CWC UDOC Declarations and Reports

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

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

DATE RECEIVED
(Leave Blank)

CWC UNSCHEDULED
DISCRETE ORGANIC
CHEMICAL
DECLARATION
CERTIFICATION FORM
Provide the information requested below in Questions C.1 through C.8.
C.1

Name of Declaration Point of Contact (D-POC):

C.2

Company Name:

C.3

Mailing Address:
State:

City:
D-POC's Telephone Number:

C.4

Zip Code:
ext.

D-POC's Fax Number:
D-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(check one box, except check two boxes for an amendment)
ANNUAL DECLARATION ON PAST ACTIVITIES (YYYY): _________

C.7
AMENDMENT

C.8

FORMS SUBMITTED
Check all forms that are included:
FORM UDOC

FORM A

FORM B

CERTIFICATION FORM Unscheduled Discrete Organic Chemical Declaration
Declaration requirements are set forth in Part 715 of the CWC
Regulations (15 CFR 715).
A separate Certification Form is required for each
Unscheduled Discrete Organic Chemical (UDOC) plant site
being declared.
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 submitted; and
(d) listing the declaration forms submitted.
Questions C.1 through C.5 Name of Declaration Point of
Contact (D-POC) and Other Requested Information: Designate a D-POC. The D-POC should be a person whom the
Department of Commerce may contact for: (1) the purposes of
clarification of information provided in the declaration; and (2)
for general information. The D-POC need not be the person
who prepares the declaration forms or signs the Certification
Form. Furthermore, it is not necessary that the D-POC be
located at the declared plant sites.

Question C.6 Certification: The Certification must be signed
and dated 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 Declaration Type: Check the box for the type of
declaration being submitted (e.g. past activities or amendment) and indicate the year for which the information applies.
The DECLARATION ON PAST ACTIVITIES provides
information on the production of UDOCs by a declared
UDOC plant site for the previous year.
The AMENDMENT is used to correct a previously submitted
Annual Declaration on Past Activities or a UDOC “No Changes”
Certification Form (e.g., change company name, increase of
production into a higher range; addition of a new PSF chemical
produced above 30 metric tons at a PSF plant not previously
declared). If you submit an AMENDMENT, indicate the year
to which the AMENDMENT refers.
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:

CWC UNSCHEDULED
DISCRETE ORGANIC CHEMICAL
DECLARATION

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

PAGE 1 OF 2
FORM UDOC UNSCHEDULED DISCRETE ORGANIC CHEMICAL DECLARATION
Submit this form for each Unscheduled Discrete Organic Chemical Production Plant Site for all
types of declarations (past activities and amendments).

PART A: Plant Site Identification
UDOC.1

Owner:
Fax Number:

Telephone Number:

UDOC.2
UDOC.3

Operator:
Fax Number:

Telephone Number:
Street Address:
City:

State:

Zip Code:

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

UDOC.4

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

Check this box if the geographic coordinates are not for the center of the plant site and/or you have attached any additional
information on the plant site to Form A.
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:
I-POC's Primary Telephone Number:

UDOC.5.1 I-POC's Alternate Telephone Number:

ext.
ext.

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

UDOC.5.2 I-POC's Alternate Telephone Number:
I-POC's Fax Number:
I-POC's E-mail Address:

ext.
ext.

