EPA Form 7740-8 Form U (Joint Submitter)

Page: 1

EPA FORM U

2016

Joint
Page
U.S. Environmental Protection Agency
Washington, DC 20460
Partial Updating of TSCA Inventory Data Base
Site Report

Form U
(Section 8(a) Toxic Substances Control Act, 15 U.S.C. 2607(a))

2016

1

of

.

Check all that apply
Original

2016 submission

Joint submission – as secondary
submitter
Revision to an original submission

Part IV. Joint Submission – Secondary Submitter

4.A.1
4.A.2
4.A.3
4.A.4
4.A.6
4.A.8

PART IV. SECONDARY COMPANY IDENTIFICATION INFORMATION
SECTION A. SECONDARY COMPANY INFORMATION
Secondary Company
Name
Secondary Company
Address (line 1)
Secondary Company
Address (line 2)
City
State
Country

4.A.5
4.A.7

County/Parish
Zip Code

X

Joint submission(s)- as primary
submitter

X

Page: 2

EPA FORM U

2016

Joint
Page

4.B.1
4.B.2
4.B.3
4.B.4
4.B.5
4.B.6
4.B.7

State
4.B.10 Country

4.D.2

4.D.3

.

SECTION B. SECONDARY TECHNICAL CONTACT INFORMATION
Prefix
First Name
Middle Initial
Last Name
Suffix
Company Name
Telephone
Email Address
Mailing Address (line 1)
Mailing Address (line 2)
City
4.B.
County/Parish

4.B.8

4.D.1

of

4.B.9

Zip Code

SECTION D. TRADE PRODUCT IDENTIFICATION INFORMATION
Trade product name
a. Chemical Name

CBI*+

b. Chemical Identifying
Number

c. ID Code

Other Information
*Substantiation required for CBI claims on chemical identity.
+Formulations provided by secondary submitters are held as confidential

d. Percent of
Formulation

Paperwork Reduction Act Notice

The annual public burden for this collection of information, which is approved under OMB
Control Number 2070-0162, varies depending on the submitter’s experience with CDR
reporting, and is estimated at 91-139 hours per response for a full report and 26-56 hours
per response for a partial report. A full report includes manufacturing, processing, and use
information. A partial report includes manufacturing information and does not include
processing and use information. According to the Paperwork Reduction Act, "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. For this collection it
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 or 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 number. The OMB control
number for this collection appears above. In addition, the OMB control numbers for EPA's
regulations, after initial display in the final rule, are listed in 40 CFR part 9. Exp. 10/31/2018.

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
the use of automated collection techniques) to: Director, Collection Strategies Division, U.S.
Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Ave, N.W.,
Washington, D.C. 20460. Include the OMB control number in any correspondence, but do
not submit the completed form to this address. The requested information should be
submitted in accordance with the instructions accompanying the form, or as specified in the

EPA Form Number <7740-8> (Rev December 2015) – Previous editions are obsolete

Form Approved OMB Number 2070-0162 (Expiration October 2018)