I C SO VISTA PICAS ~ AS ~ ~ R C
CN-4OZ TRENTON. ~.J. 08625
INDUSTRIAL SURVEY PROJECT
I NSTRUCT I ONS
The Industrial Survey Proj ect is part of an effort by the Depart-
me".t of Environmental Protection (DEP) to assemble a computerized
data base on the uses and release into the environment of about
155 carcinogenic and toxic chemicals. The enclosed questionnaire
forms, entitled "Selected Substance Report", will be mailed to
approximately fifteen thousand industrial establishments in the
State of New Jersey over a year's time. When returned to the
Department, the information contained on them will be coded for
entry and stored in a computer system. The data will then be
correlated with other information, such as death and disease
statistics, to try to identify areas of the state and population
groups who may be subj ected to an increased risk of disease due
to chemical exposure.
The Industrial Survey Project is being conducted by DEP's Toxic
Substances Program. If you have questions about the survey or the
questionnaire forms, or if you need additional information, you may
contact:
Industrial Survey Project
1474 Prospect Street
EN 405
Trenton, New Jersey 08625
Tel. (6093 292-1520
Participation in the Industrial Survey is mandatory. Willful
failure to return a completed Selected Substance Report may result
in legal action against your firm. You will be notified by letter
before any legal action is brought, however, and given adequate
time to submit the report if it has been lost or delayed for any
legitimate reason.
blew Jersey Is An Equal Op,vortunity Employer
OCR for page 145
APPENDIX G
Regulations governing the Industrial Survey Proj ect have been
adopted and codified as Chapter IF of Title 7 of the New Jersey
Administrative Code (N. J.A. C. 7:1F-l.1 et. seq.~. These regulations
describe the proj ect in somewhat greater detail, provide for the
protection of confidential information submitted by survey re-
spondents, and set penalties for persons who fail to return
questionnaires or who make unauthorized disclosures of confidential
information. You may obtain copies of the regulations by contacting
the Industrial Survey Project at the above address.
II. CONFIDENTIAL BUSINESS INFORMTION
If any question on the Selected Substance Report requires you to
submit information which is (or would lead a knowledgeable reader
to deduce from it) ~ trade secret, proprietary business information
or information related to national security, you may make a confiden-
tiality claim. DEP will then treat that information as confidential
and not disclose it in any form that would reveal the secret or
proprietary information, unless the Department makes a formal
finding that the material is not entitled to confidential treatment
under the regulations. Unless an emergency (such as a fire In your
plant which threatens to exposre nearby resident's to toxic materials)
calls for the immediate release of information, you will be notified
in advance if the Department interims to disclose information that
you have claimed as confidential. You will be given an opportunity
to challenge the Department's decision through administrative pro-
cesses, and if not satisfied with the outcome, you will be given
time (except in an emergency situational to obtain a restraining order
from a court, if you wish to pursue an appeal.
To make a confidentiality claim for information contained in the
Selected Substance Report you must do the following:
1. Submit two copies of the report. The first must contain all
the information requested. The secon" contain no information
which you believe entitled to confidential treatment. (The second
copy can be a photocopy of the first with the confidential material
braced or whited out).
2. Mark the top of each page containing confidential information
with the heading "CONFIDENTIAL" in bold type, stamp or hand 1=tter-
~ng. Do not maric every page - only the ones that contain confidential
Information.
3. Identify all information which you Cal aim to be confidential by
underlinging or highligthing it in a clear manner. Translucent
in markers are accetable for this purpose.
Example: Question 6. Quantity Consumed On Site - 140,500 lbs/yr.
145
4. Seal the copy of the report which contains confidential information
into an envelope, and mark the envelope on both sides with the work
"CONFIDENTIAL" in bold type, stamp or hand lettering. Place this
envelope, together with the second (non-confidential) copy of the
report, inside another envelope for transmittal to the Industrial
Survey Project.
- 2
OCR for page 146
146
MASS BALANCE INFORMS TION
5. Send the complete package to the Industrial Survey Proj ect
at the address listed in Part III, Instruction C, below. For
your own protection, we recommend the use of certified mail,
return receipt requested, a messenger service, personal delivery,
or some other means that will give you verification that the Pro-
ject has received your material. You may use ordinary mail, but
the Proj ect assumes no responsiblity for materials not signed for
until they are actually received in the proj ect office.
