2-1; 2-2; 2-3; 2-3 CWC Schedule 2 Declarations and Reports

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)

DATE RECEIVED
(Leave Blank)

U.S. DEPARTMENT OF COMMERCE
Bureau of Industry and Security

CWC SCHEDULE 2
DECLARATION OR REPORT

CERTIFICATION FORM
Provide the information requested below in Questions C.1 through C.8.
C.1

Name of Declaration or Report Point of Contact (D/R-POC):

C.2

Company Name:

C.3

Mailing Address:
State:

City:
D/R-POC's Telephone Number:

C.4

Zip Code:
ext.

D/R-POC's Fax Number:
D/R-POC's E-mail Address:

C.5

Date Submitted (YYYY-MM-DD):

C.6

CERTIFICATION

I hereby certify that I have reviewed the attached documents and that, to the best of my knowledge and belief, the
submitted information is true and complete.
Name and title of responsible official (type or print):
Signature:

Date Signed (YYYY-MM-DD):
TYPE OF DECLARATION OR REPORT

(check one box, except check two boxes for an amendment)

ANNUAL DECLARATION ON PAST ACTIVITIES (YYYY): ___________
ANNUAL REPORT ON EXPORTS AND IMPORTS (YYYY): ___________
COMBINED ANNUAL DECLARATION AND REPORT (YYYY): ___________

C.7
ANNUAL DECLARATION ON ANTICIPATED ACTIVITIES (YYYY): ___________
DECLARATION ON ADDITIONALLY PLANNED ACTIVITIES (YYYY): ___________
AMENDMENT

Forms Submitted
C.8

Check all forms that are included:
FORM 2-1

FORM 2-2

FORM 2-3

FORM 2-3A

FORM 2-3B

FORM 2-3C

FORM A
FORM B

CERTIFICATION FORM Schedule 2 Declaration or Report
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
A separate Certification Form is required for:
a) each Schedule 2 plant site that has declaration
requirements (declared plant site);
b) each Schedule 2 plant site with Schedule 2 reporting
requirements; and
c) each trading company with reporting requirements.
NOTE: If you submit a combined declaration and report, you
must submit only one Certification form.
This form serves several purposes, including:
a) identifying a Point of Contact;
b) certifying the accuracy of the submitted declaration;
c) identifying the type of declaration or report submitted;
and
d) listing the declaration forms submitted.
Questions C.1 through C.5 Name of Declaration or Report
Point of Contact (D/R-POC) and Other Requested Information:
Designate a D/R-POC. The D/R-POC should be a person whom
the Department of Commerce may contact for: (1) the purposes
of clarification of information provided in the declaration or
report; and (2) for general information. The D/R-POC need not
be the person who prepares the forms or signs the Certification
Form.
Question C.6 Certification: The Certification must be signed
by the owner, operator or senior management official who
certifies the accuracy and completeness of the information
submitted. The Certification signature block must contain an
original signature.
Question C.7 Type of Declaration or Report: Check the
appropriate box for the type of declaration or report being
submitted (e.g. past activities, anticipated or additionally
planned activities, exports and imports, combined declaration
and report, and amendments) and indicate the year(s) for
which the information applies.
The ANNUAL DECLARATION ON PAST ACTIVITIES
provides information on the production, processing,
consumption, domestic transfer, export and import of a
Schedule 2 chemical by a declared Schedule 2 plant site for the
previous calendar year. A plant site must submit an ANNUAL
DECLARATION ON PAST ACTIVITIES if one or more plants
on the plant site produced, processed or consumed a Schedule

2 chemical above the applicable threshold during any one of
the three previous calendar years.
The ANNUAL
DECLARATION ON PAST ACTIVITIES is submitted for the
previous year only - not for each of the three previous years.
The ANNUAL REPORT ON EXPORTS AND IMPORTS,
submitted by plant sites and trading companies, provides
information on exports and imports of a Schedule 2 chemical
above the applicable thresholds.
The COMBINED ANNUAL DECLARATION AND REPORT
provides information on a declared Schedule 2 plant site that
has a requirement to submit both an Annual Declaration on
Past Activities and an Annual Report on Exports and Imports.
The COMBINED ANNUAL DECLARATION AND REPORT
provides information on the production, processing,
consumption, domestic transfer, export and import of a
Schedule 2 chemical above the applicable threshold quantity
as well as information on the export from or import to the plant
site of a different Schedule 2 chemical above the applicable
threshold quantity that was not produced, processed or
consumed by the plant site.
Note that exports from and
imports to a plant site are determined for the entire plant site,
including all units of the plant site.
The ANNUAL DECLARATION ON ANTICIPATED
ACTIVITIES provides information on the production,
processing and consumption of a Schedule 2 chemical by a
plant site that has at least one plant that anticipates
producing, processing or consuming a Schedule 2 chemical
above the applicable declaration threshold in the next calendar
year.
The DECLARATION ON ADDITIONALLY PLANNED
ACTIVITIES provides information on additional activities
planned after submission of the Annual Declaration on
Anticipated Activities, (e.g., increased production, processing
or consumption of a previously declared Schedule 2 chemical
at any plant on your plant site by 20% or more of the originally
declared amount). NOTE: This declaration is due 15 days
before the additionally planned activities can begin.
Note that declarations on the production, processing,
consumption, domestic transfer, export and import of a
Schedule 2 chemical by declared plant sites will be transmitted
to the OPCW and will also be used to compile the U.S. national
aggregate declaration. Reports on exports and imports of
Schedule 2 chemicals are not submitted to the OPCW, but are
used to compile the U.S. national export and import aggregate
declaration.
Question C.8 Forms Submitted: Check the appropriate box for
each form that is included in the submission.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE NAME OR TRADING COMPANY NAME:

CWC SCHEDULE 2
DECLARATION OR REPORT

U.S. PLANT SITE OR TRADING COMPANY CODE
(once assigned):

FORM 2-1 SCHEDULE 2 PLANT SITE OR TRADING COMPANY IDENTIFICATION
Submit this form for each declared Schedule 2 plant site, undeclared Schedule 2 plant site, or
trading company. You must submit this form for each type of declaration or report (past activities,
anticipated or additionally planned activities, exports and imports, combined, and amendments).

2-1.1
2-1.2
2-1.3

Owner:
Telephone Number:

Fax Number:

Operator:
Telephone Number:

Fax Number:

Street Address:
City:

State:

Zip Code:

Provide the geographic coordinates of the center of the plant site (see Supplement No. 1).

2-1.4

a. Latitude (Deg/Min/Sec/N):
b. Longitude (Deg/Min/Sec/W):

Check this box if you have attached to Form A any additional information on the plant site.

2-1.5

The number of declared Scheduled 3 plants at this Schedule 2 plant site:

Designation of Inspection Point of Contact (I-POC) for inspection notifications involving this plant site.
NOTE: The Department of Commerce must be able to reach the I-POCs at all hours through the
telephone numbers shown below.
Name of I-POC:

2-1.6.1

I-POC's Primary Telephone Number:

ext.

I-POC's Alternate Telephone Number:

ext.

I-POC's Fax Number:
I-POC's E-mail Address:
Name of Alternate I-POC (optional):

2-1.6.2

I-POC's Primary Telephone Number:

ext.

I-POC's Alternate Telephone Number:

ext.

I-POC's Fax Number:
I-POC's E-mail Address:

FORM 2-1 Schedule 2 Plant Site or Trading Company Identification
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
Submit this form for each declared Schedule 2 plant site,
Schedule 2 plant site or trading company. Declared Schedule
2 plant sites must submit this form for each type of declaration
or report (past activities, anticipated or additionally planned
activities, combined declaration and report, exports and
imports, and amended) and complete questions 2-1.1 through
2-1.5. In addition, declared plant sites subject to initial or
routine inspection must complete question 2-1.6. Schedule 2
undeclared plant sites and trading companies must report
exports and imports above the applicable threshold quantity
by completing only questions 2-1.1 through 2-1.3 for their past
reporting requirements.
Submitters should assign a unique name to the plant site or
trading company and record the name in the appropriate box in
the upper right-hand corner of Form 2-1. The Department of
Commerce will provide each submitter with a unique code.
This code, hereafter referred to as a “U.S. Plant Site or Trading
Company Code,” will be the primary means of identifying a
plant site or trading company after the first declaration or
report is submitted and the Department of Commerce assigns a
code. The submitters should use this code on all future
declarations or reports.
Questions 2-1.1 through 2-1.3: Provide the name and
telephone and fax numbers of the owner and the operator or

the occupant or the agent in charge of the plant site or trading
company. Provide the address of the plant site or trading
company. DO NOT PROVIDE A POST OFFICE BOX.
Questions 2-1.4: Provide the latitude and longitude for the
center of the plant site using the following formats (see
Supplement No. 1 for guidelines on determining geographic
coordinates):
Latitude:000(degree)/00(minute)/00(second)/N
Longitude: 000(degree)/00(minute)/00(second)/W
If the geographic coordinates are not for the center of the plant
site, you must attach to Form A an explanation of the
coordinates (e.g., front gate, Building No. 15). Also, use Form
A to identify any additional voluntary information (e.g., maps,
drawings) that you have attached to this declaration to locate
this plant site with reference to the declared coordinates.
Question 2-1.5: Identify the number of declared Schedule 3
plants, if any, within this declared Schedule 2 plant site.
Question 2-1.6: Designate an Inspection Point of Contact
(I-POC) and provide telephone and fax numbers, and an e-mail
address so the Department of Commerce may notify you of
inspections of your plant site. You may also designate an
Alternate I-POC. The Department of Commerce must be able
to contact the I-POCs on a 24 hour basis.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE NAME:

CWC SCHEDULE 2
PLANT DECLARATION

U.S. PLANT SITE CODE (once assigned):

FORM 2-2 DECLARATION ON SCHEDULE 2 PLANT
Submit this form for each declared Schedule 2 plant at the plant site. Use this for all declarations
(past activities, combined, anticipated or additionally planned activities, and amendments).
PLANT CODE (once assigned):

PLANT NAME:
Owner:

2-2.1

Fax Number:

Telephone Number:
Operator:

2-2.2
2-2.3

Fax Number:

Telephone Number:
Structure Name or Building Number:

Provide any additional information that will assist in identifying the location of this plant on the plant site.

2-2.4

Check this box if you have attached any additional information on the plant to Form A.
Provide the Product Group Codes to describe products at this plant (see Supplement No. 2).

