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Appendix C U.S. EPA Form R: Toxic Chemical Release Inventory Reporting Form Submission of Form R is required for manufacturing facilities affected by SARA Section 313. Section 313(h) of SARA indicates the intended purposes of the Toxic Chemical Release Inventory Reporting Form: "(h)Use of Release Form. -The release forms required under this section are intended to provide information to the Federal, State, and local governments and the public, including citizens of communities surrounding covered facilities. The release form shall be available, consistent with section 324(a), to inform persons about releases of toxic chemicals to the environment; to assist governmental agencies, researchers, and other persons in the conduct of research and data gathering; to aid in the development of appropriate regulations, guidelines, and standards; and for other similar purposes." 87

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88 ~55 BALANCE INFORMATION Form R - Part I Page 1 2 INSTRUCTIONS FOR COMPLETING SPECIFIC SECTIONS OF EPA FORM R The following are specific instructions forcompleting each part of EPA Form R. The number designations of the parts and sections of these instructions correspond to those in Form R unless otherwise indicated. A sample, completed Form R for a hypothetical facility report- ing underTitle lil, section 313, is included as Appendix A (page 47~. You may want to referto this sample as you read through these instructions. Instructions for Completing All Parts of Form R: 1. Type or print information on the form in the units and format requested. 2. Longitudinal and latitudinal data were optional for the 1987 reports but are required for 1988 and subsequent reporting years. All information on Form R is required except Part lil, Section 8. 3. Do not leave items on Form R blank unless specifically directed to do so; if an item does not apply to you, enter "NA," not applicable, in the space provided. if your information does not fill all the spaces provided for a type of information, enter NA, in the next blank space in the sequence. 4. Do not submit an incomplete form. The certification statement (Part I) specifies that the report is complete as submitted. See page 1 of these instructions forthe defini- tion of a complete submission. 5. When completing Part IV, supplemental infomnation, or additional pages for Part II of the form, number the additional information sequentially from the prior sections of the form. 6. The box labelled "This space for your optional use" on each page may be used to differentiate one chemical- specif~c submission from another. You are QQI required to enter any Information in this space. See page 2 for use of this box relating to a voluntary revision of a previous submission. PART 1. FACILITY IDENTIFICATION INFORMATION 1.1 Are you claiming the chemical identity on page 3 trade secret? Answerthis question only after YOU hays completed the rest of the report. The specific identity of the toxic chemical being reported in Part lil, Sections 1.2 and 1.3, may be designated as trade secret. ff you are making a trade secret claim, mark "yes" and proceed to Section 1 .2. Only check "Yes" if it is your manufacturing, processing, or use of the chemical that is a trade secret. (See page 1 of these instructions for specific information on trade secrecy claims.) If you checked i'no," proceed to Section 1.3; do not answer Section 1.2. 1.2 If "yes" in 1.1. is this copy sanitized or unsanitized? Answerthisquestion onlyafteryou have completedthe rest of the report. Check "sanitized" if this copy of the report is the public version and you have claimed the chemical identity tradesecret in Part lil, Section 1.1. Othen~ise, check "unsani- tized." ~ .3 Reporting Year Enter the last two digits of the calendar year to which the reported information applies, not the year in which you are submitting the report. Information for the 1988 reporting year must be submitted on or before July 1, 1989. 2. Certification The certification statement must be signed by the owner or operator or a sen for off icial with manage me nt responsibility to r the person (or persons) completing the form. The owner, operator, or official must certify the accuracy and cornplete- ness of the information reported on the for~n by signing and dating the certification statement. Each report must contain an original signature. Print or type in the space provided the name and title of the person who signs the statement. This certification statement applies to all the information supplied on the form and should be signed only afterthe fond has been completed. 3. Facility Identification 3.1 Facility Name and Location Enter the name of yourfacility (plant site name or appropriate facility designation), street address, city, county, state, and zip code in the space provided. Do not use a post office box number as the address. The address provided should be the location where the chemicals are manufactured, processed, or otherwise used.

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APPENDIX C Page 13 Form R - Part I 3.2 Full or Partial Facility Indication A covered facility must report all releases of a listed chemical it it meets a reporting threshold forthat chemical. However, if the facility is composed of several distinct establishments, EPA allows these establishments to submit separate reports for the chemical as long as all releases of the chemical from the entire facility are accounted for. Indicate in Section 3.2 whether your report is forthe entire covered facility as a whole or for part of a covered facility. Check box a. if the chemical information applies to the entire covered facility. Check box b if the chemical information applies only to part of a covered facility. Section 313 requires reports by'1acilities," which are defined as "all buildings, equipment, structures, and other stationary items which are located on a single site or on contiguous or adjacent sites and which are owned or operated by the same person." The SIC code system defines business "establishments" as "distinct and separate economic activities [that] are performed at a single physical location." Under section 372.30(c) of the reporting rule, you may submit a separate Form R for each establishment, or for groups of establishments, in your cov- ered facility, provided that all releases of the toxic chemicals from the entire covered facility are reported. This allows you the option of reporting separately on the activities involving a toxic chemical at each establishment, or group of establish- ments (e.g., part of a covered facility), rather than submitting a single form R for that chemical for the entire facility. However, if an establishment or group of establishments does not manufacture, process, or otherwise use or release a toxic chemical, you do not have to submit a report forthat establish- ment or group of establishments. 3.3 Technical Contact Enter the name and telephone number (including area code) of a technical representative whom EPA or State officials may contact forclarif~ation of the information reported on Forrn R. This contact person does not have to be the same person who prepares the report or signs the certification statement and does not necessarily need to be someone at the location of the reporting facility; however, this person must be familiar with the details of the report so that he or she can answerquestions about the information provided. 3.4 Public Contact Enter the name and telephone number (including area code) of a person who can respond to questions from the public about the report. If you choose to designate the same person as both the technical and the public contact, you may enter 89 "Same as Section 3.3" in this space. This contact person does not have to be the same person who prepares the report or signs the certification statement and does not necessarily need to be someone at the location of the reporting facility. 3.5 Standard IDJustnal Classification [SIC] Code Enterthe appropriate 4-dig primary Standard Industrial Clas- sification (SIC) code for yourfacility (Table I, page 30, fists the SIC codes within the 20-39 range). It the report covers more than one establishment, enter the primary Digit SIC code for each establishment. You are required to enter SIC codes only for those establishments within the facility that fall within SIC codes 20 to 39. 3.6 Latitude and Longitude Enter the latitudinal and longitudinal coordinates of your facil- ity. Sources of these data include EPA permits (e.g., NPDES permits), county property records, facility blueprints, and site plans. Instnuctions on how to develop these coordinates can be found in Appendix B (page 52). Enter only numerical data. Do not preface numbers with letters such as N or W to denote the hemisphere. 3.7 Facility Dun and Bradstreet Number Enter the Digit number assigned by Dun and Bradstreet (D&B) for your facility or each establishment within your facility. These numbers code the facility for financial pur- poses. This number may be available from your facility's treasurerorfinancial officer. You can also obtain the numbers from your local Dun and Bradstreet office (check the White Pages). If none of your establishments has been assigned a D 8 B number, enter not applicable, NA, in box a. If only some of your establishments have been assigned Dun and [3rad- street numbers, enter those numbers in Section 3.7. 3.8 EP]\ Identification Number The EPA l.D. Number is a 12~igit number assigned to facilities covered by hazardous waste regulations under the Resource Conservation and Recovery Act (RCRA). Facilities not covered by RCRA are not likely to have an assigned l.D. Number. If yourfacility is not required to have an l.D. Number, enter not applicable, IDA, in box a. If your facility has been assigned EPA Identification Numbers, you must enter those numbers in the spaces provided in Section 3.8.

