Activity Time ( min) first yr Time ( min) subs yr paper* Time ( min) subs yr electronic** Proofread one field of known information ( such as facility name) 0.08 0.08 0.00 Conduct management review of data elements requiring release or other waste management estimates when technical time takes less than one hour 1.00 0.83 0.83 Conduct management review of data elements requiring release or other waste management estimates when technical time takes approximately one hour 2.00 1.67 1.67 Conduct management review of data elements requiring release or other waste management estimates when technical time takes greater than one hour 3.00 2.50 2.50 Activity Time ( min) first yr Time ( min) subs yr paper Time ( min) subs yr electronic* Check a box or type a simple code into one field ( 5 sec) 0.08 0.08 0.00 Type needed characters into one field ( 15 sec) 0.25 0.25 0.00 Conduct short information look up ( such as I. d. number) and enter in field 10.00 0.15 0.00 Determine annual chemical usage quantity 30.00 30.00 30.00 Determine chemical concentration in waste streams without monitoring data 30.00 25.00 25.00 Locate and review monitoring data to identify chemical concentration 35.00 25.00 25.00 Identify release points for the chemical 30.00 5.00 5.00 Identify waste streams containing the chemical 30.00 5.00 5.00 Sum together relevant quantities estimated for Sections 5 and 6 for reporting in Sections 8.1  8.7 5.00 5.00 5.00 TABLE 2 COMPLETION TIMES FOR STANDARD MANAGEMENT AND TECHNICAL ACTIVITIES * First year times for paper and electronic are the same because none of the electronic forms are prepopulated ** Subsequent year estimates of zero indicate that this information is prepopulated into TRI ME by loading last year's forms. Management Technical PBT Reports Highest C E M O Section 5.1: Fugitive or non point air emissions O 8.83 32.54 5.56 52.96 Section 5.2: Stack or point air emissions E 8.28 55.14 9.34 27.19 Section 5.3: Discharges to receiving streams or water bodies M 6.57 11.54 50.33 31.52 5.4.1: Underground injection onsite to Class I wells M 4.00 4.00 56.00 36.00 Section 5.4.2: Underground injection onsite to Class II V wells M 30.77 0.00 57.69 11.54 5.5.1A: RCRA Subtitle C landfills O 36.68 5.53 13.07 44.72 5.5.1B: Other landfills O 30.38 24.22 14.18 31.05 5.5.2: Land treatment/ application farming O 17.48 21.36 29.13 31.55 5.5.3: Surface impoundment C 50.13 10.70 8.49 30.68 5.5.4: Other disposal O 20.12 11.39 10.92 57.41 Section 6.1: Discharges to publicly owned treatment works ( POTWs) M 7.61 1.95 67.24 23.16 Section 6.2: Transfers to other off site locations O 26.78 3.09 29.43 40.66 Non PBT Reports Section 5.1: Fugitive or non point air emissions O 14.01 29.13 4.88 51.93 Section 5.2: Stack or point air emissions O 17.22 31.53 8.58 42.64 Section 5.3: Discharges to receiving streams or water bodies M 6.26 6.18 52.86 34.68 5.4.1: Underground injection onsite to Class I wells M 9.75 1.82 53.72 34.71 Section 5.4.2: Underground injection onsite to Class II V wells M 10.53 0.00 66.66 22.81 5.5.1A: RCRA Subtitle C landfills O 25.29 1.82 14.05 58.84 5.5.1B: Other landfills O 35.74 14.26 13.78 36.19 5.5.2: Land treatment/ application farming M 25.50 9.12 33.76 31.62 5.5.3: Surface impoundment C 54.85 5.94 9.75 29.45 5.5.4: Other disposal O 11.98 2.25 8.32 77.46 Section 6.1: Discharges to publicly owned treatment works ( POTWs) M 15.91 1.54 46.56 35.88 Section 6.2: Transfers to other off site locations O 22.38 1.13 28.90 47.56 O: Estimate based on other approaches Prevalence of code [%] FORM R BASIS OF ESTIMATE CODES TABLE 3 C: Estimate based on mass balance calculations E: Estimate based on published emission factors M: Estimate based on monitoring data or measurements Proposed Item Management Technical Total Time Incidence Rate (%) Management Technical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.17 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title NA NA NA NA NA NA NA Signature NA NA NA NA NA NA NA Date signed NA NA NA NA NA NA NA ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Facility or establishment name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Street 0.08 0.25 0.33 100.00 0.08 0.25 0.33 City/ county/ state/ zip code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Mailing address 0.08 0.25 0.33 100.00 0.08 0.25 0.33 City/ state/ zip code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Country ( non US) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 4.3: Technical contact name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Telephone number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Email address 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.4: Public contact name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Telephone number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.5: SIC code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.6: Latitude Degrees 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Minutes 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Seconds 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Section 4.6: Longitude Degrees 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Minutes 0.08 0.75 0.83 100.00 0.08 0.75 0.83 TABLE 5 FORM R PART I: FACILITY IDENTIFICATION INFORMATION FIRST YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING FORM R ELECTRONICALLY FOR A PBT CHEMICAL Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min) Seconds 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Section 4.7: Dun & Bradstreet number( s) 0.08 10.00 10.08 83.47 0.07 8.35 8.42 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 10.00 10.08 80.47 0.07 8.05 8.11 Section 4.9: Facility NPDES permit number( s) 0.08 10.00 10.08 45.97 0.04 4.60 4.64 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 10.00 10.08 0.59 0.00 0.06 0.06 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 10.00 10.08 100.00 0.08 10.00 10.08 Section 5.2: Parent company's Dun & Bradstreet number 0.08 10.00 10.08 100.00 0.08 10.00 10.08 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 1.3: Generic chemical name 0.08 0.50 0.58 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 0.58 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 0.17 46.98 0.04 0.04 0.08 Section 3.2: Process the toxic chemical 0.08 0.08 0.17 63.81 0.05 0.05 0.11 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 0.17 34.60 0.03 0.03 0.06 ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 1.00 30.00 31.00 100.00 1.00 30.00 31.00 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.17 48.21 0.04 0.04 0.08 A. Total release 3.00 195.00 198.00 51.79 1.55 100.99 102.54 B. Basis of estimate 0.08 0.25 0.33 51.72 0.04 0.13 0.17 FORM R PART II: CHEMICAL SPECIFIC INFORMATION Section 5.2: Stack or point air emissions NA 0.08 0.08 0.17 25.44 0.02 0.02 0.04 A. Total release 3.00 86.00 89.00 74.56 2.24 64.12 66.36 B. Basis of estimate 0.08 0.25 0.33 74.43 0.06 0.19 0.25 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.17 71.42 0.06 0.06 0.12 5.3.1: Stream or water body name 0.08 0.25 0.33 28.58 0.02 0.07 0.10 A. Total release 2.00 75.00 77.00 28.58 0.57 21.44 22.01 B. Basis of estimate 0.08 0.25 0.33 28.56 0.02 0.07 0.10 C. % from stormwater 3.00 107.00 110.00 18.45 0.55 19.74 20.30 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.17 99.69 0.08 0.08 0.17 A. Total release 2.00 73.00 75.00 0.32 0.01 0.23 0.24 B. Basis of estimate 0.08 0.25 0.33 0.31 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.17 99.73 0.08 0.08 0.17 A. Total release 2.00 73.00 75.00 0.27 0.01 0.20 0.20 B. Basis of estimate 0.08 0.25 0.33 0.26 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.17 98.26 0.08 0.08 0.16 A. Total release 3.00 96.00 99.00 1.74 0.05 1.67 1.72 B. Basis of estimate 0.08 0.25 0.33 1.74 0.00 0.00 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.17 90.54 0.08 0.08 0.15 A. Total release 3.00 96.00 99.00 9.46 0.28 9.08 9.37 B. Basis of estimate 0.08 0.25 0.33 9.45 0.01 0.02 0.03 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.17 97.95 0.08 0.08 0.16 A. Total release 3.00 96.00 99.00 2.05 0.06 1.97 2.03 B. Basis of estimate 0.08 0.25 0.33 2.05 0.00 0.01 0.01 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.17 46.03 0.04 0.04 0.08 A. Total release 3.00 96.00 99.00 3.98 0.12 3.82 3.94 B. Basis of estimate 0.08 0.25 0.33 3.98 0.00 0.01 0.01 5.5.3B: Other surface impoundments NA 0.08 0.08 0.17 46.03 0.04 0.04 0.08 A. Total release 3.00 96.00 99.00 3.98 0.12 3.82 3.94 B. Basis of estimate 0.08 0.25 0.33 3.98 0.00 0.01 0.01 5.5.4: Other disposal NA 0.08 0.08 0.17 86.71 0.07 0.07 0.14 A. Total release 1.00 35.00 36.00 13.29 0.13 4.65 4.78 B. Basis of estimate 0.08 0.25 0.33 13.25 0.01 0.03 0.04 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs) 6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 2.00 73.00 75.00 19.01 0.38 13.88 14.26 6.1. A. 2: Basis of estimate 0.08 0.25 0.33 18.89 0.02 0.05 0.06 6.1. B POTW name 0.08 0.25 0.33 18.90 0.02 0.05 0.06 POTW address 0.08 0.25 0.33 18.90 0.02 0.05 0.06 City 0.08 0.25 0.33 18.90 0.02 0.05 0.06 State 0.08 0.25 0.33 18.90 0.02 0.05 0.06 County 0.08 0.25 0.33 18.90 0.02 0.05 0.06 Zip 0.08 0.25 0.33 18.90 0.02 0.05 0.06 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Off site location name 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Off site address 0.17 0.50 0.67 100.00 0.17 0.50 0.67 City 0.17 0.50 0.67 100.00 0.17 0.50 0.67 State 0.17 0.50 0.67 100.00 0.17 0.50 0.67 County 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Zip 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Country ( non US) 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Is location under control of reporting facility or parent company? 0.17 0.17 0.33 100.00 0.17 0.17 0.33 A: Total transfers 3.00 107.00 110.00 100.00 3.00 107.00 110.00 B: Basis of estimate 0.17 0.50 0.67 99.90 0.17 0.50 0.67 C: Type of waste treatment/ disposal/ recycling/ energy recovery 0.17 0.50 0.67 99.83 0.17 0.50 0.67 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.17 66.44 0.06 0.06 0.11 7A. 1a: General waste stream ( enter code) 1.00 10.00 11.00 33.56 0.34 3.36 3.69 7A. 1b: Waste treatment method( s) sequence 1.00 25.00 26.00 33.56 0.34 8.39 8.73 7A. 1c: Range of influent concentration 2.00 60.00 62.00 33.56 0.67 20.14 20.81 7A. 1d: Waste treatment efficiency estimate 1.00 30.00 31.00 33.56 0.34 10.07 10.40 7A. 1e: Based on operating data? 0.17 0.17 0.33 33.56 0.06 0.06 0.11 Section 7B: On site energy recovery processes NA 0.08 0.08 0.17 98.90 0.08 0.08 0.16 Energy recovery methods 1.00 32.00 33.00 1.10 0.01 0.35 0.36 Section 7C: On site recycling processes NA 0.08 0.08 0.17 93.77 0.08 0.08 0.16 Energy recovery methods 1.00 38.00 39.00 6.23 0.06 2.37 2.43 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1c: Total off site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.33 1.96 0.00 0.00 0.01 Column B: Current reporting year 1.00 30.00 31.00 1.96 0.02 0.59 0.61 Column C: Following year 0.08 1.00 1.08 1.96 0.00 0.02 0.02 Column D: Second following year 0.08 1.00 1.08 1.96 0.00 0.02 0.02 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 0.33 2.95 0.00 0.01 0.01 Column B: Current reporting year 0.25 5.00 5.25 2.95 0.01 0.15 0.15 Column C: Following year 0.08 1.00 1.08 2.95 0.00 0.03 0.03 Column D: Second following year 0.08 1.00 1.08 2.95 0.00 0.03 0.03 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.33 7.17 0.01 0.02 0.02 Column B: Current reporting year 1.00 30.00 31.00 7.17 0.07 2.15 2.22 Column C: Following year 0.08 1.00 1.08 7.17 0.01 0.07 0.08 Column D: Second following year 0.08 1.00 1.08 7.17 0.01 0.07 0.08 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.33 30.21 0.03 0.08 0.10 Column B: Current reporting year 0.25 5.00 5.25 30.21 0.08 1.51 1.59 Column C: Following year 0.08 1.00 1.08 30.21 0.03 0.30 0.33 Column D: Second following year 0.08 1.00 1.08 30.21 0.03 0.30 0.33 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.33 6.36 0.01 0.02 0.02 Column B: Current reporting year 1.00 30.00 31.00 6.36 0.06 1.91 1.97 Column C: Following year 0.08 1.00 1.08 6.36 0.01 0.06 0.07 Column D: Second following year 0.08 1.00 1.08 6.36 0.01 0.06 0.07 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.33 5.86 0.00 0.01 0.02 Column B: Current reporting year 0.25 5.00 5.25 5.86 0.01 0.29 0.31 Column C: Following year 0.08 1.00 1.08 5.86 0.00 0.06 0.06 Column D: Second following year 0.08 1.00 1.08 5.86 0.00 0.06 0.06 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 5.25 24.37 0.06 1.22 1.28 Section 8.9: Production ratio or activity index 0.83 36.00 36.83 100.00 0.83 36.00 36.83 Section 8.10: Did your facility engage in any source reduction activities? 8.10.1 Source reduction activities 1.00 35.00 36.00 8.32 0.08 2.91 3.00 Methods to identify activity 0.08 0.25 0.33 8.29 0.01 0.02 0.03 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 61.33 1834.25 1895.83 20.76 559.50 580.26 TOTAL ( hr) 1.02 30.57 31.60 0.35 9.32 9.67 Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields. Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments. Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers. Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams. Proposed Item Management Technical Total Time Incidence Rate (%) Management Technical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.17 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title NA NA NA NA NA NA NA Signature NA NA NA NA NA NA NA Date signed NA NA NA NA NA NA NA ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Facility or establishment name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Street 0.08 0.25 0.33 100.00 0.08 0.25 0.33 City/ county/ state/ zip code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Mailing address 0.08 0.25 0.33 100.00 0.08 0.25 0.33 City/ state/ zip code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Country ( non US) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 4.3: Technical contact name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Telephone number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Email address 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.4: Public contact name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Telephone number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.5: SIC code 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 4.6: Latitude Degrees 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Minutes 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Seconds 0.08 0.75 0.83 100.00 0.08 0.75 0.83 TABLE 6 FIRST YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING FORM R ELECTRONICALLY FOR A NON PBT CHEMICAL FORM R PART I: FACILITY IDENTIFICATION INFORMATION Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min) Section 4.6: Longitude Degrees 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Minutes 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Seconds 0.08 0.75 0.83 100.00 0.08 0.75 0.83 Section 4.7: Dun & Bradstreet number( s) 0.08 10.00 10.08 83.47 0.07 8.35 8.42 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 10.00 10.08 80.47 0.07 8.05 8.11 Section 4.9: Facility NPDES permit number( s) 0.08 10.00 10.08 45.97 0.04 4.60 4.64 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 10.00 10.08 0.59 0.00 0.06 0.06 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 10.00 10.08 100.00 0.08 10.00 10.08 Section 5.2: Parent company's Dun & Bradstreet number 0.08 10.00 10.08 100.00 0.08 10.00 10.08 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 0.33 100.00 0.08 0.25 0.33 Section 1.3: Generic chemical name 0.08 0.50 0.58 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 0.33 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 0.17 33.06 0.03 0.03 0.06 Section 3.2: Process the toxic chemical 0.08 0.08 0.17 59.84 0.05 0.05 0.10 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 0.17 39.97 0.03 0.03 0.07 ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 1.00 30.00 31.00 100.00 1.00 30.00 31.00 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site FORM R PART II: CHEMICAL SPECIFIC INFORMATION Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.17 28.32 0.02 0.02 0.05 A. Total release 3.00 195.00 198.00 71.68 2.15 139.78 141.93 B. Basis of estimate 0.08 0.25 0.33 71.61 0.06 0.18 0.24 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.17 26.15 0.02 0.02 0.04 A. Total release 3.00 106.00 109.00 73.85 2.22 78.28 80.50 B. Basis of estimate 0.08 0.25 0.33 73.78 0.06 0.18 0.25 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.17 73.56 0.06 0.06 0.12 5.3.1: Stream or water body name 0.08 0.25 0.33 26.44 0.02 0.07 0.09 A. Total release 3.00 111.58 114.58 26.44 0.79 29.50 30.29 B. Basis of estimate 0.08 0.25 0.33 26.42 0.02 0.07 0.09 C. % from stormwater 0.25 2.00 2.25 16.64 0.04 0.33 0.37 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.17 98.76 0.08 0.08 0.16 A. Total release 2.00 73.00 75.00 1.24 0.02 0.91 0.93 B. Basis of estimate 0.08 0.25 0.33 1.21 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.17 99.76 0.08 0.08 0.17 A. Total release 2.00 73.00 75.00 0.24 0.00 0.18 0.18 B. Basis of estimate 0.08 0.25 0.33 0.23 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.17 98.48 0.08 0.08 0.16 A. Total release 3.00 96.00 99.00 1.52 0.05 1.46 1.50 B. Basis of estimate 0.08 0.25 0.33 1.51 0.00 0.00 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.17 94.51 0.08 0.08 0.16 A. Total release 3.00 96.00 99.00 5.49 0.16 5.27 5.44 B. Basis of estimate 0.08 0.25 0.33 5.47 0.00 0.01 0.02 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.17 98.33 0.08 0.08 0.16 A. Total release 2.00 73.00 75.00 1.67 0.03 1.22 1.25 B. Basis of estimate 0.08 0.25 0.33 1.65 0.00 0.00 0.01 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.17 47.92 0.04 0.04 0.08 A. Total release 3.00 96.00 99.00 2.09 0.06 2.00 2.06 B. Basis of estimate 0.08 0.25 0.33 2.09 0.00 0.01 0.01 5.5.3B: Other surface impoundments NA 0.08 0.08 0.17 47.92 0.04 0.04 0.08 A. Total release 3.00 96.00 99.00 2.09 0.06 2.00 2.06 B. Basis of estimate 0.08 0.25 0.33 2.09 0.00 0.01 0.01 5.5.4: Other disposal NA 0.08 0.08 0.17 90.45 0.08 0.08 0.15 A. Total release 1.00 35.00 36.00 9.55 0.10 3.34 3.44 B. Basis of estimate 0.08 0.25 0.33 9.48 0.01 0.02 0.03 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs) 6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 2.00 73.00 75.00 23.97 0.48 17.50 17.98 6.1. A. 2: Basis of estimate 0.08 0.25 0.33 23.93 0.02 0.06 0.08 6.1. B POTW name 0.08 0.25 0.33 23.92 0.02 0.06 0.08 POTW address 0.08 0.25 0.33 23.92 0.02 0.06 0.08 City 0.08 0.25 0.33 23.92 0.02 0.06 0.08 State 0.08 0.25 0.33 23.92 0.02 0.06 0.08 County 0.08 0.25 0.33 23.92 0.02 0.06 0.08 Zip 0.08 0.25 0.33 23.92 0.02 0.06 0.08 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Off site location name 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Off site address 0.17 0.50 0.67 100.00 0.17 0.50 0.67 City 0.17 0.50 0.67 100.00 0.17 0.50 0.67 State 0.17 0.50 0.67 100.00 0.17 0.50 0.67 County 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Zip 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Country ( non US) 0.17 0.50 0.67 100.00 0.17 0.50 0.67 Is location under control of reporting facility or parent company? 