2-2.5
2-2.6

Identify the declared Schedule 2 activities at this plant (check all that apply):
Production
Processing

Consumption

2-2.7

Identify whether the plant is:
Dedicated

Other (check one)

2-2.8

Multipurpose

Identify the other activity/ies performed at the plant relating to the declared Schedule 2 chemical(s):
Storage

Re-packaging, distribution

R & D (check all that apply)

Complete the following for each declared Schedule 2 chemical that was/will be produced, processed
or consumed at this plant.
a. Chemical Name:

b. CAS Registry No:

2-2.9.1

c. Production Capacity:

d. Calculation Method

___________ metric ton(s)/year
a. Chemical Name:

b. CAS Registry No:

c. Production Capacity:

Nameplate

d. Calculation Method

2-2.9.2

Nameplate

___________ metric ton(s)/year
a. Chemical Name:

b. CAS Registry No:

c. Production Capacity:

Design

Design

d. Calculation Method

2-2.9.3
Nameplate

___________ metric ton(s)/year
a. Chemical Name:

b. CAS Registry No:

c. Production Capacity:

Design

d. Calculation Method

2-2.9.4
___________ metric ton(s)/year

If additional pages of Form 2-2 for this plant are attached, indicate the total number of pages as follows:
page _________ of _________ (e.g., page x of y)

Nameplate

Design

FORM 2-2 Declaration of Schedule 2 Plant
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
Submit this form for each declared Schedule 2 plant at the plant site and
for each type of declaration (e.g., past activities, anticipated or
additionally planned activities, and amended).
Note: Submitters that only have reporting requirements for
exports or imports of a Schedule 2 chemical are not required to
submit this form.
For the ANNUAL DECLARATION ON PAST ACTIVITIES, you
must review your plant’s records for the three previous years to
determine if in any one of those years it produced, processed
or consumed a Schedule 2 chemical above the applicable
threshold. If a plant exceeded the applicable threshold in any
one of those years, you have a declaration requirement for the
previous year, even if it produced, processed or consumed the
Schedule 2 chemical below the applicable threshold in that
year. See the EXAMPLE in the instructions for Form 2-3.
For the ANNUAL DECLARATION ON ANTICIPATED
ACTIVITIES, you must declare if you anticipate a plant will
produce, process or consume a Schedule 2 chemical above the
applicable threshold in the next calendar year. You must also
complete Form 2-3.
Submitters should assign a unique name to the plant at the plant site.
Record the plant and plant site names in the appropriate boxes in the
upper-right hand corner of Form 2-2. The Department of Commerce
will provide each submitter with a unique code for each declared plant
and plant site. These codes, “U.S. Plant Code” and “U.S. Plant Site
Code,” will be the primary means of identifying both a plant and plant
site after the first declaration is submitted and the Department of
Commerce has assigned the codes. Submitters should use these
codes on all future declarations for a particular plant or plant site.
Questions 2-2.1 through 2-2.3: Provide the name and
telephone and fax numbers of the owner and the operator or
the occupant or the agent in charge of the plant. Provide the
building name or structure number, if any, used to designate
the plant.
Question 2-2.4: Provide any additional voluntary information
that will assist in identifying the location of this plant on the
plant site (e.g., latitude and longitude, street address,
landmarks).
Use Form A to identify any additional information (e.g., site diagrams,
maps, drawings) that you are attaching to this declaration to locate this
plant with reference to the declared coordinates. (Check the
box if you are submitting an attachment to Form A.)
Question 2-2.5: For the main activities at your plant, provide

one or more product group code(s) (Standard International
Trade Classification (SITC) code) that describes the type of
ultimate products manufactured at the plant.
Question 2-2.6: Check the activity or activities for which this
plant is declared. You should only check those activities for
which this plant has exceeded the applicable declaration
threshold. (Declaration thresholds for Schedule 2 chemicals
are listed in 15 CFR Part 713).
Question 2-2.7: Check the appropriate box to indicate whether
the plant is dedicated to the declared Schedule 2 activity/ies
(as listed in question 2-2.6) or is multipurpose, or is an “other”
type of plant. See Supplement No. 4 (Glossary of Terms) for
the definition of dedicated and multipurpose.
Question 2-2.8: Check the appropriate box/es to idenfify other
activities (storage, repackaging and/or distribution; R&D)
that are performed at the plant in relation to the declared
Schedule 2 chemicals.
Question 2-2.9: Provide this information for each Schedule 2
chemical produced, processed or consumed or anticipated to
be produced, processed or consumed at this plant over the
applicable threshold. For each Schedule 2 chemical, provide
the name of the chemical, and the CAS Registry Number. For
those Schedule 2 chemicals that you produce, provide the
production capacity and the calculation method in questions
2-2.8.X(c) and (d).
(See the definition of “production
capacity” noted below.) Round the production capacity to the
nearest metric ton.
If you processed or consumed the
Schedule 2 chemical, do not complete questions 2-2.8.X(c) or
(d).
Production capacity is defined as the annual quantitative potential for
manufacturing a specific chemical based on the technological process
actually used at the relevant plant. The capacity shall be deemed to be
equal to the nameplate capacity or, if the nameplate capacity is not
available, to the design capacity. For the purpose of Question
2-2.8, nameplate capacity is the product output under
conditions optimized for maximum quantity for the production
facility, as demonstrated by one or more test runs and design
capacity is the corresponding theoretically calculated product
output, without test data or other supportive plant specific
information. The production capacity of a multipurpose plant
producing one Schedule 2 chemical along with other
chemicals is calculated by assuming that the plant would be
used solely for the production of that Schedule 2 chemical
over a period of one year.
If there is an insufficient number of blocks to record all of your
chemicals, use additional copies of Form 2-2. Indicate the
page number of each additional page and total number of
pages of Form 2-2.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE NAME:

CWC SCHEDULE 2
CHEMICAL DECLARATION

U.S. PLANT SITE CODE (once assigned):

FORM 2-3 DECLARATION ON SCHEDULE 2 CHEMICAL
Submit this form to provide information on each declared Schedule 2 chemical. Use this form for all
declarations (past activities, combined, anticipated or additionally planned activities, and amendments).
CAS REGISTRY NO.:

COMMON OR TRADE NAME(S):

CHEMICAL NAME:

Check this box if you have attached a structural formula for this chemical to Form A.
INSERT THE YEAR TO WHICH THE DECLARATION APPLIES (YYYY):
Provide the amount of the Schedule 2 chemical that was/will be produced, processed, and/or consumed by
declared plants on the plant site (check all that apply).

2-3.1
2-3.2
2-3.3

Produced

If produced, specify quantity (check one box): _________

kilograms

metric tons

Processed

If processed, specify quantity (check one box): _________

kilograms

metric tons

Consumed

If consumed, specify quantity (check one box): _________

kilograms

metric tons

Identify in questions 2-3.4 through 2-3.6 the purposes for which the Schedule 2 chemical was/will be produced,
processed, and/or consumed.
Provide the Product Group Codes for chemicals processed
and/or consumed at the plant site (see Supplement No. 2).

2-3.4

2-3.5

Sales or transfers of the chemical above the
applicable threshold quantity within the United
States? (If yes, submit Form 2-3A.)

YES

NO

Identify the other purposes for which the declared chemical was/will be produced, processed or consumed (check all that apply):

2-3.6

Was/will be produced, processed or consumed:

Storage

Re-packaging, distribution

R&D

Complete Questions 2-3.7 and 2-3.8 only for the Annual Declaration on Past Activities and the
Combined Annual Declaration and Report
a. Has the chemical been directly exported by the plant site above the applicable threshold quantity? (If yes, submit Form 2-3B.)

YES

2-3.7

NO

b.Total Quantity exported: ____________ metric tons
c. Identify the destinations to which the chemical was exported (see Supplement No. 3).

a. Has the chemical been directly imported by the plant site above the applicable threshold quantity? (If yes, submit Form 2-3B.)

2-3.8

YES

NO

b.Total Quantity imported: ____________ metric tons

Complete Question 2-3.9 only for the Annual Declaration on Anticipated Activities and the
Declaration on Additionally Planned Activities
a. Will the chemical be directly exported by the plant site above the applicable threshold quantity in the next calendar year?

YES

2-3.9

NO

If yes, identify the countries to which the chemical will be exported (see Supplement No. 3).

FORM 2-3 Declaration of Schedule 2 Chemical
Declaration and reporting requirements are set forth in Part 713 of the
CWC Regulations (15 CFR 713).
Submit this form for each Schedule 2 chemical that was or will be
produced, processed or consumed above the applicable threshold at the
plant site. Use this form for all types of declarations (past activities,
anticipated or additionally planned activities, and amended). If you
check "Yes" in questions 2-3.7 and/or 2-3.8, you must also complete
Form 2-3B.
For the ANNUAL DECLARATION ON PAST ACTIVITIES, you must
review your records for the three previous years to determine if in any
one of those years one or more plants on your plant site produced,
processed, or consumed a Schedule 2 chemical above the declaration
threshold. If your plant site exceeded the applicable threshold in one or
more of those three years, you have a declaration requirement for the
past year and you must complete this form.
Example: For the ANNUAL DECLARATION ON PAST
ACTIVITIES during 2004, you must review your records for 2004,
2003, and 2002 to determine if in any of those three years you
produced, processed or consumed a Schedule 2 chemical above the
applicable threshold. In 2004 you produced chemical X below the
applicable threshold; in 2003, you produced chemical X above
threshold, and in 2002 you produced chemical X below threshold.
You must declare a production figure for 2004 because you
produced chemical X above the applicable threshold in 2003. If
you did not produce above the applicable threshold in 2004, you
enter "0" as your production figure.
You must also follow the same steps above to determine if you have a
declaration requirement for processing and/or consumption of that
Schedule 2 chemical. If you were below the threshold for the Schedule 2
chemical for all three years for all three activities, you do not have a
declaration requirement. Do not complete Question 2-3.9.
For the ANNUAL DECLARATION ON ANTICIPATED ACTIVITIES,
you must declare if you anticipate you will produce, process, or consume
a Schedule 2 chemical above the applicable threshold. You must
complete this form, except for questions 2-3.7 and 2-3.8.
In addition to declaring production, processing or consumption of a
specific Schedule 2 chemical, this form requires you to indicate exports
from or imports to your plant site above the applicable declaration
threshold for that same Schedule 2 chemical. Note that to determine
whether exports from or imports to your plant site exceeded the
applicable threshold quantities, you must aggregate all exports from or
imports to the entire plant site (e.g., you would aggregate exports of this
Schedule 2 chemical from all plants on the plant site, not only from
plants declared because of production, processing, or consumption). If
your plant site does have declaration requirements for exports and/or
imports of this Schedule 2 chemical, you will check the appropriate
"YES" box in question 2-3.7 (exports) or 2-3.8 (imports) and you will
also complete Form 2-3B to provide additional information on the
quantity exported to recipient countries or quantities imported from
source countries.
In the upper right-hand corner of this form, enter the Plant Site Name
or the U.S. Plant Site Code (once assigned) that you entered on
Form 2-1 (Schedule 2 Plant Site or Trading Company Identification).
For each Schedule 2 chemical being declared, provide the CAS Registry
number, if assigned, Chemical Name and Common or Trade Name. If
the chemical is not specifically listed by Chemical Name and CAS
Registry Number in Supplement No. 1 to Part 713 of the CWC