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go AL4SS BALANCE INFORMATION Form R - Part II Page 14 3.9 NPDES Permit Number Enter the nurturers of any permits yourfacility holds underthe National Pollutant Discharge Elimination System (NPDES). This Digit permit number is assigned to yourfacility by EPA or the State underthe authority of the Clean WaterAct. If your facility does not have a permit, enter not applicable, NA, in box a. 3.10 Receiving Streams or Water Bodies In Section 3.10 you are to enter the namers) of the streams or water body(ies) to which your facility directly discharges the chemicals you are reporting. A total of six spaces are provided, lettered a through f. The information you provide relates directly to the discharge quantity information required in Part lil, Section S.3. You can complete Section 3.10 in one of two ways. You can enter only those stream names that relate to the specific chemical that is the subject of the report or, you can enter all stream names that relate to all covered chemicals being reported by the facility. Enter the n ame of the first receiving stream or surface water body to which the chemical being reported is directly discharged. Report the name of the receiving stream or water body as it appears on the NPDES permit for the facility. If you do not have a permit, enter the name of the off-sits stream or water body by which it is publicly known. Be sure to include the receiving stream(s) or water body~ies) that receive stormwater runoff from your facility. Do not enter names of streams to which off-site treatment plants discharge. Also do not list a series of streams through which the chemical flows. Enter not applicable, NA, in 3.10a. if you do not discharge any listed toxic chemicals to surface water bodies. 3.11 Underground Injection Well Code [UIC) Identification Prober If your facility has a permit to inject a chemical-containing waste that includes the toxic chemicals into Class 1 deep wells, enter the 12~igit Underground Injection Well Code (UIC) identification number assigned by EPA or by the State under the authority of the Safe Drinking Water Act. If your facility does not hold such a permits, enter not applicable, NA, in3.11a. 4. Parent Company Information You must provide inforrr~ation on your parent company. For purposes of Form R. a parent company is defined as the highest holder located in the United States that directly owns at least 50 percent of the voting stock of yourcompany. If your facility is owned by a foreign entity, enter not applicable, NA, in this space. Corporate names should be treated as parent company names for companies with multiple sites. For example, the Bestchem Corporation is not owned orcontrolled by any other corporation. It has several sites throughout the country whose names begin with Bestchem. In this case, Bestchem Corporation would be listed as the "parent" com- pany. 4.1 Name of Parent Company Enterthe name of the corporation or other business entity that is your parent company. ~ your facility has no parent com- pany, enter not applicable, NA. 4.2 Parent Company's Dun & Bradstreet Number Enter the Dun and Bradstreet Number for your parent com- pany, if applicable. The nurturer may be obtained from the treasurer or financial officer of the company. tf your parent company does not have a Dun and Bradstreet number, enter not applicable, NA. PART II. OFF-SITE LOCATIONS TO WHICH TOXIC CHEMICALS ARE TRANSFER RED IN WASTES In this part of the form you are required to list all off-site locations to which you transfer wastes containing toxic cherr~cals. Do not list locations to which products containing toxic chemi- cals are shipped for sale or distribution in commerce or for further use. Also, do not list locations to which wastes containing chemicals are sold or sent for recovery, recycling, or reuse of the toxic chemicals. The information that you enter in this section relates to data you will report in Part lil, Section 6. You may complete Part II for only the off-site locations that apply to the specific chemical cited in a particular report ~ you can list all off-site locations that apply to all chemicals being reported and include a photostatic copy of Part II with each individual report. List only publicly owned treatment works (POTWs) and off-site treatment or disposal facilities. 1. Publicly Owned Treatment Works (POlWs) Enter the name and address of each POTW to which your facility discharges wastewater containing toxic chemicals for which you are reporting. ~ you do not discharge wastewater containing the reported toxic chemicals to a POTW, enter not applicable, NA in the facility name line of 1.1. If you discharge such wastewater to more than two POTWs, use additional copies of Part II. Cross through the printed numbers and write in numbers forthese locations in ascending order (e.g., 1.3, 1.4~. Check the box at the bottom of the page and indicate the number of additional pages of Part II that are attached.

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APPENDIX C Page 1 5 Form R - Part 111 2. Other Off-Site Locations Enter in the spaces provided, the name and address of each location (other than POTWs) to which you ship or transfer wastes containing toxic chemicals. If you do not ship or transfer wastes containing toxic chemicals to off-s~te loca- tions, enter not applicable, NA in the Off-site location narrm line of 2.1. Also enter the EPA Identification Number (RCRA l.D. Number) for each such location if known to you. This number may be found on the Uniform Hazardous Waste Manifest, which is required by RCRA regulations. Also indicate in the space provided whetherthe location is owned orcontrolled by your facility or your parent company. If the facility does not have a RCRA l.D. number, enter not applicable, MA, in this space. If yourfacility transfers toxic chemicals to more than six off-eke locations, use additional copies of Part 11. Cross through the printed numbers and write in numbers for these locations in ascending order (i.e., 2.7, 2.8~. Check the box at the bottom of the page and indicate the numberof additional pages of Part li that are attached. EXAMPLE Yourfacility is involved in chrome plating of metal parts, which are shipped to an off-site warehouse not owned by your company for distribution. Your facility produces an aqueous plating waste that is treated on-site to recover chromium sludge. The effluent from the on-site treatment plant, which contains chromium compounds (a listed toxic chemical), is piped to a POTW. The chromium sludge is transferred to an off-site, privately owned recovery firm. Chromium is recov- ered from the sludge by an ion exchange process. Yourfacil'~ty also produces a solid waste containing chromium, which is sent to an off-site permitted landfill owned by your facility. You must report the locations of the POTW and the permitted landfill in Sections 1 and 2 of Part 11 of Form R. Do not report the location of the warehouse or give any information about the on-site treatment plant in this section. Indicate that the landfill is underthe control of yourfacility. You are not required to report the location of the off-site, privately owned recovery firm or provide any information concerning off-site recovery. PART 111. CHEMICAL-SPECIFIC INFORMATION In Part 111, you areto identifythetoxicchemical being reported. You are to indicate some general uses and activities related to the chemical at your facility. Also in Part 111 you will enter quantitative data relating to releases of the chemical directly from the facility to air, water, and land. Quantities of the chemical transferred to off-site locations, identified in Part 11, are also reported in this pan. The final required section provides for reporting of waste treatment information. An 91 additional optional section is included in this part that allows you to report waste minimization information associated with the chemical. 1 .1 [Reserved] 1.2 CAS Number Enter the Chemical Abstracts Service (CAS) registry number in Section 1.2 exactly as it appears in Table 11, page 36, forthe chemical being reported. CAS numbers are cross-referenced with an alphabetical list of chemical names in Table 11 of these instructions. If you are reporting one of the chemical catego- ries in Table 11 (e.g., copper compounds), enter not applicable, NA, in the CAS number space. If you are making a trade secret claim, you must report the CAS number on your unsanitized Form R and unsanitized substantiation form. Do not report it on yoursanitized Forrn R and sanitized substantiation form. 1.3 Chemical or Chemical Category Name Enter the name of the chemical or chemical category exactly as it appears in Table 11. H the chemical name is followed by a synonym in parentheses, report the chemical by the name that directly follows the CAS nurturer (i.e., not the synonym). If the listed chemical identity is actually a product tradenarne (~.9., dicofol), the 9th Collective Index name is listed below ~ in brackets. You may report either name in this case. Do not list the name of a chemical that does not appear in Table 11, including individual members of a reportable category. For example, ~ you use silver nitrate, do not report silver nitrate with its CAS number. Report this chemical as "silver com- pounds" with no CAS number. If you are making a trade secret claim, you must report the specific chemical identity on your unsan~tized Fond R and unsanitized substantiation form. Do not report the chemical name on your sanitized Form R and sanitized substantiation form; report a generic name in Section 1.4 below. 1.4 Genenc Chemical Name Complete Section 1.4 only if you are claiming the specific chemical identity of the toxic chemical as a trade secret and have marked the trade secret block in Part 1, Section 1.1 on page 1 of Fonn R. Enter a generic chemical name that is descriptive of the chemical structure. You must limit the generic name to seventy charactem (e.g., numbers, letters, spaces, punctuation) or less. Do not enter mixture names in Section 1.4; see Section 2 below.

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92 MASS BALANCE INFORMATION Form it-Part lil Page 16 In-house plant codes and other substitute names that are not structurally descriptive of the chemical identity being withheld as a trade secret are not acceptable as a generic name. The generic name must appear on both sanitized and unsanitized Forrn it's, and the name must be the same as that used on your substantiation forms. The Emergency Planning and Community Right-to-Know Information Hotline can provide you with assistance in selecting an appropriate generic name. 2. Mixture Component Identity Do not complete this section if you have completed Section 1 of Part lilt Report the generic name provided to you by your supplier in the section if your supplier is claiming the chemical identity proprietary or trade secret. Do not answer "yes" in Part I, Section 1.1 on page 1 of the form if you complete this section. You do not need to supply substantiation forms. Enter the generic chemical name in this section only it the following four conditions apply: 1. The amount of the particular mixture or trade name prod- uct you .'use" exceeds 1 0,000 pounds or the amount you 4.process" exceeds the applicable process threshold for the year (i.e., 50,000 Ibs. in 1988~; 2. You determine that the mixture contains a listed toxic chemical but the only identity you have for that chemical is a generic name; 3. You know either the specific concentration of that toxic chemical component or a maximum concentration figure; and 4. You determine by multiplying the concentration figure by the total annual amount of the whole mixture used (or processed) that you exceed the use or process threshold for that single, generically identified mixture component. EXAMPLE Your facility uses 20,000 pounds of asolvent that yoursupplier has tom you contains 80 percent "chlorinated aromatic," their generic name for a chemical subject to reporting under section 313. You therefore know that you have used 16,000 pounds of some listed toxicchemical which exceedsthe use threshold. You would file a Forrn R and enter the name "chlonnated aromatic" in the space provided in Part lil, Section 2. 3. Activities and Uses of the Chemical at the Facility Indicate in this section whether the chemical is manufactured (including imported), processed, or otherwise used at the facility and the general nature of such activities and uses at the facility during the calendar year. Report activities that take place only at your facility, not activities that take place at other facilities involving your products. You must "heck all the. blocks in this section that again. If you are a manufacturer of the chemical, you must check a and/or b, and at least one of c, d, e, or f. Refer to the definitions of "manufacture," "process," and "otherwise use" in the general information section of these instructions or section 372.3 of the rule for explanations supplementing those provided below. 3.1 Manufacture the Chemical Check at least one: a. Produce - A chemical included in this category is produced at the facility. b. Import- A chemical included in this category is imported by the facility into the Customs Territory of the United States. Check at least one: for on-s~te use/processing - A chemical included in this category is produced or imported and then further proc- essed or otherwise used at the same facility. If you check this block you must also check at least one item in 3.2 or 3.3. d. For sale/distnbution - A chemical in this category is pro- duced or imported specifically for sale or distribution outside the manufacturing facility. e. As a byproduct- A chemical in this category is produced coincidentally during the production, processing, use, or disposal of another chemical substance or mixture and, following its production, is separated from that other chemical substance or mixture. Chemicals produced and released as a result of waste treatment or disposal are also considered byproducts. i. As an impurity- A chemical in this category is produced coincidentally as a result of the manufacture, processing or use of another chemical but remains primarily in the mixture or product with that other chemical. 3.2 Process the Chemical (incorporative-type actiy~s] a. As a reactant- A natural or synthetic chemical used in chemical reactions forthe manufacture of anotherchemi- cal substance orot a product. Includes, but is not limited to, feedstocics, raw materials, intermediates, and initia- tors.