0.17 0.17 0.33 100.00 0.17 0.17 0.33 A: Total transfers 3.00 107.00 110.00 100.00 3.00 107.00 110.00 B: Basis of estimate 0.17 0.50 0.67 99.99 0.17 0.50 0.67 C: Type of waste treatment/ disposal/ recycling/ energy recovery 0.17 0.50 0.67 99.97 0.17 0.50 0.67 ITEMS PERTAINING TO SECTION Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.17 51.48 0.04 0.04 0.09 7A. 1a: General waste stream ( enter code) 1.00 10.00 11.00 48.52 0.49 4.85 5.34 7A. 1b: Waste treatment method( s) sequence 1.00 25.00 26.00 48.52 0.49 12.13 12.62 7A. 1c: Range of influent concentration 2.00 60.00 62.00 48.52 0.97 29.11 30.08 7A. 1d: Waste treatment efficiency estimate 1.00 30.00 31.00 48.52 0.49 14.56 15.04 7A. 1e: Based on operating data? 0.17 0.17 0.33 48.52 0.08 0.08 0.16 Section 7B: On site energy recovery processes NA 0.08 0.08 0.17 95.60 0.08 0.08 0.16 Energy recovery methods 1.00 32.00 33.00 4.40 0.04 1.41 1.45 Section 7C: On site recycling processes NA 0.08 0.08 0.17 90.18 0.08 0.08 0.15 Energy recovery methods 1.00 38.00 39.00 9.82 0.10 3.73 3.83 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1c: Total off site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.33 5.42 0.00 0.01 0.02 Column B: Current reporting year 1.00 30.00 31.00 5.42 0.05 1.63 1.68 Column C: Following year 0.08 1.00 1.08 5.42 0.00 0.05 0.06 Column D: Second following year 0.08 1.00 1.08 5.42 0.00 0.05 0.06 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 0.33 18.52 0.02 0.05 0.06 Column B: Current reporting year 0.25 5.00 5.25 18.52 0.05 0.93 0.97 Column C: Following year 0.08 1.00 1.08 18.52 0.02 0.19 0.20 Column D: Second following year 0.08 1.00 1.08 18.52 0.02 0.19 0.20 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.33 10.83 0.01 0.03 0.04 Column B: Current reporting year 1.00 30.00 31.00 10.83 0.11 3.25 3.36 Column C: Following year 0.08 1.00 1.08 10.83 0.01 0.11 0.12 Column D: Second following year 0.08 1.00 1.08 10.83 0.01 0.11 0.12 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.33 22.68 0.02 0.06 0.08 Column B: Current reporting year 0.25 5.00 5.25 22.68 0.06 1.13 1.19 Column C: Following year 0.08 1.00 1.08 22.68 0.02 0.23 0.25 Column D: Second following year 0.08 1.00 1.08 22.68 0.02 0.23 0.25 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.33 24.58 0.02 0.06 0.08 Column B: Current reporting year 1.00 30.00 31.00 24.58 0.25 7.37 7.62 Column C: Following year 0.08 1.00 1.08 24.58 0.02 0.25 0.27 Column D: Second following year 0.08 1.00 1.08 24.58 0.02 0.25 0.27 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.33 28.76 0.02 0.07 0.10 Column B: Current reporting year 0.25 5.00 5.25 28.76 0.07 1.44 1.51 Column C: Following year 0.08 1.00 1.08 28.76 0.02 0.29 0.31 Column D: Second following year 0.08 1.00 1.08 28.76 0.02 0.29 0.31 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 5.25 27.65 0.07 1.38 1.45 Section 8.9: Production ratio or activity index 0.83 36.00 36.83 100.00 0.83 36.00 36.83 Section 8.10: Did your facility engage in any source reduction activities? 8.10.1 Source reduction activities 1.00 35.00 36.00 13.25 0.13 4.64 4.77 Methods to identify activity 0.08 0.25 0.33 13.25 0.01 0.03 0.04 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 58.58 1762.83 1821.41 22.25 629.49 651.74 TOTAL ( hr) 0.98 29.38 30.36 0.37 10.49 10.86 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments. Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers. Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams. Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields. Proposed Item Management Technical Total Time Incidence Rate (%) Management Technical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.17 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title NA NA NA NA NA NA NA Signature NA NA NA NA NA NA NA Date signed NA NA NA NA NA NA NA ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Facility or establishment name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Street 0.08 0.00 0.08 100.00 0.08 0.00 0.08 City/ county/ state/ zip code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Facility or establishment name or mailing address ( if different from street address) 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Mailing address 0.08 0.00 0.08 100.00 0.08 0.00 0.08 City/ state/ zip code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Country ( non US) 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 4.3: Technical contact name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Telephone number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Email address 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.4: Public contact name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Telephone number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.5: SIC code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.6: Latitude Degrees 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Minutes 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Seconds 0.08 0.00 0.08 100.00 0.08 0.00 0.08 SUBSEQUENT YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING FORM R ELECTRONICALLY FOR A PBT CHEMICAL FORM R PART I: FACILITY IDENTIFICATION INFORMATION TABLE 7 Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min) Section 4.6: Longitude Degrees 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Minutes 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Seconds 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.7: Dun & Bradstreet number( s) 0.08 0.00 0.08 83.47 0.07 0.00 0.07 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 0.00 0.08 80.47 0.07 0.00 0.07 Section 4.9: Facility NPDES permit number( s) 0.08 0.00 0.08 45.97 0.04 0.00 0.04 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 0.00 0.08 0.59 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 5.2: Parent company's Dun & Bradstreet number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 1.2: Toxic chemical or chemical category name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 1.3: Generic chemical name 0.08 0.00 0.08 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.00 0.08 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.00 0.08 46.98 0.04 0.00 0.04 Section 3.2: Process the toxic chemical 0.08 0.00 0.08 63.81 0.05 0.00 0.05 Section 3.3: Otherwise use the toxic chemical 0.08 0.00 0.08 34.60 0.03 0.00 0.03 ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 0.83 30.00 30.83 100.00 0.83 30.00 30.83 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.17 