Regulation (15 CFR 713), you must attach the structural formula of the
chemical to Form A. Check the box to indicate that you have attached
the structural formula. Insert the calendar year for which the
declaration or report applies (i.e., YYYY).
Question 2-3.1: For each Schedule 2 chemical, add the production
amount from each declared plant whose production was above the
applicable threshold and declare the total production of that Schedule 2
chemical for the plant site.
Question 2-3.2: For each Schedule 2 chemical, add the processing
amount from each declared plant whose processing was above the
applicable threshold and report the total processing of that Schedule 2
chemical for the plant site.
Question 2-3.3: For each Schedule 2 chemical, add the consumption
amount from each declared plant whose consumption was above the
applicable threshold and report the total consumption of that Schedule
2 chemical for the plant site.
For the chemical BZ, you should report all quantities to the nearest
tenth of a kilogram (e.g., 0.x kg). For the chemical PFIB and the
Amiton family, you should report all quantities to the nearest kilogram
or thousandth of a metric ton (e.g., x.00 kg or 0.00x metric tons). For
all other Schedule 2 chemicals, you should report quantities to the
nearest ten kilograms or hundredth of a metric ton (e.g., x0.0 kg, or
0.0x metric tons).
Note to Questions 2-3.1 through 2-3.2: For the Annual Declaration on
Past Activities, enter “zero” if you did not exceed the applicable
threshold for a declared activity (production, processing, or
consumption). For the Annual Declaration on Anticipated Activities,
you are not required to submit a “zero” or null declaration. See section
713 of the CWCR.
Question 2-3.4: Identify the Product Group Codes for which the
Schedule 2 chemical was or will be processed and/or consumed by
using the Standard International Trade Classification Codes (SITC
Code) in Supplement No. 2. Provide up to five chemical Product Group
Codes that contain the largest percentage of the Schedule 2 chemical.
Declaration thresholds do not apply.
Question 2-3.5: For each Schedule 2 chemical, add the quantities of sales
and transfers that have occurred or will occur within the United States.
If the sum exceeds the applicable threshold, then answer “yes” and
submit Form 2-3A. If the sum does not exceed the applicable threshold,
answer “no.”
Question 2-3.6: Check the appropriate box(es) if the Schedule 2
chemical was or will be produced, processed or consumed for any of the
listed “other purposes.”
Questions 2-3.7 and 2-3.8: If the exports from (question 2-3.7) or
imports to (questions 2-3.8) the declared and undeclared plants on the
plant site exceed the declaration threshold, answer “yes,” specify the
quantity involved, and submit Form 2-3B. If the exports or imports do
not exceed the applicable threshold, answer “no.”
Enter the
Destination Codes using Supplement No. 3.
Question 2-3.9: If you anticipate the sum of exports will be more than
the applicable Schedule 2 chemical declaration threshold during the next
year, check the “yes” box and specify the destinations to which you
may export. Enter the Destination Codes using Supplement No. 3. If
you do not anticipate the sum of your exports will exceed the
declaration threshold, check the “no” box.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE NAME:

CWC SCHEDULE 2
ON DOMESTIC SALES
OR TRANSFERS

U.S. PLANT SITE CODE (once assigned):

FORM 2-3A DECLARATION ON SCHEDULE 2 CHEMICAL SOLD OR TRANSFERRED
FROM THE PLANT SITE IN THE UNITED STATES
INSERT THE YEAR TO WHICH THE DECLARATION APPLIES (YYYY):
Submit this form to identify the destination types (i.e., other industry, trader or other destination) for
each Schedule 2 chemical sold or transferred within the United States.
CAS REGISTRY NO:

CHEMICAL NAME:

Identify the destination type for the Schedule 2 chemical that was/will be sold/transferred (check all that apply).

2-3A.1

Other Industry

Trader

Other Destination

Provide the Product Group Codes (see SITC Codes in Supplement No. 2).

CAS REGISTRY NO:

CHEMICAL NAME:

Identify the destination type for the Schedule 2 chemical that was/will be sold/transferred (check all that apply).

2-3A.2

Other Industry

Trader

Other Destination

Provide the Product Group Codes (see SITC Codes in Supplement No. 2).

CAS REGISTRY NO:

CHEMICAL NAME:

Identify the destination type for the Schedule 2 chemical that was/will be sold/transferred (check all that apply).