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APPENDIX C Page 17 Form R - Part lil b. As a formulation component - A chemical added to a product or product mixture prior to further distribution of 1. Yourfacility receives toluene and naphthalene (both listed the product that acts as a performance enhancer during toxic chemicals) from an off-site location. You react the use of the product. Examples of chemicals used in this toluene with air to form benzoic acid and react the capacity include, but are not limited to, additives, dyes, naphthalene with sulfuric acid, which forms phthalic acid reaction diluents, initiators, solvents, inhibitors, emulsifi- and also produces sulfur dioxide fumes. Your facility ers, surfactants, lubricants, flame retardants, and rheol ogical modifiers. c. As an article component- A chemical substance that becomes an integral component of an article distributed for industrial, trade, orconsumer use. One example is the pigment components of paint applied to a chair that is sold. d. Repackaging only- Processing orpreparation of a chemi cal or product mixture for distribution in commerce in a different form, state, or quantity. This includes, but is not limited to, the transfer of material from a bulk container, such as a tank truck to smaller cans or bottles. 3.3 Otherwise Use the Chemical iron-incorporative-type activities) a. As a chemkalprocessing aid- A chemical that is added to a reaction mixture to aid in the manufacture or synthesis of another chemical substance but is not intended to remain in or become part of the product or product mixture. Examples of such chemicals include, but are not limited to, process solvents, catalysts, inhibitors, initia tors, reaction terminators, and solution buffers. b. As a manufacturing aid- A chemical that aids the manu facturing process but does not become part of the result ing product and is not added to the reaction mixture during the manufacture or synthesis of another chemical sub stance. Examples include, but are not limited to, lubri cants, metalworking fluids, coolants, refrigerants, and hydraulic fluids. Ancillary or other use - A chemical in this category is used at a facility for purposes otherthan as a chemical process ing aid or manufacturing aid as described above. In cludes, but is not limited to, cleaners, degreasers, lubri cants, and fuels. c. In the example below, it is assumed that the threshold quan- tities for manufacture, process, or otherwise use (SO,OOO pounds, 50,000 pounds, and 10,000 pounds, respectively, for 1988) have been exceeded and the reporting of listed chemi- cals is therefore required. E.1CAMPLE 93 processes toluene and naphthalene. 80th are used as reactants to produce benzoic acid and phthalic acid, chemicals not on the section 313 list. The phthalic acid and benzoic acid are reacted to form a reaction intermediate. The reaction intermediate is dis- soived in sulfuric acid, which precipitates terephthalic acid (TPA). Fifty percent of the TPA is sold as a product and 50 percent is further processed at your facility into polyes- ter fiber. The TPA is treated with ethylene glycol to form an intermediate product, which is condensed to polyester. Your company manufactures terephthalic acid a listed 9 chemical, both for sale/distnbution as a commercial prod- uct and for on-site use/processing as a feedstock in the polyester process. Because it is a reactant. it is also processed. Yourfacility also uses. as well as processes. sulfuric acid, a listed substance, as it serves as a process solvent to precipitate terephthalic acid. 2. The intermediate product, from which the polyester is prepared, contains dimethyl phthalate, a listed substance. The method of reporting this substance depends on its eventual disposition in the polyester production process: (a) If the dimethyl phthalate is removed from the interme- diate product before it is reacted to form polyester fiber, then dirnethyl phthalate is manufactured at your facility as a byproduct. (b) If it is incorporated into the polyester fiber in an un reacted form, then it is manufactured at yourfacility as an impurity. (c) If the di T ethyl phthalate participates in the reaction to form polyester fiber without leaving the process, then it is Drocessed as a reactant (intermediate), as are the ethylene glycol and terephthalic acid in the process. Sections of Part lil that have been completed forscenano 2(c), are illustrated on the following page. 3. Your facility operates a fume scrubber that uses sodium hydroxide solution and recovers the sulfur dioxide fumes from the phthalic acid production process as sodium sulfate solution. Both sodium solutions are listed chemi- cals. Your facility manufactures sodium suRate as a byproduct and otherwise uses sodium hydroxide.

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94 M45S BALANCE INFORMATION Form R - Part 111 Page t 8 4. Yourfacility applies C.l. disperse yellow 3, a listed chemi- cal, to the finished polyester fiber as a dye, which is incorporated into the polyestsrfiber product and remains in the product after it is sold. Your facility ~s~s the C.1 disperse yellow 3 as an article component. To (Important: Type or print; read instructions before completing form.) . . . EPA EPA FORM R ~PART 111. CHEMICAL-SPECIFIC INFORMATION Page 3 of 5 (This space for your optional use ) 1. CHEMICAL IDENTI - (Do not complete this section if you ~nmnI-ta Sian ~ ~ 1.2 1.3 1 .4 o 'plumber (Enter the number exactly as it appears on the 313 list. Enter NA it roport~ng a cherubical category. ) 3 1 ~ 1 1-3 - ~'e,''''~a' or ~nam'Cal Category Name (Enter the name exactly as it appears on DimethY1 Phthalate 1 eneric Chemical Name (Cornple~u only it Pan I, Section ~ . ~ Is cnecKed ~ Yes. ~ Gabs rue nanny must ~ structurally descriptive. ) l Ill Al {V cnerec~ers (~.o., numbs. teasers. spaces. punctuations. ) 3. ACTIVITIES AND USES Of THE CHEMICAL A_ 3.1 3.2 3.3 M a n u f a c t u r ~,, r ~ chemical:a. [X ] Produce ~ ~c [X ] For offsided ] For sale/ b. [ ] import l le. [ ] As a byproduct f . [ ] As an impurity Process the ~ 1r 1 As a formulation r 1 As an article chemical: a. OX ~ As a reactantb ~ component c.t [component d. [ ] Repackaging only Otherwise use ~ 1As a. chemical ~1 r 1 the chemical: a. L J processing aidb.t J As a manufacturing aid c.l ~ Ancillary or other us. . . . _ _ . . -

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APPENDIX C Page 1 9 Form R - Part lil 4. Maximum Amount of the Chemical On-Sits at Any Time During the Calendar Year Insert the appropriate code (see below) that indicates the maximum quantity of the chemical (e.g., in storage tanks, process vessels, on-site shipping containers) at yourfacility at any time du ring the calendar year. If the chemical was present at several locations within your facility, use the maximum total amount present at the entire facility at any one time. Weight Range in Pounds Range Code From 01 02 03 04 05 06 07 08 09 10 o 100 1 ,000 1 0,000 1 00,000 1 ,000,000 1 0,000,000 50,000,000 1 00,000,000 500,000,000 ~ billion 99 999 9,999 99,999 999,999 9,999,999 49,999,999 99,999,999 499,999,999 999,999,999 more than 1 billion It the toxic chemical present at your facility was part of a mixture or trade name product, determine the maximum quantity of the chemical present at the facility by calculating theweight of the toxicchemkal only. Do not include the weight of the entire mixture or trade nanny product. See section 372.30(b) of the reporting rule for further information on how to calculate the weight of the chemical in the mixture or trade name product. For chemical categories (e.g., copper com- pounds), include all chemicals in the category when oalculat- ing the weight of the toxic chemical. 5. Releases of the Chemical to the Environment On-Site In Section 5, you must account forthe total aggregate releases of the toxic chemical to the environment on-site from your facility for the calendar year, Releases to the environment include emissions to the air, discharges to surface waters, and releases to land and underground injection wells. If you have no releases to a particular media (e.g., stack air), enter not applicable, NA; do not leave blank. Check the box on the last line of this section if you use Part IV, the supplemental information sheet. 95 You are not required to count as a release quantities of a toxic chemical that are lost due to natural weathering or corrosion, normal/natural degradation of a product, or normal migration of a chemical from a product. For example, amounts of a covered toxic chemical that migrate from plastic products in storage do not have to be counted in estimates of releases of that chemical from the facility. Also, amounts of listed metal compounds (e.g., copper compounds) that are lost due to normal corrosion of process equipment do not have to be considered as releases otcoppercompoundsfromthefacil ty. All air releases of the chemical from the facility must be accounted for. Do not enter information on individual emission points or releases. Enter only the total release. If there is doubt about whether an air release is a point or non~oint release, you must identify the release as one or the other rather than leave items 5.1 and 5.2 blank. Instructions for columns A, B. and C follow the discussions of Sections 5.1 through 5.5. 5.1 Fugitive or Non-Point Air Emissions These are releases to the air that are not released through stacks, vents, ducts, pipes, or any other confined air stream. You must include (1) fugitive equipment leaks from valves, pump seals, flanges, compressors, sampling connections, open-ended lines, etc.; (2) evaporative losses from surface impoundments; (3) releases from building ventilation sys- tems; and (4) any other fugitive or non-point air emissions. 5.2 Stack or Point Air Emissions These are releases to the airthat occurthrough stacks, vents, ducts, pipes, or other confined air streams. You must include storage tank emissions. Air releases from air pollution control equipment would generally fall in this category. 5.3 Discharges to Receiving Streams or Water Bodies Enter the applicable letter code for the receiving stream or water body from Section 3.10 of Part I of the form. Also, enter the total annual amount of the chemical released from all discharge points at the facility to each receiving stream or water body. Include process outfalls such as pipes and open trenches, releases from on-site wastewater treatment sys- tems, and the contribution from storrnwater runoff, if appli- cable (see instructions for column C below). Do not include discharges to a POTW or other off-site wastewater treatment facilities in this section. These off-site transfers must be reported in Part lil, Section 6 of the form.

