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OCR for page 87
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
OCR for page 88
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.
OCR for page 89
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.
OCR for page 90
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.
OCR for page 91
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.
OCR for page 92
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.
OCR for page 93
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.
OCR for page 94
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.
. . . _ _ . .
-
OCR for page 95
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.
OCR for page 96
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
OCR for page 97
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)
OCR for page 100
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
OCR for page 101
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
OCR for page 102
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
OCR for page 103
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
0°C (32°F) 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
OCR for page 104
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
OCR for page 105
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).
OCR for page 106
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
OCR for page 107
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?
OCR for page 108
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
OCR for page 109
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.
%
[=
OCR for page 110
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.
Representative terms from entire chapter:
waste stream