2-3A.3

Other Industry

Trader

Other Destination

Provide the Product Group Codes (see SITC Codes in Supplement No. 2).

CAS REGISTRY NO:

CHEMICAL NAME:

Identify the destination type for the Schedule 2 chemical that was/will be sold/transferred (check all that apply).

2-3A.4

Other Industry

Trader

Other Destination

Provide the Product Group Codes (see SITC Codes in Supplement No. 2).

If additional pages of Form 2-3A for this Plant Site are attached, indicate the total number of pages as follows:
page _________ of _________ (e.g., page x of y)

FORM 2-3A Declaration of Schedule 2 Chemical Sold or Transferred
from the Plant Site in the United States
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
Submit this form to identify each Schedule 2 chemical
declared on Form 2-3, question 2-3.5, that was or will be sold
and/or transferred domestically. This information pertains to
Schedule 2 chemicals that were or will be produced,
processed or consumed at the plant site.
For the ANNUAL DECLARATION ON PAST ACTIVITIES,
review your records for the previous three years to determine
if in any of these years you sold or transferred domestically
the Schedule 2 chemical above the applicable threshold. If
you did sell or transfer a chemical above the threshold, you
must submit this form.
For the ANNUAL DECLARATION ON ANTICIPATED
ACTIVITIES, submit this form if you anticipate you will sell
or transfer domestically the Schedule 2 chemical above the
applicable threshold in the next year.
In the upper right-hand corner of this form, enter the Plant Site
Name or the U.S. Plant Site Code (once assigned) that you
entered on Form 2-1 (Schedule 2 Plant Site or Trading
Company Identification).

Question 2-3A.x: Provide the CAS Registry Number, if
assigned, and the Chemical Name in the appropriate space on
the form for each chemical.
Identify the destination type for each chemical sold and/or
domestically transferred. The destination types include
Other Industry which may be another plant site owned by
your company or another manufacturing company. Trader
includes distributors and shippers, including companies
engaged in international trade. Other Destinations include
waste treatment or recycling facilities or other miscellaneous facilities.
Specify the SITC Code for up to five chemical product groups
that contain the largest percentage of the Schedule 2
chemical. The SITC Codes are listed in Supplement No. 2.
If there is an insufficient number of blocks to record all of
your domestic transfers, use additional copies of Form 2-3A.
Indicate the page number of each additional page and total
number of pages of Form 2-3A that are included in this
submission using the format “page x of y” (as described at the
bottom of Form 2-3A).

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE OR TRADING COMPANY NAME:

CWC SCHEDULE 2
DECLARATION OR REPORT

U.S. PLANT SITE OR TRADING COMPANY CODE
(once assigned):

FORM 2-3B EXPORTS AND IMPORTS OF SCHEDULE 2 CHEMICAL
Submit this form for each Schedule 2 chemical exported and/or imported above the applicable
threshold.
CAS REGISTRY NO.:

CHEMICAL NAME:

Check this box if you have attached a structural formula for this chemical to Form A.

INSERT THE YEAR TO WHICH THE DECLARATION OR REPORT APPLIES (YYYY):

Import

Export
a. Quantity exported:

2-3B.1.1

b. Recipient Destination (use Destination
Codes in Supplement No. 3):
a. Quantity exported:

2-3B.1.2

kilograms
metric tons

2-3B.2.1

kilograms
metric tons

b. Recipient Destination (use Destination
Codes in Supplement No. 3):
a. Quantity exported:

a. Quantity imported:

b. Source Destination (use Destination
Codes in Supplement No. 3):
a. Quantity imported:

2-3B.2.2

kilograms

b. Recipient Destination (use Destination
Codes in Supplement No. 3):
a. Quantity exported:

2-3B.1.4

a. Quantity imported:

a. Quantity exported:

2-3B.1.5

b. Source Destination (use Destination
Codes in Supplement No. 3):
a. Quantity imported:

2-3B.2.4

kilograms
metric tons

b. Recipient Destination (use Destination
Codes in Supplement No. 3):

kilograms
metric tons

2-3B.2.3

kilograms
metric tons

b. Recipient Destination (use Destination
Codes in Supplement No. 3):

kilograms
metric tons

b. Source Destination (use Destination
Codes in Supplement No. 3):

metric tons

2-3B.1.3

kilograms
metric tons

b. Source Destination (use Destination
Codes in Supplement No. 3):
a. Quantity imported:

2-3B.2.5

kilograms
metric tons

kilograms
metric tons

b. Source Destination (use Destination
Codes in Supplement No. 3):

If additional pages of Form 2-3B for this chemical are attached, indicate the total number of pages as follows:
page _______ of _______ (e.g., page x of y)