Please give careful eons iteration to what material you claim as
confidential. Be sure it really is proprietary or a trade secret.
Do not mark a report "Entire Contents Confidential'' or in some
similar fashion. Doing so will result in the Project refusing to
recognize any confidentiality claim, or in our sending it back to
you to be revised. You should also be aware that under State and
federal laws, emissions of toxic materials into the environment
are not entitled to be kept confidential.
~ . . .
I I I . INSTRUCTIONS FOR COMPLETING THE SELECTED SUBSTANCE REPORT
General Instructions
.
A. The data requested are to be supplied as they pertain to the
selected substances of concern to the Department of Environmental
Protection listed in Table 1 (attached). If your plant does not
manufacture, process, form, repackage, release, use, dispose of
or store any of the selected substances, either as a pure sub-
stance or as part of a mixture; and has not disposed of selected
substances by landfilling, lagooning, underground injection or
other subsurface methods in past years since 1930, only Items 1
through 10 of Part I need be completed.
B. If you have more than one plant location, a separate complete
report must be filed for each location. However, you will receive
a separate survey package for each plant location on file with
the State.
C. The report forms are to be completed and returned within 90
days addressed to:
. INDUSTRIAL SURVEY PROJECT
EN 405
TRENTON, NEW JERSEY 0 8 6 2 5
. . . .
Be sure to address the envelope exactly as shown in the box
above. Do not add references to "Department of Environmental
Protection" or "State of New Jersey" as this may cause misrouting
of mail.
If you use a messenger service or deliver the forms in person,
return them to:
14 74 Prospect Street
Trenton, New Jers ey
ATTN: Edward Stevenson or Cindie Scott
- 3
OCR for page 147
APPENDIX G
NOTE: The 90 day deadline may be extended by the Proj ect for
additional periods, not to exceed 90 days each, for good cause
shown by the respondent.
D. All information is to be based on calendar year 1981, if
possible. If information of 1981 is not readily available,
contact the Industrial Surrey Project (609-292-1520) for further
ins tructions .
E. Please give your answer in terms of the units specified in the
forms (i.e., pounds per year, maximum pounds per day, gallons per
day, etc. ~ . Leave boxes marked "DEP use only'' blank.
F. Complete all sections. of the report that pertain to your firm
or plant site. If a section does not apply to your operations,
write in "NA" for "not applicable".
G. Please attach process descriptions, explanatory notes, flow
charts, lists, etc., that will assist in clarifying entries made
on the report if you feel the answers require further explanation.
I f information needed to complete a section is not readily avail-
able, provide a written explanation describing the nature of the
operations involved and the reasons for not supplying the data.
H. It is intended that you use existing or readily ascertainable
data to complete the Selected Substance Report. Where quantities
can be determined from existing records (e . g . inventory or produc-
tion figures) or the cost of testing is nominal, actual figures are
to be supplied. Otherwise, estimates may be givers. You may use
engineering estimates and computations; process material balance
studies; field tests or measurements made by the plant, equipment
manufacturers or government agencies, or other technically sound
bases.
I. If you do not '-now the formulation of trade name chemicals
you use in your plant operations, you should make reasonable in-
quiries of your supplier or the manufacturer to ascertain whether
the material contains any selected substances. (For example,
Tri-Clene a solvent, is a trade name for trichloroethylene , a
selected substance) .
J. Exempt from this report are quantities of selected substances
which are manufactured, used, formed or processed for purposes of
scientific experimentation, analysis or chemical research (in-
cluding research or analysis for product development), provided
such quantities of each substance are less than 1, 000 pounds in
a one-year period.
Also exempted are quantities of selected substances which are
present as impurities, without regard to the purpose for which
the material in which such impurities are contained is produced,
provided the concentration of selected substance present as im-
pur~ty is less than It and the total amount of selected substance
present as impurity is less than 1,000 pounds in a one-year period.
