Form 9600-031 TSCA Section 12(b) Export Notification

OMB Control No. 2070-0004
Expires 11/30/2022
United States Environmental Protection Agency
Washington, DC 20460
Section 8(d) Health & Safety Data Reporting
This is an original submission:

This is an amendment:

✔
CERTIFICATION
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:

Contact Person:

Email Address:

Date Signed:

PART 1

Contact Information

Submission
Information

Submission Type:

Submitter
Information

CBI:

85-68-7
Yes: ✔ No:
Company Name:

CDX Test Org
Contact Person:

Brooke E. Plaisance
Phone Number:

3375555555
Submit on Behalf of
Another Company

Date Submitted:

Address:

123 Main St
Virginia Beach, VA, 23462
United States
Email Address:

brooke.plaisance@cgifederal.com

CBI:

Yes: ✔ No:
Company Name:

CDX Test Org
Contact Person:

Brooke Plaisance
Phone Number:

3375555555

EPA Form Number 9600-032

Address:

123 Main St
Virginia Beach, VA, 23462
United States
Email Address:

brooke.plaisance@cgifederal.com

Section 8(d) Health & Safety Data Reporting Page 2

Technical Contact
Information

CBI:

Yes: ✔ No:
Company Name:

Address:

CDX Test Org

123 Main St
Virginia Beach, VA, 23462
United States

Contact Person:

Ms Brooke E. Plaisance
Phone Number:

Email Address:

3375555555

brooke.plaisance@cgifederal.com

PART 2

Chemical Report

Chemical
Identification

Chemical Identifying #:

Chemical Name:

CASRN: 85-68-7

1,2-Benzenedicarboxylic acid, 1-butyl
2-(phenylmethyl) ester

Test
PART 3

Study Information

Ongoing Studies

Document Upload:

CBI:

Yes:

cgi-logo.png
Effects:

No:

✔

Endpoints:

Health Effects

Acute Toxicity: inhalation

Substantiation Opt-Out and Documents
Substantiation Opt-Out:

Yes:

No:

✔

o

PART 4
Substantiation
Opt-Out and
Documents

✔ No:

i

Please identify any impurity or additive known to have been CBI:
present in the substance or listed mixtures as studied:
Yes:

Document Upload:

epa-logo.png

CBI:

Yes:

No:

✔

Substantiation: Applicable to Any Claim
i. Will disclosure of the information claimed as confidential likely cause substantial harm to your
business's competitive position? If you answered yes, describe the substantial harmful effects
that would likely result to your competitive position if the information is disclosed, including but
not limited to how a competitor could use such information, and the causal relationship between
the disclosure and the harmful effects.

CBI:

Yes
:No

✔

Test
ii. Has your business taken precautions to protect the confidentiality of the disclosed information? If
yes, please explain and identify the specific measures, including but not limited to internal
controls, that your business has taken to protect the information claimed as confidential. If the
same or similar information was previously reported to EPA as non-confidential (such as in an
earlier version of this submission), please explain the circumstances of that prior submission and
reasons for believing the information is nonetheless still confidential.

CBI:

Yes
:No

✔

Test
iii.(A) Is any of the information claimed as confidential required to be publicly disclosed under any
other Federal law? If yes, please explain.

Test
EPA Form Number 9600-032

CBI:

Yes
:No

✔

Section 8(d) Health & Safety Data Reporting Page 3
Substantiation: Applicable to Any Claim
iii(B) Does any of the information claimed as confidential otherwise appear in any public documents,
including (but not limited to) safety data sheets; advertising or promotional material;
professional or trade publications; state, local, or Federal agency files; or any other media or
publications available to the general public? If yes, please explain why the information should
be treated as confidential.

CBI:

Yes
:No

✔

Test
iii(C) Does any of the information claimed as confidential appear in one or more patents or
patent applications? If yes, provide the associated patent number or patent application
number (or numbers) and explain why the information should be treated as confidential.

CBI:

Yes
:No

✔

Test
iv.

Is the claim of confidentiality intended to last less than 10 years (see TSCA section 14(e)(1)
(B))? If yes, please indicate the number of years (between 1-10 years) or the specific date
after which the claim is withdrawn.

CBI:

Yes
:No

✔

Test
v. Has EPA, another federal agency, or court made any confidentiality determination regarding
information associated with this chemical substance? If yes, please provide the circumstances
associated with the prior determination, whether the information was found to be entitled to
confidential treatment, the entity that made the decision, and the date of the determination.

CBI:

Yes
:No

✔

Test

Substantiation: Chemical Identity Claim
i. Is this chemical substance publicly known (including by your competitors) to be in U.S. commerce?
If yes, please explain why the specific chemical identity should still be afforded confidential status
(e.g., the chemical substance is publicly known only as being distributed in commerce for research
and development purposes, but no other information about the current commercial distribution of
the chemical substance in the United States is publicly available). If no, please complete the
certification statement:
I certify that on the date referenced I searched the internet for the chemical substance identity
(i.e., by both chemical substance name and CASRN). I did not find a reference to this
chemical substance that would indicate that the chemical is being manufactured or imported
by anyone for a commercial purpose in the United States. [provide date].

CBI:

Yes
:No

✔

Test
ii. Does this specific chemical substance leave the site of manufacture (including import) in any form,  CBI:
e.g., as a product, effluent, emission? If yes, please explain what measures have been taken to
Yes
guard against the discovery of its identity.

✔

:No

Test
iii. If the chemical substance leaves the site in a form that is available to the public or your
competitors, can the chemical identity be readily discovered by analysis of the substance
(e.g., product, effluent, emission), in light of existing technologies and any costs, difficulties, or
limitations associated with such technologies? Please explain why or why not.

CBI:

Yes
:No

✔

Test
iv. Would disclosure of the specific chemical identity release confidential process information? If yes,
please explain.

Test

EPA Form Number 9600-032

CBI:

Yes
:No

✔

Section 8(d) Health & Safety Data Reporting Page 4

Paperwork Reduction Act
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C.
3501 et seq. (OMB Control No. 2070-0004). Responses to this collection of information are
mandatory for certain persons, as specified at 40 CFR 716. 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 be 11 hours per response. Send comments on the Agency’s need for this

on

information, the accuracy of the provided burden estimates and any suggested methods for
minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental
Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB

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control number in any correspondence. Do not send the completed form to this address.

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Authority
The Government Paperwork Elimination Act (GPEA) (44 U.S.C. 3504) provides that, when
practicable, Federal organizations use electronic forms, electronic filings, and electronic signatures to
conduct official business with the public. EPAs Cross-Media Electronic Reporting Regulation
(CROMERR) (40 CFR part 3) (Ref. 2), provides that any requirement in title 40 of the CFR to submit
a report directly to EPA can be satisfied with an electronic submission that meets certain conditions
once the Agency published a document in the Federal Register announcing that EPA is prepared to
receive certain documents in electronic form. For more information about CROMERR, go to
http://www.epa.gov/cromerr/.

EPA Form Number 9600-032

Form Approved OMB Number 2070-0004