FORM 2-3B Exports and Imports of a Schedule 2 Chemical
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
All plant sites and trading companies that have exported and/or
imported a Schedule 2 chemical above the applicable threshold in the
previous calendar year must submit this form. Use this form for all
types of declarations or reports: past activities, combined
declaration and report, exports and imports, and amended.
You do not use this form to declare exports as part of your
Annual Declaration on Anticipated Activities.
You have a declaration or reporting requirement if the total exports
from or imports to your entire plant site (not individual declared plants)
or your trading company exceeded the applicable threshold for the
Schedule 2 chemical.
If your plant site has declared a specific Schedule 2 chemical for
production, processing or consumption reasons, and has also checked
“Yes” in questions 2-3.7 and/or 2-3.8 on Form 2-3, then you must
submit this form as part of your ANNUAL DECLARATION
ON PAST ACTIVITIES.
If your plant site has not declared a specific Schedule 2 chemical for
production, processing or consumption, but has exported or
imported a Schedule 2 chemical above the applicable
declaration threshold, you must submit this form as part of
your ANNUAL REPORT ON EXPORTS AND IMPORTS. If
your trading company has exported or imported a Schedule 2
chemical above the applicable declaration threshold, you must
submit this form as part of your INITIAL REPORT ANNUAL
REPORT ON EXPORTS AND IMPORTS.
Plant Sites declaring a specific Schedule 2 chemical:
ANNUAL DECLARATION ON PAST ACTIVITIES. If your
plant site has a declaration requirement for the past production,
processing or consumption of a Schedule 2 chemical and has also
exported and/or imported that Schedule 2 chemical above the
applicable threshold in the previous calendar year, you must also
complete this form.
NOTE: A plant site that is declared because of the production,
processing or consumption of one Schedule 2 chemical may also have
a reporting requirement for exports or imports of another Schedule 2
chemical that it did not produce, process or consume over the
applicable declaration threshold.

Plant Sites that have not declared a specific Schedule 2 chemical for
production, processing or consumption and all Trading
Companies:
If your plant site does not have an ANNUAL DECLARATION
ON PAST ACTIVITIES for a Schedule 2 chemical, but your
entire plant site exported or imported that Schedule 2 chemical
above the applicable threshold in the previous calendar year,
you must submit an ANNUAL REPORT ON EXPORTS AND
IMPORTS on this form. If your trading company exported or
imported a Schedule 2 chemical above the applicable
threshold in the previous calendar year, you must submit an
ANNUAL REPORT ON EXPORTS AND IMPORTS on this
form.
In the upper right-hand corner of this form, enter a Plant Site or
Trading Company Name, and/or the U.S. Plant Site or Trading
Company Code (once assigned) that you entered on Form 2-1
(Schedule 2 Plant Site or Trading Company Identification).
For each exported or imported Schedule 2 chemical being declared
or reported, provide the CAS Registry Number, if assigned, and the
Chemical Name. If the chemical is not specifically listed by Chemical
Name and CAS Registry Number in Supplement No. 1 to part 713
of the CWC Regulation (15 CFR 713), you must attach the structural
formula of the chemical to Form A. Check the box to indicate that you
have attached the structural formula.
Questions 2-3B.1 and 2-3B.2: Use a separate form 2-3B for each
Schedule 2 chemical. Total the annual exports to each
destination and total the annual imports from each
destination. Use a separate block in Question 2-3B.1 and 23B.2 to indicate the quantities exported to each recipient
destination and the quantities imported from each source
destination. Report the specific quantity exported to or
imported from a particular destination and round to the nearest
0.1 metric tons. (Use Supplement No. 3 to identify the
Destination Code.)
If additional spaces are needed to report all declarable or
reportable export and/or import transactions, use additional
copies of this form. Number the pages as shown on the
bottom of the form.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)
PLANT SITE NAME:

CWC SCHEDULE 2
DECLARATION

U.S. PLANT SITE CODE (once assigned):

FORM 2-3C DECLARATION ON ANTICIPATED OR ADDITIONALLY PLANNED
ACTIVITIES OF SCHEDULE 2 CHEMICAL
Submit this form for each Schedule 2 chemical that will be produced, processed or consumed above the
applicable threshold at the plant site during the next calendar year.
CAS REGISTRY NO:

CHEMICAL NAME:

Production
Provide the total quantity anticipated to be
produced during the next calendar year:

kilograms

metric tons

Provide the time period(s) during which the anticipated production will occur:

2-3C.1

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

Starting Date (YYYY-MM):
Starting Date (YYYY-MM):

Ending Date (YYYY-MM):
Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):
Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Processing

2-3C.2

Provide the total quantity anticipated to be
kilograms
metric tons
processed during the next calendar year:
Provide the time period(s) during which the anticipated processing will occur:
Ending Date (YYYY-MM):
Starting Date (YYYY-MM):
Starting Date (YYYY-MM):
Ending Date (YYYY-MM):
Starting Date (YYYY-MM):
Starting Date (YYYY-MM):

Ending Date (YYYY-MM):
Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):
Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Consumption
Provide the total quantity anticipated to be
consumed during the next calendar year:

kilograms

metric tons

Provide the time period(s) during which the anticipated consumption will occur:

2-3C.3

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):
Ending Date (YYYY-MM):

Starting Date (YYYY-MM):
Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

Starting Date (YYYY-MM):

Ending Date (YYYY-MM):