48.21 0.04 0.04 0.08 A. Total release 2.50 115.00 117.50 51.79 1.29 59.56 60.85 B. Basis of estimate 0.08 0.25 0.33 51.72 0.04 0.13 0.17 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.17 25.44 0.02 0.02 0.04 A. Total release 1.67 60.00 61.67 74.56 1.24 44.74 45.98 B. Basis of estimate 0.08 0.25 0.33 74.43 0.06 0.19 0.25 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.17 71.42 0.06 0.06 0.12 5.3.1: Stream or water body name 0.08 0.25 0.33 28.58 0.02 0.07 0.10 A. Total release 2.50 85.09 87.59 28.58 0.71 24.32 25.03 B. Basis of estimate 0.08 0.25 0.33 28.56 0.02 0.07 0.10 C. % from stormwater 0.25 2.00 2.25 18.45 0.05 0.37 0.42 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.17 99.69 0.08 0.08 0.17 A. Total release 1.67 63.00 64.67 0.32 0.01 0.20 0.21 B. Basis of estimate 0.08 0.25 0.33 0.31 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.17 99.73 0.08 0.08 0.17 A. Total release 1.67 63.00 64.67 0.27 0.00 0.17 0.17 B. Basis of estimate 0.08 0.25 0.33 0.26 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.17 98.26 0.08 0.08 0.16 A. Total release 1.67 66.00 67.67 1.74 0.03 1.15 1.18 B. Basis of estimate 0.08 0.25 0.33 1.74 0.00 0.00 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.17 90.54 0.08 0.08 0.15 A. Total release 1.67 66.00 67.67 9.46 0.16 6.24 6.40 B. Basis of estimate 0.08 0.25 0.33 9.45 0.01 0.02 0.03 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.17 97.95 0.08 0.08 0.16 A. Total release 1.67 66.00 67.67 2.05 0.03 1.35 1.39 B. Basis of estimate 0.08 0.25 0.33 2.05 0.00 0.01 0.01 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.17 46.03 0.04 0.04 0.08 A. Total release 1.67 66.00 67.67 3.98 0.07 2.62 2.69 B. Basis of estimate 0.08 0.25 0.33 3.98 0.00 0.01 0.01 5.5.3B: Other surface impoundments NA 0.08 0.08 0.17 46.03 0.04 0.04 0.08 A. Total release 1.67 66.00 67.67 3.98 0.07 2.62 2.69 B. Basis of estimate 0.08 0.25 0.33 3.98 0.00 0.01 0.01 5.5.4: Other disposal NA 0.08 0.08 0.17 86.71 0.07 0.07 0.14 A. Total release 0.83 35.00 35.83 13.29 0.11 4.65 4.76 B. Basis of estimate 0.08 0.25 0.33 13.25 0.01 0.03 0.04 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs) 6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 1.67 58.00 59.67 19.01 0.32 11.03 11.34 6.1. A. 2: Basis of estimate 0.08 0.25 0.33 18.89 0.02 0.05 0.06 6.1. B POTW name 0.08 0.00 0.08 18.90 0.02 0.00 0.02 POTW address 0.08 0.00 0.08 18.90 0.02 0.00 0.02 City 0.08 0.00 0.08 18.90 0.02 0.00 0.02 State 0.08 0.00 0.08 18.90 0.02 0.00 0.02 County 0.08 0.00 0.08 18.90 0.02 0.00 0.02 Zip 0.08 0.00 0.08 18.90 0.02 0.00 0.02 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Off site location name 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Off site address 0.17 0.25 0.42 100.00 0.17 0.25 0.42 City 0.17 0.25 0.42 100.00 0.17 0.25 0.42 State 0.17 0.25 0.42 100.00 0.17 0.25 0.42 County 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Zip 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Country ( non US) 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Is location under control of reporting facility or parent company? 0.17 0.08 0.25 100.00 0.17 0.08 0.25 A: Total transfers 2.50 82.00 84.50 100.00 2.50 82.00 84.50 B: Basis of estimate 0.17 0.25 0.42 99.90 0.17 0.25 0.42 C: Type of waste treatment/ disposal/ recycling/ energy recovery 0.17 0.25 0.42 99.83 0.17 0.25 0.42 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.17 66.44 0.06 0.06 0.11 7A. 1a: General waste stream ( enter code) 0.83 5.00 5.83 33.56 0.28 1.68 1.96 7A. 1b: Waste treatment method( s) sequence 0.83 7.00 7.83 33.56 0.28 2.35 2.63 7A. 1c: Range of influent concentration 0.83 30.00 30.83 33.56 0.28 10.07 10.35 7A. 1d: Waste treatment efficiency estimate 0.83 10.00 10.83 33.56 0.28 3.36 3.64 7A. 1e: Based on operating data? 0.17 0.17 0.33 33.56 0.06 0.06 0.11 Section 7B: On site energy recovery processes NA 0.08 0.08 0.17 98.90 0.08 0.08 0.16 Energy recovery methods 0.83 24.00 24.83 1.10 0.01 0.26 0.27 Section 7C: On site recycling processes NA 0.08 0.08 0.17 93.77 0.08 0.08 0.16 Energy recovery methods 0.83 27.00 27.83 6.23 0.05 1.68 1.73 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1c: Total off site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.33 92.85 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 92.85 0.23 4.64 4.87 Column C: Following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Column D: Second following year 0.08 1.00 1.08 92.85 0.08 0.93 1.01 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.33 1.96 0.00 0.00 0.01 Column B: Current reporting year 0.83 30.00 30.83 1.96 0.02 0.59 0.60 Column C: Following year 0.08 1.00 1.08 1.96 0.00 0.02 0.02 Column D: Second following year 0.08 1.00 1.08 1.96 0.00 0.02 0.02 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 1.00 1.08 2.95 0.00 0.03 0.03 Column B: Current reporting year 0.25 5.00 5.25 2.95 0.01 0.15 0.15 Column C: Following year 0.08 1.00 1.08 2.95 0.00 0.03 0.03 Column D: Second following year 0.08 1.00 1.08 2.95 0.00 0.03 0.03 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.33 7.17 0.01 0.02 0.02 Column B: Current reporting year 0.83 30.00 30.83 7.17 0.06 2.15 2.21 Column C: Following year 0.08 1.00 1.08 7.17 0.01 0.07 0.08 Column D: Second following year 0.08 1.00 1.08 7.17 0.01 0.07 0.08 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.33 30.21 0.03 0.08 0.10 Column B: Current reporting year 0.25 5.00 5.25 30.21 0.08 1.51 1.59 Column C: Following year 0.08 1.00 1.08 30.21 0.03 0.30 0.33 Column D: Second following year 0.08 1.00 1.08 30.21 0.03 0.30 0.33 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.33 6.36 0.01 0.02 0.02 Column B: Current reporting year 0.83 30.00 30.83 6.36 0.05 1.91 1.96 Column C: Following year 0.08 1.00 1.08 6.36 0.01 0.06 0.07 Column D: Second following year 0.08 1.00 1.08 6.36 0.01 0.06 0.07 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.33 5.86 0.00 0.01 0.02 Column B: Current reporting year 0.25 5.00 5.25 5.86 0.01 0.29 0.31 Column C: Following year 0.08 1.00 1.08 5.86 0.00 0.06 0.06 Column D: Second following year 0.08 1.00 1.08 5.86 0.00 0.06 0.06 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 5.25 24.37 0.06 1.22 1.28 Section 8.9: Production ratio or activity index 0.83 36.00 36.83 100.00 0.83 36.00 36.83 Section 8.10: Did your facility engage in any source reduction activities? 