FORM UDOC Unscheduled Discrete Organic Chemical Declaration
Declaration requirements are set forth in Part 715 of the CWC
Regulations (15 CFR 715).
Submit this form (which consists of 2 pages -- Part A - Plant
Site Identification and Part B - Plant Site Activities) for each
declared unscheduled discrete organic chemical (UDOC)
plant site, and for all types of declarations (past activities and
amendments). Your plant site is a declared UDOC plant site if
it produced more than 200 metric tons aggregate of UDOCs
(including all PSF-chemicals). For purposes of calculating the
200 metric ton amount, you must include all PSF chemicals that
were produced on your plant site. Your plant site is also a
declared plant site if one or more plants on your plant site
individually produced more than 30 metric tons of a single
UDOC containing phosphorus, sulfur, or fluorine ("PSFchemical"). Only declared plant sites subject to routine
inspection must complete Question UDOC.5.
For the ANNUAL DECLARATION ON PAST ACTIVITIES,
submit this form for each UDOC plant site that produced
above the applicable threshold in the previous calendar year.
The submitter of this declaration should assign a unique name
to the plant site, and record this name in the appropriate box
in the upper right-hand corner of Form UDOC, Parts A and B.
The Department of Commerce will provide each submitter a
unique code for each declared plant site. This code, hereafter
referred to as a "U.S. Plant Site Code," will be the primary
means of identifying a plant site after the first declaration is
submitted and the Department of Commerce assigns a code.
The submitter should use this code on all future declarations
for a particular plant site.

PART A - PLANT SITE IDENTIFICATION
Questions UDOC.1 through UDOC.3: Provide the name and
telephone and fax numbers of the owner and the operator the
occupant or the agent in charge of the plant site. Provide the
address of the plant site. DO NOT PROVIDE A POST
OFFICE BOX.
Question UDOC.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:
Longitude:

000(degree)/00(minute)/00(second)/N
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 information (e.g., maps, drawings)
that you have attached to this declaration to locate this plant
site with reference to the declared coordinates. (Check the box
if you are submitting Form A with attachments.)
Questions UDOC.5.1 & UDOC.5.2: 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 UNSCHEDULED
DISCRETE ORGANIC CHEMICAL
DECLARATION

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

PAGE 2 of 2
FORM UDOC UNSCHEDULED DISCRETE ORGANIC CHEMICAL DECLARATION
PART B: Plant Site Activities
Specify the main activities at this plant site.
UDOC.6

UDOC.7

Provide the Product Group Codes to describe products at this plant site to which the production of
Unscheduled Discrete Organic Chemicals contribute (see Supplement No. 2)

If the plant site produced more than 200 metric tons of Unscheduled Discrete Organic Chemicals,
provide the approximate number of plants that produced any amount of Unscheduled Discrete Organic
Chemicals (including all PSF chemicals): ____________
Indicate the approximate aggregate amount of production (by production range) of Unscheduled
Discrete Organic Chemicals produced by all plants at the plant site (including all PSF chemicals).

UDOC.8

above 200 metric tons to 1,000 metric tons
above 1,000 metric tons to 10,000 metric tons
above 10,000 metric tons

Answer UDOC.9 and UDOC.10 below, if at least one plant on the plant site produced an "individual" PSF chemical
over 30 metric tons.

UDOC.9

Provide the exact number of plants at this plant site that produced an "individual" PSF chemical
over 30 metric tons ("PSF" Plant): ________

UDOC.10

Indicate in UDOC.10.1 through UDOC.10.4 below, the number of PSF plants whose approximate
aggregate production of all PSF chemicals falls within each of the PSF-chemical production ranges.
NOTE: The total number of PSF plants identified in UDOC.10.1 through UDOC.10.4 should
equal the number of PSF plants indicated in UDOC.9.

UDOC.10.1 Number of PSF plants that produced above 30 metric tons to 200 metric tons:

_____________

UDOC.10.2 Number of PSF plants that produced above 200 metric tons to 1,000 metric tons:

_____________

UDOC.10.3 Number of PSF plants that produced above 1,000 metric tons to 10,000 metric tons: _____________
UDOC.10.4 Number of PSF plants that produced above 10,000 metric tons:

_____________

FORM UDOC Unscheduled Discrete Organic Chemical Declaration (Continued)
Declaration requirements are set forth in Part 715 of the CWC
Regulations (15 CFR 715).
The submitter of this declaration should assign a unique name
to the plant site, and record this name in the appropriate box
in the upper right-hand corner of Form UDOC, Parts A and B.
The Department of Commerce will provide each submitter
with a unique code for each declared plant site. This code,
hereafter referred to as a "U.S. Plant Site Code," will be the
primary means of identifying a plant site after the first
declaration is submitted and the Department of Commerce
assigns a code. The submitter should use this code on all
future declarations for a particular plant site.
PART B - PLANT SITE ACTIVITIES
Question UDOC.6: Provide the appropriate Standard International Trade Classification (SITC) Code for up to five
chemical product group categories that describe the type of
ultimate products that are manufactured at the plant site to
which the production of UDOCs contribute (see Supplement
No. 2 for the SITC Codes).
Question UDOC.7: If your plant site produced more than 200
metric tons aggregate of unscheduled discrete organic

chemicals (UDOCs) in the previous calendar year, provide the
approximate number of plants that produced any amount of
UDOCs (including all PSF-chemicals).
Question UDOC.8: Check the appropriate box to indicate the
approximate aggregate amount of production of all UDOCs
(including all PSF-chemicals) produced at this plant site in the
previous calendar year.
Question UDOC.9: Provide the exact number of plants that
produced an individual PSF-chemical over 30 metric tons at
this plant site in the previous calendar year. An individual
plant that produced more than 30 metric tons of a single PSFchemical is a "PSF plant." Do not include plants that produced
less than 30 metric tons of a PSF chemical.
Question UDOC.10: If one or more plants on the plant site
produced an individual PSF chemical above 30 metric tons,
provide the number of PSF plants whose approximate
aggregate production of PSF-chemicals falls within each of the
PSF-chemical production ranges in the previous calendar
year. NOTE: The total number of PSF plants identified in
Question UDOC 10.1 through 10.4 should equal the number of
PSF plants indicated in Question UDOC.9.

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

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

DATE RECEIVED
(Leave Blank)

CWC UNSCHEDULED
DISCRETE ORGANIC
CHEMICAL DECLARATION
"NO CHANGES" CERTIFICATION FORM
This "No Changes" Certification Form for Unscheduled Discrete Organic Chemicals (UDOCs) may only be used
by your plant site to certify that the information declared in last year's Annual Declaration on Past Activities has
not changed. If you did not submit an Annual Declaration on Past Activities or a "No Changes" Certification Form
last year, you may not use this form.

A.1
A.2
A.3

Company Name:
Plant Site Name:
Plant Site USC Code:

NOTE: The company and plant site names as well as the plant site USC code declared in Questions A.1
through A.3 must be the same as those declared in last year's Annual Declaration on Past Activities,
including the Certification Form and UDOC Forms A and B.

A.4

Date Submitted (YYYY-MM-DD):

A.5

CERTIFICATION

I hereby certify that the information declared in last year's Annual Declaration on Past Activities is unchanged for
the reporting year listed in Question A.6 below. To the best of my knowledge and belief this information is true
and complete.
Name and title of responsible official (type or print):

Signature:

Date Signed (YYYY-MM-DD):
REPORTING YEAR:

A.6
ANNUAL DECLARATION ON PAST ACTIVITIES (YYYY): ____________

UDOC “No Changes” Certification Form
Declaration requirements for Unscheduled Discrete Organic
Chemicals (UDOCs) are set forth in Part 715 of the CWC
Regulations (15 CFR 715).
Unscheduled Discrete Organic Chemical (UDOC) production
is declared in broad ranges, therefore, many plant sites’
declarations do not change from year to year. As a convenience,
you may use this UDOC “No Changes” Certification Form to
meet your declaration requirement.
Submit a separate UDOC “No Changes” Certification Form for
each UDOC Plant Site being declared that has no updates or
changes to the information declared in the last Annual
Declaration on Past Activities, except changes to the Certifying
Official and dates submitted and signed in Questions A.4 and
A.5.
The UDOC “No Changes” Certification Form may only be used
to certify the information declared in your last Annual
Declaration on Past Activities or UDOC “No Changes”
Certification Form has not changed. If you did not submit an
Annual Declaration on Past Activities or a “No Changes”
Certification Form last year, you may not use this form.