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96 AL4SS BALANCE INFORMATION Form R - Part lil Page 20 5.4 Underground Injection Enterthe total annual amount of the chemical that was injected into all wells, including Class I welts, at the facility. 5.5 Releases to Land Report quantities of the chemical that were landfilled, treated or applied in farming, impounded, or otherwise disposed of at the facility. Do not report land disposal at off-site locations in this section. For the purpose of this form,' a surface impoundment is considered "final disposal." Quantities of the chemical re- leased to surface impoundments that are used merely as part of a wastewater treatment 'process generally must not be reported in this section of the form. However, if the impound- ment accumulates sludges containing the chemical, you must include an estimate in this section unless the sludges are removed and otherwise disposed of (in which case they should be reported underthe appropriate section of the form). Forthe purposes of this reporting, storage tanks are not considered to be a type of disposal and are not to be reported in this section of the form. A. Total Release Only on-site releases of the toxic chemical to the environment for the calendar year are to be reported in this section of the form. The total releases from your facility do not Include transfers or shipments of the chemical from your facility for sale or distribution in commerce or of wastes to otherfacilities fortreatment or disposal (see Part lil, Section 6~. Both routine releases, such as fugitive airemissions, and accidental or non- routine releases, such as chemical spills, must be included in your estimate of the quantity released. Total annual releases or off-site transfers of a toxic chemical from the facility of less than 1 pound may be reported in one of several ways. The fractional figure may be entered in column A.2. However, EPA encourages rounding to the nearest pound. For example, if the estimate is 0.5 pounds or greater, you should either check the range bracket of "1-499" in column A.1 or enter "1" in column A.2. Do not use both columns A.1 and A.2. If the release is less than 0.5 pounds, you may round to zero and check the "0" bracket in A. 1. Note that releases of less than 0.5 pounds from the processing or use of an article does not negate the article status of that item. Thus, if the only releases you have are from an article and such releases are less than O.5 pounds per year, you are not required to submit a report for that chemical. A.1 Reporting Ranges For reports submitted forcalendaryears 1987, 1988 and 1989 Q2Y, you may take advantage of range reporting for releases to an environmental medium that are less than ~ ,000 pounds for the year. If you choose this option, mark one of the three boxes, 0, 1-499, or 500-999, that corresponds to releases of the chemical to the appropriate environmental medium (i.e., any line item). You are not required, however, to use these range check boxes; you have the option of providing a specific figure in column A.2, as described below. However, do not mark a range and also enter unspecific estimate in A.2. For releases to any medium that amount to 1,000 pounds or more for the year, you must provide an estimate in pounds per year in column A.2. Any estimate provided in column A.2 is required to be accurate to no more than two significant digits A.2 Enter Estimate If you do not use the range reporting option, provide your estimates of releases in pounds for the year in column A.2. This estimate is required to be rounded to no more than two significant digits. Calculating Releases' - To provide the release information required in both columns A.1 and A.2 in this section of the form, you must use all readily available data (including rele- vant monitoring data and emissions measurements) collected at your facility pursuant to other provisions of law or as part of routine plant operations, to the extent you have such data for the toxic chemical. When relevant monitoring data or emission measurements are not readily available, reasonable estimates of the amounts released must be made using published emission factors, material balance calculations, or engineering calculations. You may not use emission factors or calculations to estimate releases if more accurate data are available. No additional monitoring or measurement of the quantities or concentrations of anytoxt chemical released into the enyir~n- ment. or'of the frequency of such releases. is required for the purpose of completing this form. beyond that which is required under other provisions of law or regulation or as part of rout jive olant operations. You must estimate as accurately as possible the quantity in pounds of the chemical or chemical category that is released annually to each environmental medium. Include only the quantity of the toxic chemical component of the waste stream in this estimate. If the toxic chemical present at your facility was part of a mixture ortrade name product, calculate onlythe releases of the chemical. Do not report releases of the other components of the mixture or trade name product. If you are

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APPENDIX C Page 21 Form R - Part 111 only able to estimate the releases of the mature ortrade name product as a whole, you must assume that the release of the toxic chemical is proportional to its concentration in the mix- ture or trade name product. See section 372.30(b) of the reporting rule (Appendix G) for further information on how to calculate the concentration and weight in the mixture or trade name product. If you are reporting a chemical category listed in Table 11 of these instructions, rather than a specific chemical, you must combine the release data for all chemicals in the listed chemi- cal category (e.g., all glycol ethers or all chlorophenols) and report the aggregate amount for that chemical category. Do not report releases of each individual chemical in that category separately. Forexample, it yourtac~lRy releases 3,000 pounds per year of 2-chlorophenol, 4,000 pounds per year of 3-chlo- rophenol, and 4,000 pounds per year of 4-chlorophenol, you should report that your facility releases 11,000 pounds per year of chlorophenols. For listed chemicals with the qualifier "solution," such as sodium sulfate, at concentrations of 1 percent (or 0.1 percent in the case of a carcinogen) or greater, the chemical concen- trations must be factored into threshold and release calcula- tions because threshold and release amounts relate to the amount of chemical in solution, not the amount of solution. For metal compound categories (e.g., chromium compounds), report releases of only the parent metal. For example, a user of various inorganic chromium salts would report the total chromium released in each waste type regardless of the chemical form (e.g., as the or ginal salts, chromium ion, oxide) and exclude any contribution to mass made by other species in the molecule. EXAMPLE Your facility disposes of 14,000 pounds of lead chromate (PbC~, PbO) and 15,000 pounds of zinc bichromate (ZnCr2O,3H2O) in an on-site landfill and transfers 16,000 pounds of lead selenate (PbSeO4) to an off-site land disposal taciiity. You would therefore be submitting four separate reports on the following: lead compounds, zinc compounds, selenium compounds, and chromium compounds. However, the quantities you would be reporting would be the pounds of "parent" metal being released or transferred off-site. All quantities are based on mass balance calculations (See Section 5.B for information on Basis of Estimate and Section 6.C tortrcatment/ disposal codes and inform lotion on transfers of chemical wastes). You would calculate releases of lead, zinc, ch romium, and selenium by f irst determining the pe rcent- age by weight of these metals in the materials you use as follows: 97 Lead Chromate (PbCrO4 PbO) tdolecular weight Lead 2 Pb Molecular weight Chromate 1 Cr Molecular weight = 546.37 = = 51.996 207.2 x 2 = 414.4 Lead chromate is therefore (% by weight) (414.4/546.37) = 75.85%1cadand(51.996/546.37) = 9.52% chromium You can then calculate the total amount of the metals that you must report. 14,000 pounds of lead chromate contains: 14,000 x 0.7585 = 10,619 Ibs of lead 14,000 x 0.0952 = 1,332.8 Ibs of chromium Similarly, zinc bichromate is (65.38~335.4) = 19.49% zinc and (51.996 x 2/335.4) = 31.01% chromium, and lead selenate is (207.21350.17) = 59.17%1ead and (78.96/350.17) = 22.55% selenium. The total pounds of lead, chromium, zinc, and selenium released or transferred from your facility are as follows: Lead Release: 0.7585 x 14,000 = 10,619.0 Ibs from lead chromate (round to 11,000 Ibs) Transfer 0.5917 x 16,000 = 9,467.2 Ibs from lead selenate (round to 9,500 Ibs) AS an example, the releases and transfers of lead should be reported as illustrated on the next page. Chromium Release: 0.0952 x 14,000 = 1,332.8 Ibs from lead chromate (round to 1,300 Ibs) Release: 0.3101 x 15,000 = 4,651.5 Ibs from zinc bichromate (round to 4,700 Ibs) Zip Release: 0.1949 x 15,000 = 2,923.5 Ibs from zinc bichromate (round to 2,900 1bs)