-4-
147
OCR for page 148
148
AL4SS BALANCE INFORMATION
Example: You produce 100,000 pounds per year of xylene
in which benzene is present as an impurity at
a concentration of .65 percent. You do not
have to report the presence of benzene since
it is present in a concentration less than
1% and annual production is only 650 pounds.
Example: You produce 50,000 pounds per year of xylene
in which benzene is present as an impurity at
a concentration of 1.3 percent. You must
report the presence of benzene because the
concentration is greater than 1%, even though
annual production is only 650 pounds.
Example: You produce 1,OOO,OOO pounds per year of xylene
in which benzene is present as an impurity at
a concentration of .5 percent. You must report
the presence of benzene, even though its con-
centratzon is less than 1%, because annual pro-
duction is 5,000 pounds.
In the case of the third example (involving a concentration less
than 1~) you would not be required to report the presence of the
Impurity unless you know or have reason to know of its presence.
See paragraph H.
Specific Instructions
The Selected Substance Report is divided into two parts. Part I
consists of 15 questions about the plant site, its operations and
its use of selected substances. Part II consists of separate sheets,
each of which is to be filled out with information about only one
selected substance. Three copies of the form for Part II have been
sent to you; if you need extra ones, you may make photocopies or
request additional forms from the Project.
The questions in Part I should be self-explantory. Refer to the
following for guidance in completing Part II.
QUESTION 1 - enter the plant name and location
QUESTION 2 - enter ache name of the selected substance and the
corresponding CAS number, as lis ted in Table 1.
QUESTION 3 - "use" refers to any use made of the selected substance
at your plant site. It includes synthesis, whether the
substance is incorporated into a finished product or
produced only as an intermediate; use as raw material,
where the substance is chemically changed or in-
corporated into another; mixing, blending, repackaging
or transshipment; use as supplementary fuel or for
cleaning, and anything else. If the substance is used
for more than one purpose at your plant site, list all
uses.
5
OCR for page 149
APPENDIX G
Example: vinyl chloride (monomer) is used in the
production of polyvinyl chloride resin.
Example: 1,1,1 trichloroethane is used as a parts
decreased.
THROUGH- PUT QUANTITIES (Questions 4-83: These questions seek
specific information about the quantities of selected substances
used in your production or processing operations. The figures
you supply' in your answers to the questions will not necessarily
give rise to a material balance . Some subs Lances may be counted
in more than one category. The Proj ect is aware of this, and it
has beer taken into account in the design of the computer programs
that will analyze the survey responses.
QUESTION 4 - Quantity Producted on Site: this refers to quantities
of the substance synthesized in your plant production
processes. It includes isolated intermediates (those
drawn off and stored for later use in the production
process), but not transient intermediates (i.e. ,
substances formed in the production process as in-
termediates (i.e., substances formed in the production
process as an intermediate step but immediately
transformed into something else). Also included are
by products and quantities generated as impurities
or waste.
QUESTION S - Quantity Brought onto Site: This refers to quantities
of the substance brought into your plant from suppliers
off-site, including other plants or divisions of your
own firm. Include all quantities shipped onto the site,
whether they are to be used as raw materials, cleaning
materials, or simply repac'^aoed for reshipment.
QUESTION 6 - Quantity Consumed on Site: In some cases ~ selected
substance is consumed in a chemical reaction either
through incorporation into the molecular structure
of the product or by combining with a reactant or
solvent to alter its structure and thus lose its
identity.
Example: You make nitrobenzene by reacting benzene
and nitric acid. Benzene is "consumed" in
the production process because it under-
goes chemical change and ceases to exist
as benzene.
On the other hand, quantities of selected substance
which are used in plant processes but not chemically
transformed should not be listed as "consumed".
Example: You use trichloroethylene (ICE) as a de-
greasing agent for cleaning metal. Some of
the chemical evaporates in the process, and
the rest becomes too contaminated for reuse.
The quantities should be recorded under "Air
Emissions" and "Waste Disposal", not under
"Quantity Consumed".
