Toxic Chemical Release Inventory Reporting Forms and Instructions

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Facility Eligibility Determination for Submitting an EPCRA Section 313 Report Figure 2D. EPCRA Section 313 Reporting Threshold Worksheet for Dioxin and Dioxin-Like Compounds Chemical Category Facility Name: __________________________________________________________________ EPCRA Section 313 Chemical or Chemical Category: Dioxin and Dioxin-Like Compounds Chemical Category Code: N150____________________________________________________ Reporting Year: _________________________________________________________________ Amounts of the EPCRA Section 313 chemical or chemical category manufactured, processed, or otherwise used. Mixture Name or Other Identifier Information Source Total Weight (g) Percent EPCRA Section 313 Chemical by Weight EPCRA Section 313 Chemical Weight (g) Date Worksheet Prepared: _____________________ Prepared By: ________________________________ Amount of the EPCRA Section 313 Chemical or Chemical Category by Activity (g.): Manufactured Processed Otherwise Used 1. 2. 3. 4. Subtotal: (A)_________g (B)_______g (C)_________g Exempt quantity of the EPCRA Section 313 chemical or chemical category that should be excluded. Mixture Name as Listed Above Applicable Exemption (articles, facility, activity) 1 Fraction or Percent Exempt (if Applicable) Amount of the EPCRA Section 313 Chemical Exempt from Above (g): Manufactured Processed Otherwise Used 1. 2. 3. 4. Subtotal: (A 1 )_________g (B 1 )________g (C 1 )_________g Amount subject to threshold: (A-A 1 )_____ g (B-B 1 )_____ g (C-C 1 )_____ g Compare to threshold for EPCRA section 313 reporting. 0.1 gram 0.1 gram 0.1 gram If any threshold is exceeded, reporting is required for all activities. Do not submit this worksheet with Form R; retain it for your records. 1 Note: Chemicals listed as PBT are not eligible for the de minimis exemption. 30 Toxics Release Inventory Reporting Forms and Instructions
C. Instructions for Completing EPA Form R Part I. Facility Identification Information Section 1. Reporting Year This is the calendar year to which the reported information applies, not the year in which you are submitting the report. Information for the 2003 reporting year must be submitted on or before July 1, 2004. Section 2. Trade Secret Information 2.1 Are you claiming the EPCRA section 313 chemical identified on page 2 a trade secret? Answer this question only after you have completed the rest of the report. The specific identity of the EPCRA section 313 chemical being reported in Part II, Section 1, may be designated as a trade secret. If you are making a trade secret claim, mark “yes” and proceed to Section 2.2. Only check “yes” if you manufacture, process, or otherwise use the EPCRA section 313 chemical whose identity is a trade secret. (See page 2 of these instructions for specific information on trade secrecy claims.) If you checked “no,” proceed to Section 3; do not answer Section 2.2. 3 Do not submit trade secret reports electronically or on diskette. 2.2 If “yes” in 2.1, is this copy sanitized or unsanitized? Answer this question only after you have completed the rest of the report. Check “sanitized” if this copy of the report is the public version that does not contain the EPCRA section 313 chemical identity but does contain a generic name in its place, and you have claimed the EPCRA section 313 chemical identity trade secret in Part I, Section 2.1. Otherwise, check “unsanitized.” Section 3. Certification The certification statement must be signed by a senior official with management responsibility for the person (or persons) completing the form. A senior management official must certify the accuracy and completeness of the information reported on the form by signing and dating the certification statement. Each report must contain an original signature. You should 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 after the form has been completed. Section 4. Facility Identification 4.1 Facility Name, Location, and TRI Facility Identification Number Enter the full name that the facility presents to the public and its customers in doing business (e.g., the name that appears on invoices, signs, and other official business documents). Do not use a nickname for the facility (e.g., Main Street Plant) unless that is the legal name of the facility under which it does business. Also enter the street address, mailing address, city, county, state, and zip code in the space provided. Do not use a post office box number as the street address. The street address provided must be the location where the EPCRA section 313 chemicals are manufactured, processed, or otherwise used. If your mailing address and street address are the same, you should enter NA in the space for the mailing address. If your facility is not in a county, put the name of your city, district (for example, District of Columbia), or parish (if you are in Louisiana) in the county block of the Form R and Form A as well as in the county field of TRI-ME. “NA” or “None” are not acceptable entries. If you have submitted a Form R or Form A for previous reporting years, a TRI Facility Identification Number has been assigned to your facility. If you know your TRI Facility Identification Number, you should complete Section 4. If you do not know your TRI Facility Identification Number, you should contact the EPCRA Call Center (see page 7). If your facility has moved, do not enter your TRI Facility Identification Number, enter “New Facility.” If you are filing a separate Form R for each establishment at your facility, you should use the same TRI Facility Identification Number for each establishment. The TRI Facility Identification Number is established by the first Form R submitted by a facility at a particular location. This identification number is retained by the facility even if the facility changes name, ownership, production processes, SIC codes, etc. This identification number will stay with this location. If a new facility moves to this location it should use this TRI Facility Identification Number. Establishments of a facility that report separately should use the TRI Facility Identification Number of the facility. You should enter “New Facility” in the space for the TRI Facility Identification number if this is your first submission. 4.2 Full or Partial Facility Indication EPCRA section 313 requires reports by “facilities,” 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 (or by any person which controls, is controlled Toxics Release Inventory Reporting Forms and Instructions 31
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Toxic Chemical Release Inventory Re
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Toxic Chemical Release Inventory Re
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More Information or Assistance TRI
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Important Information for Reporting
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Toxics Release Inventory Reporting
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Page 17 and 18: III. Industry-Specific Guidance EPA
Page 19 and 20: Form Approved OMB Number: 2070-0093
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Page 65 and 66: Instructions for Completing Part I
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Page 69 and 70: Instructions for Completing Part II
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Page 105 and 106: Instructions for Completing Part I
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Page 109 and 110: Table I. SIC codes 10 Metal Mining
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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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