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100 MASS BALANCE INFORMATION Form R - Part lil Page 24 EXAMPLE Bi-monthly stormwater monitoring data shows that the aver- age concentration of zinc in the stormwater runoff from your facility from a biocide containing a zinc compound is 1.4 milligrams per liter, and the total annual stormwaterdischarge from the facility is 7.527 million gallons. The total amount of zinc discharged to surface water through the plant wastewater discharge (non-stormwater) is 250 pou nds per year. The total amount of zinc discharged with stormwater is: (7,527,000 gallons storrnwater) x (3.785 liters/gallon) = 28,489,695 liters stormwater (28,4B9,695 liters stormwater) x (1.4 mg. zinciliter) = 39,885.6 9 zinc = 87.9 Ibs zinc The total amount of zinc discharged from all sources of your facility is: 250 Ibs zinc from wastewater discharge + 87.9 Ibs zinc from stormwater runoff . 337.9 Jbs zinc total water discharge Round to 340 Ibs. of zinc for report. The percentage of zinc discharged through stormwater is: 87.9/337.9 x 100 - 26% If yourfacility does not have periodic measurements of storm- water releases of the chemical, but has submitted chemical- specific monitoring data in permit applications, then these data must be used to calculate the percent contribution from stormwater. Rates of flow can be estimated by multiplying the annual amount of rainfall by the land area of the facility and then multiplying thatfigure bythe runoffcoefficient. The runoff coefficient represents the fraction of rainfall that does not infiltrate into the ground but runs off as stormwater. The runoff coefficient is directly related to how the land in the drainage area is used. (See table below.) Descngtion of Land Area Runoff Coefficient Business - Downtown areas 0.70-0.95 Neighborhood areas 0.50-0.70 Industrial Light areas 0.50-0.80 Heavy areas 0.60-0.90 Railroad yard areas O.20-0.40 Unimproved areas 0.10-0.30 Streets Asphaltic 0.70 0.95 Concrete 0.80-0.95 Brick Drives and walks Roofs Lawns: Sandy Soil Flat, 2% Average, 2-7% Steep, 7% Lawns: Heavy Soil Flat, 2~/o Average, 2-7% Steep, 7% 0.70-0.85 0.70-0.85 0.75-0.95 0.05-0.1 0 0.10-0.15 0.1 5-0.20 0.13-0.17 0.1 8-0.22 0.25-0.35 Choose the most appropriate runoff coefficient for your site or calculate a weighted-average coefficient, which takes into account different types of land use at your facility: Weighted-average Area, C, + Area2C2 + AC; runoff coefficient = Total Site Area where C; = runoff coefficient for a specific land use of Area. E AMPLE Your facility is located in a semi-arid region of the United States which has an annual precipitation (including snowfall) of 12 inches of rain. (Snowfall should be converted to the equivalent inches of rain; assume one foot of snow is equiva- lent to one inch of rain.) The area covered by yourfacility is 42 acres (about 170,000 square meters or 1,829,520 square teet). The area of your facility is 50 percent unimproved area, 10 percent asphaltic streets, and 40 percent concrete pave- ment. The total stormwater runoff from your facility is therefore calculated as follows: Runoff Land Use /OAma Coeff~nt Unimproved area 50 0.20 Asphalts streets 10 O.85 Concrete pavement 40 0.90 Weighted-average (50%) x (0.20) + (10%) x (0.85) runoff coefficient = + (40%] x (0.903 1 00/O Area = 0.545 (Rainfall) x (land area) x (conversion factor) x (runoff coeffi- cient) = stormwater runoff (1 foot) x (1,829,520 82) X (7.48 gaiety) x (0.545) = 7,458,221 gallons/year Total storrrnuater runoff = 7.45 million gallons/year

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APPENDIX C 101 Page 25 Form R - Part lil 6.Transfers of the Chemical in Waste to Off-Site Locations You must report in this section the total annual quantity of the chemical sent to any of the oft-site disposal, treatment, or storage facilities for which you have provided an address in Part II. You are not required to report quantities of the chemical sent off-site for purposes of recycle or reuse. On line 6.1.1, report the amount of the listed chemical trans- ferred to a POTW listed in Part II, Section 1. In the block provided, enterthe numberfrom Part II, Section 1 correspond- ing to the POlW to which the discharge is sent. For example, if the discharge is sent to the location listed in Part II, Section 1.1, then enter "1" in the block provided (the first digit of this section number has been precoded). If you transfer waste containing the toxic chemical to more than one POTW, check the box at the bottom of Section 6 and use the Part IV, the supplemental information sheet to report these transfers. On lines 6.2.1 through 6.2.3, reportthe amount of the chemical transferred to other off-site locations corresponding to those listed in Part il. Sections 2.1 through 2.6, including privately owned wastewater treatment facilities. In the block provided, enter the numberfrom Part II, Section 2 corresponding to the oft-site location to which the transfer is sent. For example, if the transfer is sent to the location listed in Part II, Section 2.3, enter .63" in the block provided (the first digit of this section number has been precoded). If you need additional space, check the box at the bottom of Section 6 and use the supplemental information sheet (Part IV, Section 6) to report these transfers. A. Total Transfers Follow the instructions for providing estimates as presented in the instructions for column A of Section 5 above. Enter the amount, in pounds, of the toxic chemical that is being trans- ferred, including mixtures or trade name products containing the chemical. Do not enterthe total poundage of wastes. See Section 5 for information on reporting oft-site transfers of less than 1 pound. As in Section 5, if the total amount transferred is fess then 1,000 pounds, you may report a range, but onlyfor reporting years 1987, 1988, and 1989. Enter not applicable, NA, if you have no off-s~te transfers. B. Basis of Estimate You must identify the basis for your estimate. Enter the letter code that applies to the method by which the largest percent- age of the estimate was denved. Use the same codes identified in the instructions for column B of Section 5. C. Type of Treatment/Disposal Enter one of the following codes to identify the type of treatment or disposal method used by the off-s~te location for the chemical being reported. You should use more than one line for a single location when the toxic chemical is subject to different disposal methods; the same location code may be used more than once. You may have this information in your copy of EPA Forrn SO, Item S of the Annual/Biennial Hazard- ous Waste Treatment, Storage, and Disposal Report (RCRA). Applicable codes for this Section 6(c) are as follows: M10 Storage Only M40 Solid~fication/Stabilization M50 IncinerationtThermal Treatment M61 Wastewater Treatment (Excluding POTW) M69 Other Treatment M71 Underground Injection M72 Landfill/Disposal Surface Impoundment M73 Land Treatment M79 Other Land Disposal M90 Other Off-S'te Management M91 Transfer to Waste Broker M99 Unknown 7. Waste Treatment Methods and Efficiency In Section 7, you must provide the following information related to the chemical for which releases are being reported: (A) the general waste stream types containing the chemical being reported; (B) the waste-treatment methods used on all waste streams containing the chemical; (C) the range of concentrations of the chemical in the influent to the treatrr~nt method; (D) whether sequential treatment is used; (E) the efficiency or effectiveness of each treatment method in re- moving the chemical; and (F) whetherthe treatment efficiency figure was based on actual operating data. Use a separate line in Section 7 for each treatment method used on a waste stream. Report in this section only information about troat- ment of waste streams at your facility. not about off-site treatment. If you do not perform on-site treatment of wastes, enter not applicable, NA, in 7.1 b. A. General Waste Stream For each waste treatment method, indicate the type of waste stream containing the chemical that is treated. Enterthe letter code that corresponds to the general waste stream type: A = Gaseous (gases, vapors, airborne particulates) W= Wastewater (aqueous waste) L = Liquid waste (non-aqueous waste) S = Solid waste (including sludges and slurries) If a waste is a mixture of water and organic liquid, you must report it as wastewater unless the organic content exceeds 50 percent. Slurries and sludges containing water must be reported as solid waste if they contain appreciable amounts of dissolved solids, or soles that may settle, such that the

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102 M45S BALANCE INFORAL4TION Form R - Part 111 - Page 26 viscosity or density of the waste is considerably different from that of process wastewater. B. Treatment Method Enterthe appropriate code from one of the lists below foreach treatment method used on a waste stream containing the toxic chemical, regardless of whether the treatment method actu- ally removes the specific chemical being reported. Treatment methods must be reported for each type of waste being treated (i.B., gaseous wastes, aqueous wastes, liquid non- aqueous wastes, and solids). Waste streams containing the chemcal may have a single source or may be aggregates of many sources. Forexample, process waterfrom several pieces of equipment at yourfacility may be combined prior to treatment. Report treatment meth- ods that apply to the aggregate waste stream, as well as treatment methods that apply to individual waste streams. If your facility treats various wastewatsr streams containing the chemical in different ways, the different treatment methods must each be listed separately. Your facility may have several pieces of equipment perform- ing a s imil ar service and for such equ ipment you may combine the reporting on a single line. It is not necessary to enterfour lines of data to coverfour scrubber units, for exarnpis, if all four are treating wastes of similar character (e.g., sulfurs acid mist emissions), have similar influent concentrations, and have similar removal efficiencies. If, however, any of these parame- ters differ from one unit to the next, each scrubber must be listed separately. Air Emissions Treatment A01 Flare A02 Condenser A03 Scrubber A04 Absorber A05 Electrostatic Precipitator A06 Mechanical Separation A07 Other Air Emission Treatrrmnt Biological Treatment B11 Biological Treatment -- Aerobic B21 Biological Treatment -- Anaerobic B31 Biological Treatment - Facultative B99 Biological Treatment - Other Chemical Treatment CO' Chemical Precipitation -- Lime or Sodium Hydroxide C02 Chemical Precipitation -- Sulfide CO9 Chemical Precipitation -- Other Neutralization Chromium Reduction Complexed Metals Treatment (other than pH Adjustment) C41 Cyanide Oxidation - Alkaline Chlorination C42 Cyanide Oxidation -- Electrochemical C43 Cyanide Oxidation - Other C44 General Oxidation "including Disinfection) Chlorination C45 General Oxidation (including Disinfection) Ozonation C46 General Oxidation (including Disinfection) -- Other C99 Other Chemical Treatment Incineration/rhermal Treatment F01 F11 F19 Other Rotary Kiln F31 Two Stage F41 Fixed Hearth F42 Multiple Hearth F51 Fluidized Bed F61 Infra-Red F71 FurrmA/apor F81 Pyrolytic Destructor F82 Wet Air Oxidation F83 -a F99 Liquid Injection Rotarv Kiln with Liquid Injection Unit thermal Drying/Dewatenng Other IncinerationlThennal Treatment Physical Treatn~nt P01 Equalization PO9 Other Blending P1 1 Settling/Clarification P1 2 Filtration P13 Sludge Dewatering (non-thermal) P14 Air Flotation P15 Oil Skimming P16 Emulsion Breaking -- Thermal P17 Emulsion Breaking -- Chemical P18 Emulsion Breaking -- Other P19 Other Liquid Phase Separation P21 Adsorption -- Carbon P22 Adsorption -- Ion Exchange (other than for recovery/reuse) P23 Adsorption -- Resin P29 Adsorption -- Other P31 Reverse Osmosis (other than for recovery/reuse) P41 Stripping - Air P42 Stripping -- Steam P49 Stripping -- Other P51 Acid Leaching (other than for recove~ytreuse) P61 Solvent Extraction (other than recovery/reuse) P99 Other Physical Treatment

