Form 9350-3 Form R Schedule 1

Toxic Chemical Release Reporting (Renewal)

1363.23 Form R Schedule 1-rev-11.17.2014

Toxic Chemical Release Reporting (Form R)

OMB: 2025-0009

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Page 1 of 4
TRI Facility ID Number

FORM R Schedule 1
United States
Environmental Protection
Agency

PART II. CHEMICAL-SPECIFIC INFORMATION

(conti nued)

SECTION 5. QUANTITY OF DIOXIN AND DIOXIN-LIKE COMPOUNDS ENTERING EACH ENVIRONMENTAL MEDIUM ON-SITE
5.1

NA
Fugitive or nonpoint air emissions

5.2

NA

5.3

Stack or point
air emissions

Discharges to receiving streams or water bodies
(Enter data for one stream or water body per box)
5.3.1

1
D. Mass (grams) of each compound in the category (1-17)

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
If additional pages of Section 5.3 are attached, indicate the total number of pages in this box
and indicate the Section 5.3 page number in this box
EPA Form 9350-3

(Example: 1, 2, 3, etc.)

5.3.2

NA
5.3.3

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FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION

(conti nued)

SECTION 5. QUANTITY OF DIOXIN AND DIOXIN-LIKE COMPOUNDS ENTERING EACH ENVIRONMENTAL MEDIUM ON-SITE
5.4 – 5.5 Disposal to land on-site
5.4.1 NA

5.4.2 NA

5.5.1.A NA

5.5.1.B

Class I
Underground
Injection Wells

Class II-V
Underground
Injection Wells

RCRA Subtitle C
landfills

Other landfills

1

C. Mass (grams) of each compound in the category (1-17)

2
3
4
5
6
7
8
9
10
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13
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17

EPA Form 9350-3

NA

5.5.2

NA

5.5.3A

NA

Land treatment/
RCRA Subtitle C
application farming surface
impoundments

5.5.3B

NA

Other surface
impoundments

5.5.4

NA

Other disposal

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FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION

Page 3 of 4
TRI Facility ID Number

(continued)

SECTION 6. TRANSFERS OF DIOXIN AND DIOXIN-LIKE COMPOUNDS IN WASTES TO OFF-SITE LOCATIONS
6.1. DISCHARGES TO PUBLICLY OWNED TREATMENT WORKS (POTWs)
6.1. __

NA

C. Mass (grams) of Each Compound in the Category (1-17)

1

2

3

4

5

6

7

8

10

11

12

13

14

15

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17

6.2 TRANSFERS TO OTHER OFF-SITE LOCATIONS
6.2.__
1.
9

2.
9

3.
9

4.
9

9

2.
9

3.
9

4.
9

NA

D. Mass (grams) of each compound in the category (1-17)
1

2

3

4

5

6

7

8

10

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12

13

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15

16

17

1

2

3

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5

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8

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17

1

2

3

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10

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14

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17

1

2

3

4

5

6

7

8

10

11

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13

14

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16

17

6.2.__
1.

D. Mass (grams) of each compound in the category (1-17)
1

2

3

4

5

6

7

8

10

11

12

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14

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17

1

2

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5

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14

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17

1

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3

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13

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17

1

2

3

4

5

6

7

8

10

11

12

13

14

15

16

17

If additional pages of Section 6.1 or 6.2 are attached, indicate the total number of pages in this box
and indicate the Section 6.1 or 6.2 page number in this box

EPA Form 9350-3

9

(Example: 1, 2, 3, etc.)

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FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION

Page 4 of 4
TRI Facility ID Number

(continued)

SECTIONS 8.1-8.8. WASTE MANAGEMENT QUANTITIES FOR DIOXIN AND DIOXIN-LIKE COMPOUNDS (current year only)
8.1-8.7 Production-related waste managed
8.8
8.1a
Total on-site
disposal to
Class 1
Underground
Injection Wells,
RCRA Subtitle
C landfills, and
other landfills

8.1b
Total other
on-site disposal
or other
releases

8.1c
Total off-site
disposal to
Class 1
Underground
Injection Wells,
RCRA Subtitle
C landfills, and
other landfills

8.1d
Total other
off-site disposal
or other
releases

8.2
Quantity used
for energy
recovery
on-site

8.3
Quantity used
for energy
recovery
off-site

8.4
Quantity
recycled
on-site

8.5
Quantity
recycled
off-site

8.6
Quantity
treated
on-site

8.7
Quantity
treated
off-site

Column f. Mass (grams) of each compound in the category (1-17)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

EPA Form 9350-3

*Includes quantities released to the environment or transferred off-site as a result of remedial actions, catastrophic events, or other one-time events not associated with production processes

Non-production
related waste
managed*


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AuthorCassandra
File Modified2014-11-17
File Created2014-10-29

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