8.10.1 Source reduction activities 0.83 35.00 35.83 8.32 0.07 2.91 2.98 Methods to identify activity 0.08 0.25 0.33 8.29 0.01 0.02 0.03 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 46.08 1258.51 1304.59 17.49 370.13 387.63 TOTAL ( hr) 0.77 20.98 21.74 0.29 6.17 6.46 Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields. Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments. Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams. Proposed Item Management Technical Total Time Incidence Rate (%) Management Technical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.33 100.00 0.08 0.25 0.33 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.17 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title NA NA NA NA NA NA NA Signature NA NA NA NA NA NA NA Date signed NA NA NA NA NA NA NA ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Facility or establishment name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Street 0.08 0.00 0.08 100.00 0.08 0.00 0.08 City/ county/ state/ zip code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Facility or establishment name or mailing address ( if different from street address) 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Mailing address 0.08 0.00 0.08 100.00 0.08 0.00 0.08 City/ state/ zip code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Country ( non US) 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.17 100.00 0.08 0.08 0.17 Section 4.3: Technical contact name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Telephone number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Email address 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.4: Public contact name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Telephone number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.5: SIC code 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.6: Latitude Degrees 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Minutes 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Seconds 0.08 0.00 0.08 100.00 0.08 0.00 0.08 FORM R PART I: FACILITY IDENTIFICATION INFORMATION TABLE 8 SUBSEQUENT YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING FORM R ELECTRONICALLY FOR A NON PBT CHEMICAL Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min) Section 4.6: Longitude Degrees 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Minutes 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Seconds 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 4.7: Dun & Bradstreet number( s) 0.08 0.00 0.08 83.47 0.07 0.00 0.07 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 0.00 0.08 80.47 0.07 0.00 0.07 Section 4.9: Facility NPDES permit number( s) 0.08 0.00 0.08 45.97 0.04 0.00 0.04 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 0.00 0.08 0.59 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 5.2: Parent company's Dun & Bradstreet number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 1.2: Toxic chemical or chemical category name 0.08 0.00 0.08 100.00 0.08 0.00 0.08 Section 1.3: Generic chemical name 0.08 0.00 0.08 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.00 0.08 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.00 0.08 33.06 0.03 0.00 0.03 Section 3.2: Process the toxic chemical 0.08 0.00 0.08 59.84 0.05 0.00 0.05 Section 3.3: Otherwise use the toxic chemical 0.08 0.00 0.08 39.97 0.03 0.00 0.03 ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 0.83 30.00 30.83 100.00 0.83 30.00 30.83 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.33 100.00 0.08 0.25 0.33 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.17 28.32 0.02 0.02 0.05 A. Total release 2.50 115.00 117.50 71.68 1.79 82.43 84.22 B. Basis of estimate 0.08 0.25 0.33 71.61 0.06 0.18 0.24 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.17 26.15 0.02 0.02 0.04 A. Total release 1.67 66.00 67.67 73.85 1.23 48.74 49.97 B. Basis of estimate 0.08 0.25 0.33 73.78 0.06 0.18 0.25 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.17 73.56 0.06 0.06 0.12 5.3.1: Stream or water body name 0.08 0.25 0.33 26.44 0.02 0.07 0.09 A. Total release 2.50 82.44 84.94 26.44 0.66 21.80 22.46 B. Basis of estimate 0.08 0.25 0.33 26.42 0.02 0.07 0.09 C. % from stormwater 0.25 2.00 2.25 16.64 0.04 0.33 0.37 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.17 98.76 0.08 0.08 0.16 A. Total release 1.67 63.00 64.67 1.24 0.02 0.78 0.80 B. Basis of estimate 0.08 0.25 0.33 1.21 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.17 99.76 0.08 0.08 0.17 A. Total release 1.67 63.00 64.67 0.24 0.00 0.15 0.16 B. Basis of estimate 0.08 0.25 0.33 0.23 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.17 98.48 0.08 0.08 0.16 A. Total release 1.67 66.00 67.67 1.52 0.03 1.00 1.03 B. Basis of estimate 0.08 0.25 0.33 1.51 0.00 0.00 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.17 94.51 0.08 0.08 0.16 A. Total release 1.67 66.00 67.67 5.49 0.09 3.62 3.71 B. Basis of estimate 0.08 0.25 0.33 5.47 0.00 0.01 0.02 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.17 98.33 0.08 0.08 0.16 A. Total release 1.67 63.00 64.67 1.67 0.03 1.05 1.08 B. Basis of estimate 0.08 0.25 0.33 1.65 0.00 0.00 0.01 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.17 47.92 0.04 0.04 0.08 A. Total release 1.67 66.00 67.67 2.09 0.03 1.38 1.41 B. Basis of estimate 0.08 0.25 0.33 2.09 0.00 0.01 0.01 5.5.3B: Other surface impoundments NA 0.08 0.08 0.17 47.92 0.04 0.04 0.08 A. Total release 1.67 66.00 67.67 2.09 0.03 1.38 1.41 B. Basis of estimate 0.08 0.25 0.33 2.09 0.00 0.01 0.01 5.5.4: Other disposal NA 0.08 0.08 0.17 90.45 0.08 0.08 0.15 A. Total release 0.83 35.00 35.83 9.55 0.08 3.34 3.42 B. Basis of estimate 0.08 0.25 0.33 9.48 0.01 0.02 0.03 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs) 6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 1.67 58.00 59.67 23.97 0.40 13.90 14.30 6.1. A. 2: Basis of estimate 0.08 0.25 0.33 23.93 0.02 0.06 0.08 6.1. B POTW name 0.08 0.00 0.08 23.92 0.02 0.00 0.02 POTW address 0.08 0.00 0.08 23.92 0.02 0.00 0.02 City 0.08 0.00 0.08 23.92 0.02 0.00 0.02 State 0.08 0.00 0.08 23.92 0.02 0.00 0.02 County 0.08 0.00 0.08 23.92 0.02 0.00 0.02 Zip 0.08 0.00 0.08 23.92 0.02 0.00 0.02 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Off site location name 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Off site address 0.17 0.25 0.42 100.00 0.17 0.25 0.42 City 0.17 0.25 0.42 100.00 0.17 0.25 0.42 State 0.17 0.25 0.42 100.00 0.17 0.25 0.42 County 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Zip 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Country ( non US) 0.17 0.25 0.42 100.00 0.17 0.25 0.42 Is location under control of reporting facility or parent company? 