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APPENDIX C Page 27 Form R - Part lil RecoverylReuse R01 Reuse as Fuel -- Industrial Kiln R02 Reuse as Fuel -- Industrial Furnace R03 Reuse as Fuel -- Boiler R04 Reuse as Fuel - Fuel Blending R09 Reuse as Fuel - Other R11 Solvents/Organics Recovery-- Batch Still Distillation R12 Solvents/Organics Recovery -- Thin-Film Evaporation Solvents/Organics Recovery-- Fractionation Solvents/Organics Recovery-- Solvent Extraction Solvents/Organics Recovery ~ Other Metals Recover-- Electrolytic Metals Recovery-- Ion Exchange Metals Recovery -- Acid Leaching Metals Recovery-- Reverse Osmosis Metals Recovery -- Solvent Extraction Metals Recovery -- Other Other Reuse or Recovery R13 R14 R19 R21 R22 R23 R24 R26 R29 R99 Solidif ication/Stabi lization G01 Cement Processes (including Silicates) G09 Other Pozzolonic Processes (including Silicates) G11 Asphaltic Processes G21 Thermoplastic Techniques G99 Other Solidification Processes C. Range of Influent Concentration The form requires an indication of the range of concentration of the toxic chemical in the waste stream (i.e., the influent) as it typically enters the treatment equipment. E nter in the space provided one of the following code numbers corresponding to the concentration of the chemical in the influent: 1 = Greater than 1 percent 2 -100 parts per million (0.01 percent) to 1 percent (10,000 parts per million) 3 = 1 part per million to 100 parts per million 4 = 1 part per billion to 1 part per million 5 = Less than 1 part per billion LHote: Parts per million (ppm) is milligrams/kilogram (mass/ mass) for solids and liquids; cubic centimeters/ cubic meter (volun~holume) for gases; milligrams/liter for solutions or dispersions of the chemical in water; and milligrams of chemi- calJkilogram of airforparticulates in air. If you have particulate concentrations (at standard temperature and pressure) as grains/cubic foot of air, multiply by 1766.6 to convert to parts per million; if in mill~rams/cubk meter, multiply by o.n3 to obtain parts per million. Factors are for standard conditions of 0C (32F) and 760 mmHg atmospheric pressure.] 103 it). Sequential Treatment? The blocks in this column may be used in the following case: O Individual treatment steps are used in a series to treat the chemical, but O You have no data on the individual efficiencies of each step, but you are able to estimate the overall efficiency of the treatment sequence. If this is the case, then you may do the following: O List the appropriate codes for the treatment steps in order (column B) and then put an "X" in the boxes in column D for all these sequential treatment steps. O Enter the appropriate code for the influent concentration (column C) for only the first treatment step in the SQ- quence. Leave this item blank forthe rest of the treatment steps in the sequence only . Enter NA in column E for the efficiency of preceding steps in the sequence. O Provide the treatment efficiency (column E) for the entire sequence by entering that value in connection with the last treatment step in the sequence only. Enter NA in column E for the efficiency of preceding steps in the sequence. An example of how to use the sequential treatment option is provided in Appendix A (page 47). E. Treatment Efficiency Estimate In the space provided, enter the number indicating the per- centage of the toxic chemical removed from the waste stream through destruction, biological degradation, chemical conver- sion, or physical removal. The treatment efficiency (ex- pressed as percent removal) represents the mass or weight percentage of chemical destroyed or removed, not rrwrely changes in volume or concentration of the chemical or the waste stream. The efficiency refers only to the percent conversion or removal of the listed toxic chemical from the waste stream, not the percent conversion or removal of other waste stream constituents (alone or together with the listed chemical), and not the general efficiency of the method for any waste stream. For some treatments, the percent removal will represent removal by several mechanisms, as in secondary wastewater treatment, where a chemical may evaporate, be biodegraded, or be physically removed in the sludge. Percent removal must be calculated as follows: (I ~ E) x 1 00 where I ~ mass of the chemical in the influent waste stream and E ~ mass of the chemical In the effluent waste stream

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104 MASS BALANCE INFOR~4TION' Form R - Part till Page 28 O Mark yes or no in column F only in connection with the final step in the sequence. Do not marts in this column for pro- ceeding steps in the sequence. Calculate the mass or weight of chemical in the waste stream being treated by multiplying the concentration (by weight) of the chemical in the waste stream by the flow rate. In most cases, the percent removal compares the treated effluent to the influent for the particular type of waste stream. However, forsometreatment methods, such as incineration orsolidifica- tion of wastewater, the percent removal of the chemical from the influent waste stream would be reported as 100 percent because the waste stream does not exist in a comparable form after treatment. Some of the treatments (e.g., fuel blending and evaporation) do not destroy, chemically convert, or physi- cally remove the chemical from its waste stream. For these treatment methods, an efficiency of zero must be reported. For metal compounds, the calculation of the reportable con- centration and treatment efficiency is based on the weight of the parent metal, not on the weight of the metal compounds. Metals are not destroyed, only physically removed or chemi- cally converted from one form into another. The treatment efficiency reported represents only physical removal of the parent metal from the waste stream, not the percent chemical conversion of the metal compound. If a listed treatment method converts but does not remove a metal (e.g., chromium reduction), the method must be reported, but the treatment efficiency must be reported as zero. All data available at your facility must be utilized to calculate treatment efficiency and influent chemical concentration. You are Quit requiredto collect any newdataforthe purposes of this reporting requirement. If data are lacking, estimates must be made using best engineering judgment or other methods. F. Based on Operating Data? This column requires you to indicate "Yes" or "No" to whether the treatment efficiency estimate is based on actual operating data. For example, you would check "Yes" if the estimate is based on monitoring of influent and effluent wastes under typical operating conditions. For sequential treatment. do not indicate "Yes" or "No" in column F for a treatment step unless you have provided a treatment estimate in column E. If the efficiency estimate is based on published data forsimilar processes or on equipment suppliers literature, or if you otherwise estimated either the influent or effluent waste comparison or the flow rate, check "No." EXAMPLE Yourtacility produces several different waste streams treated on-site and transferred to off-site facilities. You have previ ously indicated, in Part II, Section 2.1, of Form R. the location of the off-site facilities and the quantity of each reported chemical transferred to off-site facilities in Part 111, Section 6.2.1, of the form, using a separate form for each chemical. One waste stroamgenerated by yourfacility is aqueous waste containing lead chromate, zinc bichromate, and lead selenate as discussed in a previous example in these instructions. In this example, the waste is transferred to off-site facilities after on-site wastewater treatment. The on-site wastewater treat- ment plant precipitates metal sludges. The wastewater is first treated with sulfuric acid and sodium disulfate to reduce the hexavalent chromate to trivalent chromium and then treated with lime to raise the pH. This precipitates chromium hydrox- ide, zinc hydroxide, and lead hydroxide, but does not remove the selenium. The selenium is removed fromthe wastewater by an ionic exchange system. The chromium, zinc, and lead hydroxide sludge (solid) waste is transferred to an off-site land disposal facility and the selenium-containing ion exchange resin is transferred to an off-site facility for metal recovery (off- s~to recovery should not be reported). The treated wastewater is sent to a POTW after neutralization. You would indicate the following treatrrent methods for the on-site treatment of each of the lead, Zinc, chromium, and selenium compounds: C21 - Chromium Reduction C01 - Chemical Precipitation -- Lime or Sodium Hydroxide R22 - Metals Recovery-- Ion Exchange C11 - Neutraiization All sequential treatment steps must be indicated for all the metal compound categories reported even if the treatment method does not affect the particular metal. For example, ionic exchange must be reported as a treatment method for lead, zinc, chromium, and selenium compounds, even though the method affects only the selenium compound. You would calculate the percent removal of chromium, lead, zinc, and selenium, by subtracting the amount of each metal in the wastewater discharge from the amount of each metal in the wastewater before treatment, and then dividing by the amount of each metal in the wastewater before treatment. You would indicate a discharge to a POTW in Part lil, Section 6.1.1 and the location of the POTW in Part II, Section 1 .1. You would also indicate the release of the metal sludge to an off- site land disposal facility in Part lil, Section 6.2.1. 8. Optional Intonnation on Waste Minimization Information provided in Part lilt Section 8. of Form R is optional. In this section, you may identify waste minimization efforts relating to the reported toxic chemical that may not have been reflected in your responses to previous sections of the form. Waste minimization reduces the amount of the

