Form EPA Form 7740-8 EPA Form 7740-8 Form U (Primary Submitter)

Page: 1

EPA FORM U

2016

Primary
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 4 .

Check all that apply
Original 2016 submission

X

Joint submission(s)- as primary
submitter
Joint submission – as secondary
submitter
Revision to an original submission

CERTIFICATION
Certification Statement: I hereby certify to the best of my knowledge and belief that (1) all information entered on this
form is complete and accurate; and (2) any confidentiality claims are true and correct as to that information for which
they have been asserted. Any knowing and willful misinterpretation is subject to criminal penalty pursuant to 18 USC
1001.

Signature

Official
Title
Email
Address

Name (printed)
Date Signed

1.A.1
1.A.2
1.A.3
1.A.4
1.A.5
1.A.7

PART I. COMPANY & SITE IDENTIFICATION INFORMATION
SECTION A. PARENT COMPANY INFORMATION*
Parent Company Name
Parent Company Dun & Bradstreet Number
Parent Company Address
(line 1)
Parent Company Address
(line 2)
City
1.A.6
County/Parish
State
1.A.8
Zip Code
SECTION B. SITE INFORMATION*

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

Site Name
Site Dun & Bradstreet Number
Site Address (line 1)
Site Address (line 2)
City
State

1.B.6 County/Parish
1.B.8 Zip Code

Page: 2

EPA FORM U

1.C.1
1.C.2
1.C.3
1.C.4
1.C.5
1.C.6
1.C.7
1.C.10

2016

Primary

Page 2

of 4 .

SECTION C. 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
1.C.8
State
1.C.9 Zip Code
Country

*Confidentiality claims for information in Part I, Sections A, B, and C, are made, as necessary, for each chemical substance on subsequent pages.

PART II. MANUFACTURING INFORMATION
2.A.1
2.A.2
2.A.4

SECTION A. CHEMICAL IDENTIFICATION
CBI for Chemical Identification*
Chemical Identifying Number
2.A.3
Chemical Name

Number ID Code

2.A.5

SECTION A. JOINT SUBMISSION INFORMATION (Primary Submitter only)
Trade name

2.A.6

Other Information

2.A.7

Secondary Company
Name
Secondary Company
Address
City

2.A.7
2.A.9

2.B.1
2.B.2

2.A.10

State or
2.A.11 Zip
Province
Code
SECTION B. MANUFACTURING INFORMATION
CBI for Company Identification
2.B.10
Number of Workers
2.B.11
Maximum
CBI for Site Identification*
Concentration
2.B.12

2.B.3

CBI for Technical Contact
Information

Report

Report CY 2015 Production Volume
Activity

2.B.5
2.B.6
2.B.7
2.B.8
2.B.9

CBI

2.B.13

Domestically
Manufactured

CBI

2.B.14

Imported

CBI

2.B.15

CBI

2.B.16

Other Solid

CBI
CBI

2.B.17
2.B.18

Gas or Vapor
Liquid

2.B.19

NKRA

Chemical
physically at site
Volume used on site
Volume Exported

M or I

2.A.12

Country

CBI
CBI

Is chemical being
recycled?

Physical Form

2.B.4

NA

Dry Powder
Pellets or Large
Crystals
Water or Solvent
Wet Solid

CBI
a. Physical
Form
Check
all that
apply

CBI

b. % PV in
Each Physical
Form
Percent

CBI

Page: 3

EPA FORM U
Report Past
PV
2.B.20

2016

Primary

a. CY 2014
PV
CBI

Page 3
b. CY 2013
PV
CBI

of 4 .

c. CY 2012
PV
CBI

d.
PV

CBI

PART III. PROCESSING AND USE INFORMATION
SECTION A. INDUSTRIAL PROCESSING AND USE
c. Industrial
d. Percent
a. Type of
b. Sector(s)
Function
Production
Process or Use
Category
Volume
Code
CBI*
Code
CBI*
Code
CBI*
%
CBI*

N/A
e. Number of
Sites
Code

f. Number of
Workers

CBI*

Code

CBI*

3.A.1
3.A.2
3.A.3
3.A.4
3.A.5
3.A.6
3.A.7
3.A.8
3.A.9
3.A.10
SECTION B. CONSUMER AND COMMERCIAL USE
b. Consumer or
c. Used in Products
d. Percent
a. Product
Commercial
Intended for
Production
Category
or both
Children?
Volume
CBI
Code CBI*
Code
Code
CBI*
%
CBI*
*

N/A
e. Maximum
Concentration
Code

CBI*

3.B.1
3.B.2
3.B.3
3.B.4
3.B.5
3.B.6
3.B.7
3.B.8
3.B.9
3.B.10
*Substantiation required for CBI claims on chemical identity, site identity, and processing or use information.

f. Number of
Commercial Workers
Reasonably Likely to
be Exposed

Code

CBI*

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
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existing ways to comply with any previously applicable instructions and requirements; train
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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.,
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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)