Toxic Chemical Release Inventory Reporting Forms and Instructions

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Paperwork Reduction Act Notice: The annual public burden related to the Form R, which is approved under OMB Control No. 2070-0093, is estimated to average 30.2 hours per response for non-PBT chemicals and 52.1 hours per response for PBT chemicals. The annual public burden related to the Form A, which is approved under OMB Control No. 2070-0143, is estimated to average 20.6 hours for a facility that certifies one chemical per Form A Certification Statement. Responding to this information collection requires 1) determining whether a listed toxic chemical is eligible for certification under the alternate threshold, and 2) completing the Form A Certification Statement. The burden of determining eligibility for certification and associated recordkeeping is estimated to average 19.2 hours for each chemical that is certified. The burden of completing the Form A Certification Statement is estimated to average 1.4 hours, regardless of the number of chemicals being certified. The total burden per response is the combination of these two, and will vary depending on the number of listed toxic chemicals being certified. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control numbers for EPA's regulations are listed in 40 CFR Part 9 and 48 CFR Chapter 15. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number and OMB control number in any correspondence. The completed forms should be submitted in accordance with the instructions accompanying the form, or as specified in the corresponding regulation. x Toxics Release Inventory Reporting Forms and Instructions
Form Approved OMB Number: 2070-0093 (IMPORTANT: Type or print; read instructions before completing form) Approval Expires: 01/31/2006 Page 1 of 5 United States Environmental Protection Agency FORM R Section 313 of the Emergency Planning and Community Right-to-Know Act of 1986, also Known as Title III of the Superfund Amendments and Reauthorization Act WHERE TO SEND COMPLETED FORMS: 1. TRI Data Processing Center 2. APPROPRIATE STATE OFFICE P. O. Box 1513 (See instructions in Appendix F) Lanham, MD 20703-1513 ATTN: TOXIC CHEMICAL RELEASE INVENTORY IMPORTANT: See instructions to determine when “Not Applicable (NA)” boxes should be checked. PART 1. FACILITY IDENTIFICATION INFORMATION SECTION 1. REPORTING YEAR SECTION 2. TRADE SECRET INFORMATION Are you claiming the toxic chemical identified on page 2 trade secret? 2.1 Yes (Answer question 2.2; No (Do not answer 2.2; Attach substantiation forms) Go to Section 3) SECTION 3. CERTIFICATION TRI Facility ID Number Toxic Chemical, Category or Generic Name Enter “X” here if this is a revision For EPA use only 2.2 Is this copy Sanitized Unsanitized (Answer only if “YES” in 2.1) (Important: Read and sign after completing all form sections.) 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 and 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/operator or senior management official: Signature: Date Signed: SECTION 4. FACILITY IDENTIFICATION 4.1 TRI Facility ID Number Facility or Establishment Name Facility or Establishment Name or Mailing Address (If different from street address) Street City/County/State/Zip Code Mailing Address City/State/Zip Code Country (Non-US) 4.2 This report contains information for: (Important: Check a or b; check c or d if applicable) a. An entire facility b. 4.3 Technical Contact Name Email Address Part of a facility c. A Federal facility d. Telephone Number (include area code) GOCO 4.4 Public Contact Name Telephone Number (include area code) 4.5 SIC Code (s) (4 digits) 4.6 Latitude 4.7 Dun & Bradstreet Number (s) (9 digits) Primary a. b. c. d. e. f. Degrees Minutes Seconds Longitude Degrees Minutes Seconds 4.8 EPA Identification Number 4.9 Facility NPDES Permit Underground Injection Well Code 4.10 (RCRA ID No.) (12 characters) Number(s) (9 characters) (UIC) I.D. Number(s) (12 digits) a. a. a. a. b. b. b. b. SECTION 5. PARENT COMPANY INFORMATION 5.1 Name of Parent Company NA 5.2 Parent Company’s Dun & Bradstreet Number NA EPA Form 9350 -1 (Rev. 02/2004) - Previous editions are obsolete.
Page 1 and 2: Toxic Chemical Release Inventory Re
Page 3 and 4: Toxic Chemical Release Inventory Re
Page 5 and 6: More Information or Assistance TRI
Page 7 and 8: Important Information for Reporting
Page 9 and 10: Toxics Release Inventory Reporting
Page 11 and 12: Toxics Release Inventory Reporting
Page 13 and 14: TRI Reporting Software Toxics Relea
Page 15 and 16: Chemical and Industry Guidance Docu
Page 17: III. Industry-Specific Guidance EPA
Page 21 and 22: Form Approved OMB Number: 2070-0093
Page 29 and 30: (IMPORTANT: Type or print; read ins
Page 31 and 32: IMPORTANT: Type or print; read inst
Page 33 and 34: A. General Information Reporting to
Page 35 and 36: General Information may request doc
Page 37 and 38: General Information < Use for motor
Page 39 and 40: General Information A.8 How to Obta
Page 41 and 42: B. Facility Eligibility Determinati
Page 43 and 44: Facility Eligibility Determination
Page 63 and 64: C. Instructions for Completing EPA
Page 65 and 66: Instructions for Completing Part I
Page 67 and 68: Part II. Chemical Specific Informat
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Instructions for Completing Part II
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Example 14: Container Residue Instr
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D. Facility Eligibility Determinati
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E. Instructions for Completing EPA
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Instructions for Completing Part I
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Section 2. Mixture Component Identi
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Table I. SIC codes 10 Metal Mining
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Table I 2542 Office and store fixtu
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Table I 3431 Enameled iron and meta
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Table I 3873 Watches, clocks, clock
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Table II. EPCRA Section 313 Chemica
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Table II quantities. Phosphorus (ye
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Table II De Minimis CAS Number Chem
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Table II N171 Ethylenebisdithiocarb
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Table III. State Abbreviations Alab
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Table IV. Federal Information Proce
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Table IV YI YM ZA ZI Yugoslavia Yem
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Appendix A. Federal Facility Report
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Appendix A More Help is Available!
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Appendix B. Reporting Codes For EPA
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Appendix B F99 Other Incineration/T
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Appendix B Reporting the Waste Mana
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Appendix B Section 7B. On-site Ener
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Appendix C. Facility Data Profiles
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Appendix C C. Common Errors in Comp
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Appendix C ” Generic chemical nam
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Appendix C ” Any time a reported
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Appendix C ” M95 Transfer to Wast
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Appendix C 25. EPA has corrected th
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Appendix C one of the activity(ies)
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Appendix C 89. You reported a negat
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Appendix D. Supplier Notification R
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Appendix D “ 0.1 percent if the E
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Appendix D Sample Notification Lett
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Appendix E. How To Determine Latitu
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Appendix E (5) To determine the inc
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Appendix F. State Designated Sectio
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Appendix F Illinois Ms. Deirdre McQ
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Appendix F New Hampshire Ms. Wallen
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Appendix F Texas U.S. Postal Servic
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Appendix G. Section 313 EPA Regiona
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Appendix H. Other Relevant Section
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Appendix I. Sample Revision and Wit
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Index A Activity Exemptions 15 Acti
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United States Environmental Protect
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