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APPENDIX C Page 29 Form R - Part lil chemical in wastes that are generated. Treatment or disposal does not minimize waste, but recycling or reuse of a waste should be counted as waste minimization. Waste minimiza- tion applies to air emissions and wastewater, as well as to liquid or solid materials that are released, disposed of, or treated. For example, a program to recycle material from reactor cleaning could reduce the amount of a listed chemical in wastewater prior to treatment. This reduction might not show up in annual reports of releases to receiving streams (due to effective treatment, for example) but would be cap- tured in this section. A. Type of Modification Enter from the following list the one code that best describes the type of waste minimization activity: M1 Recycling/Reuse On-Site M2 RecyclinglReuse Off-Site Ma Equipment/Technology Modifications M4 Process Procedure Modifications M5 Reformulation/Redesign of Product Me ~7 Substitution of Raw Materials Improved Housekeeping, Training, Inventory Control Other Waste Minimization Technique B. Quantity of the Chemical in the Wastestream Prior to TreatmentlDisposal Me Enterthe pounds of the toxic chemical contained in all wastes in the reporting year and the pounds contained in all wastes in the year prior to the reporting year. Alternatively, to protect confidential information, you may wish to enter only the percentage by which the weight of the chemical in the wastes has changed. This figure may be calculated using the follow ing formula: R1 R2 (toxic chemical in wastes in reporting year- R3 toxic chemical in wastes in Drior veer) x 100 R4 R5 toxic chemical in wastes in prior year 105 The resulting figure may be either negative or positive (i.e., if the amount of waste generated has been reduced. a negate number should be reported). C. Index Enterthe ratio of reporting-year production to production in the year prior to the reporting year. This index should be catcu- lated to most closely reflect activities involving the chemical. The index provides a means for users of the data to distinguish effects due to changes in business activity from the e ects specifically due to waste minimization efforts. It is not neces- sary to indicate the units on which the index is based. Ex- amples of acceptable indices include: Cl Amount of chemical produced in 1 988/amount of chemi- cal produced in 1987. forexample, a company manufac- tures 200,000 pounds of a chemical in 1987 and 250,000 pounds of the same chemical in 1988. The index figure to report would be 1.3 (1.25 rounded to two significant digits). O Amount of paint produced in 1 988Jamount of paint pro- duced in 1987. O Nunber of appliances coated in 1 988/number of ap~pli- ances coated in 1987. O Square feet of solar collector fabricated in 1 988/square feet of solar collector fabricated in 1987. D. Reason for Action Finally, enter the codes from the following list that best describe the reason for initiating the waste minimization effort: Regulatory Requirement for the Waste Reduction of TreatmenUDisposal Costs Other Process Cost Reduction Self-lnitiated Review Other (e.g., discontinuation of product, occupational safety).

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106 Lo (Important or read instructions before com pleting form . ) EPA FORM R MASS BALANCE INFORMATION Form Approved OMB No . 2070-009 3 Approval Expires 01/91 G Page 1 of 5 PART 1. FACILITY IDENTIFICATION IN FORMATION Public reporting' burden for this collection of information is estimated to vary from 30 to 34 hours per response, with an average of 32 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy Branch (PM-223), US EPA, 401 M St., SW Washington, D. C. 20460 Attn: TRI Burden and to the Office of Information and Regulatory Affairs, Office of Reducgtion ParnodecBudge(t2~p7aopeoowork Washington, D. C. 20603. ~. . 1 .1 Are you claiming the chemical identity on page 3 trade secret? l .2 If "Yes" in ~ ~ th s LOW: 1. [ ] Yes tAnswer question 1.2; [ ] No (Do not answer 1.2, [ ] Sanitized [ ] Unsanitized Attach substantiation forms.) Go to question 1.3.) _ . _ EPA u s Environmental Protection Agency TOXIC CHEMICAL RELEASE INVENTORY REPORTING FORM Section 313 of the Emergency Planning and Community Rlght-to-Know Act of 1986, _~ (This same t~ y~ - E ~ ~ 19 2. CERTIFICATION (Read I hereby certify that I have reviewed the attached documents and that. to the best of my knowledge and belief, the submitted information is true and complete 2nd that the amounts and values in this report are accurate based on reasonable estimates using data available to the preparers of this report. Name and official title of owner/oxrator or senior management official I Signature ~- Date sioned 13 FACILITY InFNT'Ft~^T'c~N 3.2 . 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.1 3.1 ., 31 _ Street Address City County State Zip Code This report contains information for (Check one): ~1 a. l ~ An entire facility WHERE TO SEND COMPLETED FORMS: 1. U.S. ENVIRONMENTAL PROTECTION AGENCY P.O. BOX 70266 WASHINGTON, DC 20024-0266 ATTN: TOXIC CHEMICAL RELEASE INVENTORY 2. APPROPRIATE STATE OFFICE (See instructions Appendix E) b. [ ] Part of a facility. , 1 Technical Contact Public Contact . _ SIC Code (4 digit) a. b. _ Latitude . . Telephone Number (include area code) Telephone Number (include area code) c. Loncitude f. Degrees Minutes Seconds Dun & 3radstreet Number(s) a. a. a. 1 _ Degrees Minutes in. EPA Identification Number(s) (RCRA l.D. No.) NODES Permit Number(s) Seconds I b. 1 I b. Receiving Streams or Water Bodies (enter one name per box) c. Underground Injection Welt Code (UIC) Identification Number(s) ~ I d. 1 4.1 4.2 ~' ! EPA Form 9350-1 (1-89) Revised-Do not use previous versions. I b. I Name of Parent Company 1 I Parent Company's Dun 8 Bradstreet Number

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APPENDIX C Lo (Important: Type or print; read instructions before completing form.) `~ EPA FORM R EPA PART 11. OFF-SITE LOCATIONS TO WHICH TOXIC CHEMICALS ARE TRANSFERRED IN WASTES 107 Lo (This space for your optional use.) 1. PUBLICLY OWNED TREATMENT WORKS (POTWs) .1 POTW name Street Address City State 1.2 PO7W name Street Address County city- 1 . . . __ County State hi. v ~ non ~rr-ol I c LAVA I IUNti (DO NOT REPORT LOCATIONS TO WHICH WASTES ARE SENT ONLY FOR RECYCLING OR REUSE). 2.1 Off-site location name EPA Identiticatic~n Plumber (RCRA ID. No. ) Street Address City . _ State Zip . 1; location under control of reporting facility or parent company7 _ County [ ]Yes [ ] No z.z Off-sito location name EPA Identification Number (RCRA ID. No. ) Street Address City . County State _ . Is location under control of reporting facility or parent company? [ ] Yes [ ] No 2.3 Off-sito location name EPA Identification Number (RCRA ID. No. ) Street Address City State Zip Is locatic~n urKIer control of reporting facility or parent company? 2.4 Off-site location name EPA Identitication Number (RCPtA ID. No. ) County _ ~ _ 2.5 Off-site lo__ EPA Identification Number (RCRA ID. No. ) ___ Street Address City _ _ State Zip . Is location under control of reporting facility or parent company? County [ ]Yes [ ] NO ] Chock if additional pages of Part 11 are attached. How many? EPA Form 9350-1(1-89) Revised-Do not use previous versions. Street Address . City State | Zip - - . Is location under control of reporting facility c r parent company? County my_ ~] Yes [ ] No EPA Identification Number (RCRA ID. No. ) Street Address City State I Zip Is location under control of reporting facility or parent company?

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108 JO (Important: Type or print; read instructions before completing form.) EPA EPA FoRMR ~PART lIl. CHEMICAL-SPECIFIC INFORMATION M 4SS BALANCE INFORMS TION JO Page 3 of 5 (This space for your optional use.) 1. CHEMICAL IDENTITY(Do not complete this section if you complete Section 2.) 1.1 .2 .3 .4 ~A:5 NumDer (Enter the number exactly as it appears on the 313 fist. Enter NA if reporting a chemical category. ) Chemical or Chemical Category Name (Enter the name exactly as it appears on the :~3 list. ~ Generic Chemical Name (Complete only it Part I, Section 1.1 is check" " Yes. " Generic name must be structurally descriptive. ) _ _ 2. MIXTURE COMPOINIENT IDENTITY (Do not complete this section if you complete Section 1; ) Generic Chemical Name Provided by Supplier (Limit the name to a maximum of 70 characters (e.g., numbers, letters, spaces, punctuation). ) l 3.1 3.2 3.3 . . r Manufacture the chemical: ~1_ a. ~J Produce b. [ ] Import Process ther ~ chemical:a. l J As a reactant . ~1 _ . a. I ~ Repackaging only if produce or import: ~ 1 For on-site C. L J Use/processing . e.[ ] As a byproduct r 1 As a formulation b. ~ ~ Component r l For sale/ d.L J distribution f. [ ] As an impurity [ ] As an article c. component Otherwise use ~lAs a chemical ~1 ~1 the chemical: a. ~J processing aid b.L J As a manufacturing aid c.l J Ancillary or other use 4. MAXIMUM ANtlOUNT OF THE CHEMICAL ON-SITE AT AN _ You may report releases of less than 1.000 Ibs. by checking ranges under A.1. (Do not use both A.1 and A.2) 1 5.1 Fugitive or non-point air emissions - 5.2 Stack or point air emissions 5.2a 5.3 Dlscharges to recelvTngO streams or water bodies 5 ~ 3 t (Enter letter code from Part I= Section 3.10 for stream(s) in5.3.2 1 1 the box provided. ) 5.3.3 O 5.4 Underground injection 5.5 Releases to land 5.5.1 On-site landfill 5. 5.2 Land treatment/application farming 5.5.3 Surface impoundment 5.5.4 Other disposal A. Total Release (Ibstyr) s.3 1a 5.3.2a 5.3.3a 5.4a 5.5. 1a 5.5.2a 5.5.3a 5.5.4a A.1 Reporting Ranges 0 ~ 499 soo-sss - [ ][ ][ ] [ ][ ][ ] . [ ] [ ] [ ] [ ][ ]E ] ['][ ][ ] [ ][ ][ ] [ ][ ][ ] [ ][ ][ ] [ ] [ ] [ ] [ ] [ ]_[ ] . EPA Form 9350-1(1-89) Revised-Do not use previous versions. A.2 Enter Estimate 1 B. Basis of I Estimate I (enter code) r 5.1b LO 5.2b O 5.3.1b O 5.3.2b O 5.3.3b O 1 5.4b O 5.5.1b O 5.5.2b O 5.5.3b O 1 l 1 5.5.4b L_J

