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Appendix C: U.S. EPA Form R: Toxic Chemical Release Inventory Reporting Form
Pages 87-110

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From page 87...
... Section 313(h) of SARA indicates the intended purposes of the Toxic Chemical Release Inventory Reporting Form: "(h)
From page 88...
... , street address, city, county, state, and zip code in the space provided. Do not use a post office box number as the address.
From page 89...
... of the reporting rule, you may submit a separate Form R for each establishment, or for groups of establishments, in your covered 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 establishments (e.g., part of a covered facility)
From page 90...
... Do not list locations to which products containing toxic chemicals 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.
From page 91...
... 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
From page 92...
... 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 product 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.
From page 93...
... 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.
From page 94...
... ) 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 ~ .
From page 95...
... 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.
From page 96...
... 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.
From page 97...
... 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 chemical category (e.g., all glycol ethers or all chlorophenols) and report the aggregate amount for that chemical category.
From page 98...
... If the monitoring data, mass balance, or emission factor used to estimate the release is not specific to the toxic chemical being reported, the form should identify the estimate as based on engineering calculations or judgment. If a mass balance calculation yields the flow rate of a waste stream, but the quantity of reported chemical in the waste stream is based on solubility data, report "O" because "engineering calculations" were used as the basis of estimate of the quantity of the chemical in the waste stream.
From page 99...
... E~e (enter coder 5.2b 5.3.1b C ~ From Stormwater 5~.
From page 100...
... = 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.
From page 101...
... 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.
From page 102...
... Forexample, process waterfrom several pieces of equipment at yourfacility may be combined prior to treatment. Report treatment methods that apply to the aggregate waste stream, as well as treatment methods that apply to individual waste streams.
From page 103...
... E Treatment Efficiency Estimate In the space provided, enter the number indicating the percentage of the toxic chemical removed from the waste stream through destruction, biological degradation, chemical conversion, or physical removal.
From page 104...
... 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.
From page 105...
... Waste minimization 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.
From page 106...
... ) EPA FORM R MASS BALANCE INFORMATION Form Approved OMB No .
From page 107...
... ) Street Address City State I Zip Is location under control of reporting facility or parent company?
From page 108...
... 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.
From page 109...
... WASTE TREATMENT METHODS ARID EFFICI ENCY A General B
From page 110...
... 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 .


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