0.17 0.08 0.25 100.00 0.17 0.08 0.25 A: Total transfers 2.50 82.00 84.50 100.00 2.50 82.00 84.50 B: Basis of estimate 0.17 0.25 0.42 99.99 0.17 0.25 0.42 C: Type of waste treatment/ disposal/ recycling/ energy recovery 0.17 0.25 0.42 99.97 0.17 0.25 0.42 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.17 51.48 0.04 0.04 0.09 7A. 1a: General waste stream ( enter code) 0.83 5.00 5.83 48.52 0.40 2.43 2.83 7A. 1b: Waste treatment method( s) sequence 0.83 7.00 7.83 48.52 0.40 3.40 3.80 7A. 1c: Range of influent concentration 0.83 30.00 30.83 48.52 0.40 14.56 14.96 7A. 1d: Waste treatment efficiency estimate 0.83 10.00 10.83 48.52 0.40 4.85 5.26 7A. 1e: Based on operating data? 0.17 0.17 0.33 48.52 0.08 0.08 0.16 Section 7B: On site energy recovery processes NA 0.08 0.08 0.17 95.60 0.08 0.08 0.16 Energy recovery methods 0.83 24.00 24.83 4.40 0.04 1.06 1.09 Section 7C: On site recycling processes NA 0.08 0.08 0.17 90.18 0.08 0.08 0.15 Energy recovery methods 0.83 27.00 27.83 9.82 0.08 2.65 2.73 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1c: Total off site disposal to Class I Underground Injection Wells, RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.33 93.89 0.08 0.23 0.31 Column B: Current reporting year 0.25 5.00 5.25 93.89 0.23 4.69 4.93 Column C: Following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Column D: Second following year 0.08 1.00 1.08 93.89 0.08 0.94 1.02 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.33 5.42 0.00 0.01 0.02 Column B: Current reporting year 0.83 30.00 30.83 5.42 0.05 1.63 1.67 Column C: Following year 0.08 1.00 1.08 5.42 0.00 0.05 0.06 Column D: Second following year 0.08 1.00 1.08 5.42 0.00 0.05 0.06 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 0.33 18.52 0.02 0.05 0.06 Column B: Current reporting year 0.25 5.00 5.25 18.52 0.05 0.93 0.97 Column C: Following year 0.08 1.00 1.08 18.52 0.02 0.19 0.20 Column D: Second following year 0.08 1.00 1.08 18.52 0.02 0.19 0.20 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.33 10.83 0.01 0.03 0.04 Column B: Current reporting year 0.83 30.00 30.83 10.83 0.09 3.25 3.34 Column C: Following year 0.08 1.00 1.08 10.83 0.01 0.11 0.12 Column D: Second following year 0.08 1.00 1.08 10.83 0.01 0.11 0.12 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.33 22.68 0.02 0.06 0.08 Column B: Current reporting year 0.25 5.00 5.25 22.68 0.06 1.13 1.19 Column C: Following year 0.08 1.00 1.08 22.68 0.02 0.23 0.25 Column D: Second following year 0.08 1.00 1.08 22.68 0.02 0.23 0.25 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.33 24.58 0.02 0.06 0.08 Column B: Current reporting year 0.83 30.00 30.83 24.58 0.20 7.37 7.58 Column C: Following year 0.08 1.00 1.08 24.58 0.02 0.25 0.27 Column D: Second following year 0.08 1.00 1.08 24.58 0.02 0.25 0.27 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.33 28.76 0.02 0.07 0.10 Column B: Current reporting year 0.25 5.00 5.25 28.76 0.07 1.44 1.51 Column C: Following year 0.08 1.00 1.08 28.76 0.02 0.29 0.31 Column D: Second following year 0.08 1.00 1.08 28.76 0.02 0.29 0.31 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 5.25 27.65 0.07 1.38 1.45 Section 8.9: Production ratio or activity index 0.83 36.00 36.83 100.00 0.83 36.00 36.83 Section 8.10: Did your facility engage in any source reduction activities? 8.10.1 Source reduction activities 0.83 35.00 35.83 13.25 0.11 4.64 4.75 Methods to identify activity 0.08 0.25 0.33 13.25 0.01 0.03 0.04 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 46.08 1258.11 1304.19 18.93 413.18 432.12 TOTAL ( hr) 0.77 20.97 21.74 0.32 6.89 7.20 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments. Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams. Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore data for 8.1 in RY 2002 were applied to all of the new fields. Proposed Item Management Technical Clerical Total Time Incidence Rate (%) Management Technical Clerical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 1.18 1.34 100.00 0.08 0.08 1.18 1.34 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 1.18 1.34 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Signature 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Date signed 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Facility or establishment name 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Street 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 City/ county/ state/ zip code 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Mailing address 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 City/ state/ zip code 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Country ( non US) 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 1.18 1.34 100.00 0.08 0.08 1.18 1.34 Section 4.3: Technical contact name 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Telephone number 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Email address 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Section 4.4:

Public contact name 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Telephone number 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 FIRST YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING A PAPER FORM R FOR A PBT CHEMICAL TABLE 10 Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min)

FORM R PART I: FACILITY IDENTIFICATION INFORMATION Section 4.5: SIC code 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Section 4.6: Latitude Degrees 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Minutes 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Seconds 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Section 4.6: Longitude Degrees 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Minutes 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Seconds 0.08 0.75 1.18 2.01 100.00 0.08 0.75 1.18 2.01 Section 4.7: Dun & Bradstreet number( s) 0.08 10.00 1.18 11.26 83.47 0.07 8.35 0.98 9.40 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 10.00 1.18 11.26 80.47 0.07 8.05 0.95 9.06 Section 4.9: Facility NPDES permit number( s) 0.08 10.00 1.18 11.26 45.97 0.04 4.60 0.54 5.18 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 10.00 1.18 11.26 0.59 0.00 0.06 0.01 0.07 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 10.00 1.18 11.26 100.00 0.08 10.00 1.18 11.26 Section 5.2: Parent company's Dun &