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APPENDIX C to (Important: Type or print; read instructions before completing form.) . - 109 on Page 4 of 5 "EPA EPAFoRMR PART 111. CHEMICAL-SPECIFIC INFORMATION (continued) (This space for your optional use. ) | 6. TRANSFERS OF THE CHEMICAL IN WASTE TO OFF-SITE LOCATIONS You may report transfers of less than 1,000 Ibs. by checking ranges under A.1. (Do not use both A.1 and A.2) A. Total Transfers (Ibs/yr) A.1 Reporting Ranges 0 1 4 - ~_9 A.2 Enter Estimate Discharge to K)TW (enter location number 6.1.1 from Part II, Section 1.) 1 . [ ][ ][ ] _ _ _ Other off-site location (enter location number lo 6.2.1 fran Pan 11, Section 2. ) Li Other off-site location (enter location number 2 _ 6.2 .2 from Part II, Section 2. ) _ . Other oft-site location (enter location number 1: 6.2.3 from Part ll, Sectior' 2.) ~- [ ] (Check if additional information is provTded on Part IV-Supplemental Information. ) [ ] [ ] [ ] [ ] [ ] [ ] [ ][ ][ ] 6.2.1b O 6.2.2b O 6.2.3b 3 B. Basis of Estimate C.Type of Treatment/ Disposal 6 . 2 . 1 c L!!~! _ _ _ 6.2.2c M 6.2.3c t 7. WASTE TREATMENT METHODS ARID EFFICI ENCY A. General B. Treatment C. Range ofD. Sequential T E. Treatment Wastestream Method tnfluentTreatment ? I Efficiency Concentration (check if I Estimate (enter code) applicable" I (enter code) ~(enter code) 7.1a O 7.1b 1 1 1 1 ~7.1c O 7.1d [ ] 7.2a O 7.2b 1 1 1 1 7.2c ~7.2d [ ] 7.3a O 7.3b ~ | | | 7.3`c O 7.3d [ ] 7.4a O 7.4b 1 1 1 1 7.4c O 7.4d [ ] 7. 5a 0 7. Sb n:] 7. So O 7. Sd [ ] . _ 7.6a O 7.6b | 1 1 i 7.6c O 7.6d [ ] 7. 7a O 7. 7b 1 1 1 1 7. 7c ~7. 7d [ ] 7.8a O 7.8b 1 1 1 1 7.8c O [ ] 7.9a ~7.9b 1 | | | 7.9c O [ ] 7.10b 1 1 1 1 | F. Based onl | Operatingl I Data ?I I YesNo | 1 7 1 ~/n 1 7.1f [ ] [ 17.2f [ ][ ]1 7.3f [ ] [ ] 7.4f [ ] [ ] 75f ~ ][ ] 7.6f [ ] [ ] 7.7f [ ] [ ] 7.8f [ ] [ ] 7.9f [ ] [ ] [ ] (Check if additional information Is provided on Part IV-Supplemental Information.) 1 8. OPTIONAL INFORMATION ON WASTE MINIMIZATION | (Indicate actions taken to reduce the amount of the chemical being released from the facility. See the instructions for coded I Items and an explanation of what information to include.) I A. Type of I Modification I (enter code) 1 _ Em B. Quantity of the Chemical In Wastes Prior to Treatment or Disposal C. Index D. Reason for Action ( enter code ) Current Prior I Or percent reporting year ~ change year (Ibs/yr) (Ibs/yr) i 1 EPA Form 9350-1 ( 1-89) Revised - Do not use previous versions. % [=

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110 to (Important: Type or print; read instructions before completing form.) -- If EPA EPA FORM R PART IV. SUPPLEMENTAL INFORMATION Use this section if you need additional space for answers to questions in Part 111. Number the lines used sequentially from lines in prior sections (e.g.. 5.3.4, 6.1.2, 7.11) AMISS BALANCE INFORMATION to Page 5 of 5 . . (This space for y our . ~ ADDITIONAL INFORMATION ON RELEASES OF THE CHEMICAL TO THE ENVIRONMENT ON-SITE (Part 111, Section 5.3) , . ._ You may report releases of less than 1,000 Ibs. by checking ranges under A.1. (Do not use both A.1 and A.2) A. Total Release (Ibs/yr) A.1 Reporting Ranges . 0 1 499 soo-sss A.2 Enter Estimate B. Basis of Estimate (enter code in box Provided 5.3 Discharges to receiving streams or rr 1 r 1 r 1 water bodies 5~3. '- 5.3.a L ~L J l ~ i;Enter letter code from Part I ~l . ~ the Lox P; voided )tream(s) in 5 3 ~ 5.3.a [ ] [ ] [ ]5.3. bU 5.3._015.3._a 1[ ] [ ] [ ]1 15-3-_b~| 5 3 c . ADDITIONAL I~JFORMATION ON TRANSFERS OF THE CHEMICAL IN WASTE TO OFF-SITE LOCATIONS (Part til, Section 6) , ., You may report transfers of less than 1,000 Ibs. by checking ranges under A.1. (Do not use both A.1 and A.2) Discharge to POTW (enter location number 1 6.1. from Part li, Section 1.) _ . Other off-site location e, 2 Her location number ~ from Part II, Section 2. ) |. _ 5.3. bow A.Total Transfers (Ibs/yr) A.1 Reporting Ranges 0 1 499 500-999 A.2 Enter Estimate B. Basis of Estimate (enter code in box provided) C.% From Stormwater C. Type of Treatment/ Disposal (enter code in box provided 1 [ ] [ ] [ ] ~1 6.2. b rim |62_c~M1 1 1 Other off-site location r I I I Am, I I I 1 6.2. {eorteetorcalltiosectulmonbe2r ) L2J U | [] [ ] [ ] | | 6.2. b L: | 6 2-c | M| I I Ct her of f-site Ixat ion j6.2. iromPar~ll section2.)~l [] [ ] [ ]| | 6.2. b O |6.2._c|M| | | __ r C ADDI,'ONAL INFORMATION ON WASTE TREATMENT METHODS AND EFFICIENCY tPart 111 Section 7) t . , . ~ A. General ~ B. Treatment I C. Range of I D. Sequential I E. Treatment I F. Based on WastestreamI Method I Influent I Treatment? I Efficiency I Operating I; (enter code I (enter code | Concentration| (check if I Estimate I Data? bc, provided)| in box provided) __4 (enter code) I applicable) | | Yes No i7_a 0 1 7~_b 1 1 1 1 ~ 7 c O ~7 d [ ] ~7 e % ~7_f [ ] [] ~ 7._a ~ ~ 7. b 1 1 1 1 1 7. c O 1 7. d [ ] 1 7 e % 1 7. f [ ] [] 1 ~ 1 ~1 i 7._ 2 ~ 1 7. b 1 1 1 1 1 7 _c O 1 7 d [ ] 1 7 _e % 7 f [ ] [ ] 1 ~ 7. a O | 7. b | | | | | 7 c O | 7 d [ ] 7. a r1 1 7. b 1 1 1 1 1 7._c O 1 7 d [ ] 1 i - ~ . a O ~ 7. b A | | | | 7 c O | 7 d [ ] - ~_. ... 7. a :: 1 7 b 1 1 1 1 1 7. c 0 1 7- d [ ] 1 1 ~ ~7. a O 1 7. b 1 1 1 1 1 7. c O 1 7. d [ ] ~7. a :] 1 7. b 1 1 1 1 1 7. c 0 1 7. d [ ] 17. c O i 7. c O 7. c O 7. c O 7. c O 17. c O 1 17 c O 17 t[ ][ ] 7 f[ ][ ] 7 f [ ~ [ ] 7 f[ ] [ ] 17 f[ ][ ] 1 ~_ 1 1 7 f[ ] [ ] EPA Form 9350-1(1-89) Revised-Do not use previous versions.