FORM 2-3C Declaration of Anticipated or Additionally Planned Activities for Schedule 2 Chemical
Declaration and reporting requirements are set forth in Part 713
of the CWC Regulations (15 CFR 713).
Submit this form as part of your ANNUAL DECLARATION
ON ANTICIPATED ACTIVITIES if you anticipate that one or
more plants on your plant site will produce, process or
consume a Schedule 2 chemical above the applicable
threshold in the next calendar year. You must also submit this
form if, after you have submitted the ANNUAL
DECLARATION ON ANTICIPATED ACTIVITIES, you have
any additionally planned activities at the plant site.
In the upper right-hand corner of this form, enter a Plant Site
Name, and/or the U.S. Plant Site Code (once assigned) that
you entered on Form 2-1 (Schedule 2 Plant Site or Trading
Company Identification).
For each Schedule 2 chemical being declared, provide the CAS
Registry Number, if assigned, and the Chemical Name.
Question 2-3C.1 through 3. For anticipated activities and
additionally planned activities, determine the activities
(production, processing and/or consumption) on the plant site
involving the declared Schedule 2 chemical that will occur in
the next calendar year.
Check the appropriate box(es) to indicate the anticipated
activity (production, processing and/or consumption) for the
Schedule 2 chemical during the next calendar year. Provide the
total aggregate quantity anticipated for each activity
(production, processing and/or consumption) during the next
calendar year. To determine the total quantity for the Schedule
2 chemical for each activity (production, processing and/or
consumption), aggregate the amounts of the Schedule 2
chemical for the activity for each plant declared for the activity.
Enter the approximate starting and ending dates (i.e., YYYYMM) for each period during which the activity (production,
processing and/or consumption) is anticipated to occur on the
plant site during the next calendar year.
NOTE: For the chemical BZ, you should declare all quantities
to the nearest tenth of a kilogram (e.g., 0.x kg). For the chemical

PFIB and the Amiton family, you should declare all quantities
to the nearest kilogram or thousandth of a metric ton (e.g., x.00
kg or 0.00x metric tons). For all other Schedule 2 chemicals you
should declare quantities to the nearest ten kilograms or
hundreth of a metric ton (e.g., x0.0 kg, or 0.0x metric tons).
After you have submitted the ANNUAL DECLARATION ON
ANTICIPATED ACTIVITIES, you must submit a
DECLARATION ON ADDITIONALLY PLANNED
ACTIVITIES for additionally planned production, processing,
and/or consumption of a Schedule 2 chemical if:
(1) You plan that a previously undeclared plant on your
plant site will produce, process, or consume a Schedule
2 chemical above the applicable declaration threshold;
(2) You plan to produce, process, or consume at a declared
plant an additional Schedule 2 chemical above the
applicable declaration threshold;
(3) You plan an additional activity (production, processing,
or consumption) at your declared plant above the
applicable declaration threshold for a previously
declared chemical;
(4) You plan to increase the production, processing, or
consumption of a Schedule 2 chemical by a declared
plant from the amount exceeding the applicable
declaration threshold to an amount exceeding the
applicable inspection threshold;
(5) You plan to change the starting or ending date of
previously declared anticipated production, processing,
or consumption by more than three months; or
(6) You plan to increase the production, processing, or
consumption of a Schedule 2 chemical by a declared
plant site by 20 percent or more of the originally
declared amount.
This declaration must be submitted no later than 15 days
before the commencement of the additionally planned
activities.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)

COMPLETE AS MANY COPIES OF THIS FORM AS NECESSARY.

CWC SCHEDULE 2
FORM A

Use this form to describe any attachment to this declaration or report.
Attachments may include, for example, any additional information on the
precise location of a declared plant site, site map, chemical structural formula.

FORM A ATTACHMENTS FOR SCHEDULE 2 PLANT SITE
OR TRADING COMPANY
Plant Name

Form Number

Plant Site or Trading Company Name:

Identify each attachment with a unique name or description.

FORM A Attachments for Schedule 2 Plant Site or Trading Company
Declaration and reporting requirements are set forth in Part 713 of the CWC Regulations (15 CFR 713).
Submit this form to list any attachments containing additional information (e.g., site diagrams, maps, drawings, chemical
structural formulas).
PLANT SITE OR TRADING COMPANY NAME: Enter the name of the plant site or trading company, and if assigned, enter its
U.S. Plant Site or Trading Company Code.
PLANT NAME: If providing information on a plant, enter in column 1, the name of the plant, and once assigned, enter its U.S.
Plant Code.
FORM NUMBER: In column 2, enter the form number to which this additional information refers.
IDENTIFY ATTACHMENT: In column 3, provide a description of the attachment and assign a unique name to it (e.g., site map).
For structural formulas, provide the CAS Registry Number, if assigned, chemical name and/or common trade name.
Insert all attachments in an envelope and staple the envelope to Form A.

FORM APPROVED: OMB NO. 0694-0091 (JAN-2004)

CWC SCHEDULE 2
FORM B
FORM B OPTIONAL COMMENTS
Comments on form number ____________, question number ______________:

B.1.1

Comments on form number ____________, question number ______________:

B.1.2

Comments on form number ____________, question number ______________:

B.1.3

Comments on form number ____________, question number ______________:

B.1.4

Comments on form number ____________, question number ______________:

B.1.5
Comments on form number ____________, question number ______________:

B.1.6

General comments or suggestions:

B.2.1

FORM B Optional Comments
Declaration and reporting requirements are set forth in Part 713 of the CWC Regulations (15 CFR 713).
Please use this form to record comments or suggestions. Use as many copies of this form as necessary. Submission of this
form is optional, and the information provided will be used only by the Department of Commerce to improve the forms and the
CWC reporting process.