Your signature on the UDOC “No Changes” Certification Form
authorizes the Department of Commerce to use the information
from your last year’s Annual Declaration on Past Activities to
create an official declaration for your plant site for the current
reporting year.
If, after submitting the UDOC “No Changes” Certification
Form, there are updates or changes to the declared information,
you must submit an Amendment to your Annual Declaration
on Past Activities. You must submit a Certification Form and
UDOC Form Parts A and B
Question A.1 through A.3 Company Name and Plant Site Name
and USC Code: Provide the name of the company, plant site
and the plant site USC code. This information must be the
same as declared in the last Annual Declaration on Past
Activities. If there are any changes to this information, you
must complete an Annual Declaration on Past Activities,
including the Certification Form and UDOC Form Parts A
and B.
Questions A.4 and A.5 Date Submitted and Certification: The
Certification must be signed and dated 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. The date
submitted block should indicate the date the certification is
submitted.

FORM APPROVED: OMB NO. 0694-0091

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

DATE RECEIVED
(Leave Blank)

CWC UNSCHEDULED
DISCRETE ORGANIC
CHEMICAL DECLARATION
"CHANGE IN INSPECTION STATUS" FORM
This "Change in Inspection Status" Form may only be used by an Unscheduled Discrete Organic Chemical
(UDOC) plant site if:
1) the plant site is "declared" and subject to inspection based on production by synthesis in excess of
200 metric tons aggregate of UDOCs (including any amount of PSF-chemicals) during the previous
calendar year; and
2) the plant site does not anticipate producing by synthesis in excess of 200 metric tons aggregate of
UDOCs during the remainder of the current calendar year.
NOTE: This "Change in Inspection Status" Form must be submitted no later than December 15th of the current
calendar year. The purpose of this form is to ensure your plant site will not be selected for inspection during the
first 90 days of the next calender year if your current calendar year activities are not anticipated to exceed the
CWC Regulations' inspection thresold (§715.1(d)).

B.1
B.2
B.3

Company Name:

B.4

Date Submitted (YYYY-MM-DD):

B.5

CERTIFICATION

Plant Site Name:
Plant Site USC Code:

I hereby certify that the inspection status for the declared plant site is below the inspection threshold (i.e., less than
200 metric tons aggregate of UDOCs) for the current year and is anticipated to remain below the threshold. To the
best of my knowledge and belief this information is true and complete.
Name and title of responsible official (type or print):

Signature:

Date Signed (YYYY-MM-DD):
REPORTING YEAR:

B.6
Change in Inspection Status for the Current Calendar Year (YYYY): ____________
General Optional Comment:

B.7

UDOC “Change In Inspection Status” Form
Declaration requirements for Unscheduled
Discrete Organic Chemicals (UDOCs) are set
forth in Part 715 of the CWC Regulations (15
CFR 715).
You may submit this form to ensure that your
plant site will not be selected for inspection by
the Organization for the Prohibition of Chemical
Weapons (OPCW) during the first 90 days of
the next calendar year if:

1) your plant site is currently subject to
inspection by the OPCW as outlined under
Section 715.1(d) of the CWC Regulations
because it produced by synthesis in excess
of 200 metric tons aggregate of UDOCs
during the previous year; and
2) your plant site is not anticipating to exceed
the 200 metric ton aggregate production
threshold during the current calendar
year.
The “Change in Inspection Status Form” must
be submitted no later than December 15th of
the current calendar year. This form may only
be used to certify that the inspection status of
the plant site will change based on current year
activities. If you do not submit a “Change in
Inspection Status” Form, your plant site will
continue to be subject to inspection (during the
first 90 days of the next calendar year) until: (1)
a new Annual Declaration on Past Activities
(ADPA) has been submitted that declares the
production range for the plant site as below the
inspection threshold and thereby changes the
inspection status; or (2) your plant site is not
required to submit an ADPA (Note: The OPCW
will be informed that your plant site is no longer
subject to declaration – see Question B.7).
NOTE 1: In lieu of submitting a “Change
in Inspection Status” Form, you may submit
an Annual Declaration on Past Activities
(ADPA) by December 15 if you are certain
the aggregate production threshold for the
plant site will not change before the end of
the current calendar year.

