Form EPA Form 7710-56 EPA Form 7710-56 Notice of Commencement of Manufacture or Import

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O.M.B. No. 2070-0012 EPA Form 7710-56 (11-2019)
Date of Receipt
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U.S. Environmental Protection Agency

NOTICE OF COMMENCEMENT OF
MANUFACTURE OR lMPOHT(40CFR§720.102)

Part I - SUBMITTER IDENTIFICATION
Manufacturer/
Importer

Name of Authorized Official

Mallinn Address fnumber and street\

CoJnn<>nv Name

Cltv, State, ZIP code

Name

Telephone Number

(in·u.S.)

Technical

Contact

On U.S.)

Document Control #'.

.

car
car

Part II - Premanufacture Notice (PMN) "P" Case Number:
. Part Ill - Check the appropriate box and provide the exact date of manufacture or importation:
·

0 First Commercill.l Importation***

D First Commercial Manufacture..

date:
•• Date of commencement Is the date of coinpletlcin of non-exempt manufacture-of the first amQUOt (batch, drum, �tc.)
""•for importers, the date of commencement is the date that the.-�ew �ical substance c!��s U.S. tustoms.

· date:

-

Part IV - Manufacturing Plant Site(s) or Importing Site(s): (Importers, provide street address of destination)
OBI'

Part V - Specific Chemical Identity:

· Part VI - Generic Chemical Name

□
□

(For Consolidated submissions, eacti substance must have a separate NOC form
wi1h the specnic identity of each chemical substance.)

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(if chemical identity is claimed CBI'):

Part VII - Substance Identity Confidentiality Status:

.

I wish to continue to claim the substance identity confidential and the substantiation to support this claim is attached.
Failure to submit the required substantiation in accordanci, with 40 CFR 720.SS(b) will result in a waiver of your claim.
I previously claimed the substance identity as confidential and hereby relinquish that claim.

0 I did not claim the substance identity as confidential in my original·PMN submission.

You must submit your completed notice no later than 30 calendar days atter the first date of commercial manufacture/importation
to Malling address:

USEPA

OPPT Document Control Office {7407M)
1200 Pennsylvania Ave., NW
Washington, D.C. 20460
ATTN: Notice of Commencement

Address using courier service:

Document Control Officer
TSCA Confidential Business Information Center
Room 6428
EPA East Building
1201 Constitution Ave., N.W.

Washington, DC 20004-3302
Telephone: 202-564-8930 or 202-564-8940

Siqnature of authorized official
Note: CBI* - refers to the term "Confidential Business Information•. Mark (X) in the box if the information is to be held Confidential.

IDate

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2070-0012). Responses to this collection of
information are mandatory (40 CFR 720). 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 public reporting and recordkeeping burden for this collection of information is estimated to average 0.8 hours per response. 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 (2822T), 1200
Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed EPA Form 7710-56 to this address.