-6-
149
OCR for page 150
150
~45S BALANCE INFORMATION
QUESTION 7 - Quantity Shipped Off-site As (or In) Product:
The information sought here is the amount of
selected substance that leaves your plant site
in product form - that is, in a form suitable
for final use or for further processing leading
to eventual final use. This includes materials
shipped to other plants or divisions of your
own firm. It does not, however, include wastes;
these should be recorded in the "Waste Disposal"
section. Enter only the quantity of selected
substance shipped off-site, not the quantity
of product in which it is contained.
Example: You ship to customers 10.0, 000 pounds
per year of a mixture containing 10%
by weight of isophorene, Chat is, 10, 000
pounds of isophorene. Your answer
to Question 7 should be 10,000 pounds,
not 100,000.
QUESTION 8 - Maximum Inventory : In this question we are attempting
to gain an idea of the quantities of selected sub-
stance stored on your site at a given moment in time.
Since computing an average daily storage quantity would
require averaging your daily inventory records over
an ent' re year, to simplify your response we have
requested only the maximum quantity stored. Enter
the largest amount of selected substance you had in
storage on-site at any time during 1981. Again,
enter the quanti ty of substance only, not the amount
of material in which At is contained.
AIR EMISSIONS (Question 9 and 103: These questions seek Deco lean
the amounts of selected substances your plant releases into the
atmosphere from all sources. Please attach explanatory notes,
itemized sources of emissions, calculations, etc., that will
assist in clarifying your responses.
QUESTION 9 - Stack Emissions: These are emissions which are re-
leased into the atm-osphe re from a readi ly - ident i f i ab le
point source, such as a chimney or exhaust vent.
QUESTION 10 - Fugitive Emissions: These are emissions other than
stack emissions. Included should be such items as
evaporation from tanks, vapor or dust emissions
during blending, transfer discharging reaction vessels,
etc.
OCR for page 151
APPENDLY G
151
WASTEWATER DISCHARGES (Questions 11 and 123: These questions
are concerned only with discharges into surface waters and publicly
owned treatment works (POTW's) . Discharges into subsurface waters
or onto land (e. q. lagooning, spray irrigation) should be recorded
under the section on Waste Disposal . Here again, the questions
are concerned only with the quantity of selected substance discharged,
not with the volume of effluent in which it is contained. Thus, if
you discharge a million gallons of effluent containing 500 pounds
of selected substance, you enter 500 pounds for Question 11 or 12.
QUESTION 11 - Surface Water Discharges: Enter the total quantity of
selected substance you discharged into surface water,
other than quantities which went to surface waters via
a POTW (Question 12~.
QUESTION 12 - Discharge into Publicly Owned Treatment Works: Enter
the total quantity of selected substance you discharged
into a municipal sewer system or one owned by an MUA,
SA or regional utilities authority.
WASTE DISPOSAL (Question 133: This question asks you to describe
how you dispose of wastes containing selected substances which are
not emitted into the atmosphere or discharged into surface waters or
sewerage systems.
QUESTION 13 - Disposal of Waste Containing the Selected Substance.
This question is organized in tabular form. In the
first column, list the name and location of each final
disposal site to which you send waste contai ning the
selected substance. This includes disposal facilities
located on your own plant site, e.g., a chemical landfill
or lagoon. In general, "final disposal site" means
final with respect to you. If the operator of the d~s-
posal site makes further economic use of the waste
(for example, he recovers solvents from it) you do not
have to report this further use. (Note: do not list a
transfer station as a final disposal site.)
In the second column, you are to characterize the physical
state of the waste you sent to the disposal sites listed
in column one. Consult Table A and enter the appropriate
physical state code or codes. If selected substance is
contained in more than one type of waste, enter all
appropriate code numbers.
For the third column, consult Table B and enter the
appropriate code or codes. Your entries should reflect
the disposal method employed at the site you listed in
the corresponding row.
In the fourth column enter the quantity of selected sub-
stance contained in the waste disposed at the site you
1 isted in the corresponding row. Once again, enter only
the quantity of selected substance, not the total
quantity of waste in which it is contained.
The fifth column is for DEP use only. Leave it blank.
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OCR for page 152
Representative terms from entire chapter:
selected substances