Note 2: Upon receipt of the “Change In
Inspection Status” Form or ADPA, the
Department of Commerce will inform the
OPCW that your plant site is not inspectable
during the next calendar year, if appropriate.
Your signature on the “Change in Inspection
Status” Form authorizes the Department of
Commerce to inform the OPCW that your plant
site will not be subject to inspection during the next
calendar year thereby eliminating the possibility that
an inspection may occur during the first 90 days of
the next calendar year.
If after submitting a “Change in Inspection Status”
Form, you determine that the production for the
plant site actually exceeded 200 metric tons
aggregate threshold, you must submit by February
28 an ADPA (i.e., Certification Form, UDOC
Form - Parts A and B, and Form B) and indicate
on Form B the reason the plant site exceeded the
inspection threshold after submission of the
“Change in Inspection Status” Form.
Question B.1 through B.3 Company Name and
Plant Site name and USC Code: Provide the name
of the company, plant site and the plant site USC
code.
Questions B.4 and B.5 Date Submitted and
Certification: The Certification must be signed and
dated 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. The date submitted block should indicate
the date the certification is submitted.
Question B.6 Reporting Year: Provide the current
year for which the information applies.
Question B.7: General Optional Comment: Provide
any voluntary comments regarding your plant site
(e.g., no longer subject to declaration).

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

COMPLETE AS MANY COPIES OF THIS FORM AS NECESSARY.

CWC UNSCHEDULED
DISCRETE ORGANIC CHEMICAL
FORM A
FORM A ATTACHMENTS FOR UNSCHEDULED
DISCRETE ORGANIC CHEMICAL PLANT SITE
Form Number

Use this form to describe any attachment to this declaration. Attachments may
include, for example, any additional information on the precise location of a
declared plant site, site map.
Plant Site Name:

Identify each attachment with a unique name or description.

FORM A Attachments for Declared Unscheduled Discrete Organic Chemical Plant Sites
Declaration requirements are set forth in Part 715 of the CWC Regulations (15 CFR 715).
Submit this form to list any attachments containing additional information (e.g., site diagrams, maps, drawings) on any declared plant
site. Any additional attachment submitted to further characterize the plant site and to clarify the exact location is on a voluntary basis.
PLANT SITE NAME: Enter the name of the plant site, and if assigned, enter its U.S. Plant Site code.
FORM NUMBER: In column 1, enter the form number to which this additional information refers.
IDENTIFY ATTACHMENT: In column 2, provide a description of the attachment and assign a unique name to it (e.g., site map).
Insert all attachments in an envelope and staple the envelope to Form A.

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

CWC UNSCHEDULED
DISCRETE ORGANIC CHEMICAL
FORM B
FORM B OPTIONAL COMMENTS
Comments on form number

, question number

:

Comments on form number

, question number

:

Comments on form number

, question number

:

Comments on form number

, question number

:

Comments on form number

, question number

:

Comments on form number

, question number

:

B.1.1

B.1.2

B.1.3

B.1.4

B.1.5

B.1.6

General comments or suggestions:

B.2.1

FORM B Optional Comments
Declaration requirements are set forth in Part 715 of the CWC Regulations (15 CFR 715)
Please use this form to record comments or suggestions. Use as many copies of this form as necessary. Submission of this
form is optional. The information provided will be used only by the Department of Commerce to improve the forms and the
CWC reporting process.