Bradstreet number 0.08 10.00 1.18 11.26 100.00 0.08 10.00 1.18 11.26 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 Section 1.3: Generic chemical name 0.08 0.50 1.18 1.76 0.00 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 1.18 1.51 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 1.18 1.34 46.98 0.04 0.04 0.55 0.63 Section 3.2: Process the toxic chemical 0.08 0.08 1.18 1.34 63.81 0.05 0.05 0.75 0.86 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 1.18 1.34 34.60 0.03 0.03 0.41 0.46 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 1.00 30.00 1.18 32.18 100.00 1.00 30.00 1.18 32.18 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 1.18 1.51 100.00 0.08 0.25 1.18 1.51 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 1.18 1.34 48.21 0.04 0.04 0.57 0.65 A. Total release 3.00 195.00 1.18 199.18 51.79 1.55 100.99 0.61 103.15 B. Basis of estimate 0.08 0.25 1.18 1.51 51.72 0.04 0.13 0.61 0.78 Section 5.2: Stack or point air emissions NA 0.08 0.08 1.18 1.34 25.44 0.02 0.02 0.30 0.34 A. Total release 3.00 86.00 1.18 90.18 74.56 2.24 64.12 0.88 67.23 B. Basis of estimate 0.08 0.25 1.18 1.51 74.43 0.06 0.19 0.88 1.12 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 1.18 1.34 71.42 0.06 0.06 0.84 0.96 5.3.1: Stream or water body name 0.08 0.25 1.18 1.51 28.58 0.02 0.07 0.34 0.43 A. Total release 3.00 116.07 1.18 120.25 28.58 0.86 33.17 0.34 34.37 B. Basis of estimate 0.08 0.25 1.18 1.51 28.56 0.02 0.07 0.34 0.43 C. % from stormwater 0.25 2.00 1.18 3.43 18.45 0.05 0.37 0.22 0.63 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 1.18 1.34 99.69 0.08 0.08 1.17 1.34 A. Total release 2.00 73.00 1.18 76.18 0.32 0.01 0.23 0.00 0.24 B. Basis of estimate 0.08 0.25 1.18 1.51 0.31 0.00 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 1.18 1.34 99.73 0.08 0.08 1.17 1.34 A. Total release 2.00 73.00 1.18 76.18 0.27 0.01 0.20 0.00 0.21 B. Basis of estimate 0.08 0.25 1.18 1.51 0.26 0.00 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 1.18 1.34 98.26 0.08 0.08 1.16 1.32 A. Total release 3.00 96.00 1.18 100.18 1.74 0.05 1.67 0.02 1.74 B. Basis of estimate 0.08 0.25 1.18 1.51 1.74 0.00 0.00 0.02 0.03 5.5.1B: Other landfills NA 0.08 0.08 1.18 1.34 90.54 0.08 0.08 1.06 1.22 A. Total release 3.00 96.00 1.18 100.18 9.46 0.28 9.08 0.11 9.48 B. Basis of estimate 0.08 0.25 1.18 1.51 9.45 0.01 0.02 0.11 0.14 5.5.2: Land treatment/ application farming NA 0.08 0.08 1.18 1.34 97.95 0.08 0.08 1.15 1.31 A. Total release 3.00 96.00 1.18 100.18 2.05 0.06 1.97 0.02 2.05 B. Basis of estimate 0.08 0.25 1.18 1.51 2.05 0.00 0.01 0.02 0.03 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 1.18 1.34 46.03 0.04 0.04 0.54 0.62 A. Total release 3.00 96.00 1.18 100.18 3.98 0.12 3.82 0.05 3.98 B. Basis of estimate 0.08 0.25 1.18 1.51 3.98 0.00 0.01 0.05 0.06 5.5.3B: Other surface impoundments NA 0.08 0.08 1.18 1.34 46.03 0.04 0.04 0.54 0.62 A. Total release 3.00 96.00 1.18 100.18 3.98 0.12 3.82 0.05 3.98 B. Basis of estimate 0.08 0.25 1.18 1.51 3.98 0.00 0.01 0.05 0.06 5.5.4: Other disposal NA 0.08 0.08 1.18 1.34 86.71 0.07 0.07 1.02 1.16 A. Total release 1.00 35.00 1.18 37.18 13.29 0.13 4.65 0.16 4.94 B. Basis of estimate 0.08 0.25 1.18 1.51 13.25 0.01 0.03 0.16 0.20 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs)

6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 2.00 73.00 1.18 76.18 19.01 0.38 13.88 0.22 14.48 6.1. A. 2: Basis of estimate 0.08 0.25 1.18 1.51 18.89 0.02 0.05 0.22 0.29 6.1. B POTW name 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 POTW address 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 City 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 State 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 County 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 Zip 0.08 0.25 1.18 1.51 18.90 0.02 0.05 0.22 0.29 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 Off site location name 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 Off site address 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 City 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 State 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 County 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 Zip 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 Country ( non US) 0.17 0.50 1.18 1.84 100.00 0.17 0.50 1.18 1.84 Is location under control of reporting facility or parent company? 0.17 0.17 1.18 1.51 100.00 0.17 0.17 1.18 1.51 A: Total transfers 3.00 107.00 1.18 111.18 100.00 3.00 107.00 1.18 111.18 B: Basis of estimate 0.17 0.50 1.18 1.84 99.90 0.17 0.50 1.17 1.84 C: Type of waste treatment/

disposal/ recycling/ energy recovery 0.17 0.50 1.18 1.84 99.83 0.17 0.50 1.17 1.84 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 1.18 1.34 66.44 0.06 0.06 0.78 0.89 7A. 1a: General waste stream ( enter code) 1.00 10.00 1.18 12.18 33.56 0.34 3.36 0.39 4.09 7A. 1b: Waste treatment method( s)

sequence 1.00 25.00 1.18 27.18 33.56 0.34 8.39 0.39 9.12 7A. 1c: Range of influent concentration 2.00 60.00 1.18 63.18 33.56 0.67 20.14 0.39 21.20 7A. 1d: Waste treatment efficiency estimate 1.00 30.00 1.18 32.18 33.56 0.34 10.07 0.39 10.80 7A. 1e: Based on operating data? 0.17 0.17 1.18 1.51 33.56 0.06 0.06 0.39 0.51 Section 7B: On site energy recovery processes NA 0.08 0.08 1.18 1.34 98.90 0.08 0.08 1.16 1.33 Energy recovery methods 1.00 32.00 1.18 34.18 1.10 0.01 0.35 0.01 0.38 Section 7C: On site recycling processes NA 0.08 0.08 1.18 1.34 93.77 0.08 0.08 1.10 1.26 Energy recovery methods 1.00 38.00 1.18 40.18 6.23 0.06 2.37 0.07 2.50 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 1.18 1.51 92.85 0.08 0.23 1.09 1.40 Column B: Current reporting year 0.25 5.00 1.18 6.43 92.85 0.23 4.64 1.09 5.97 Column C: Following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Column D: Second following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 1.18 1.51 92.85 0.08 0.23 1.09 1.40 Column B: Current reporting year 0.25 5.00 1.18 6.43 92.85 0.23 4.64 1.09 5.97 Column C: Following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Column D: Second following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Section 8.1c: Total off site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 1.18 1.51 92.85 0.08 0.23 1.09 1.40 Column B: Current reporting year 0.25 5.00 1.18 6.43 92.85 0.23 4.64 1.09 5.97 Column C: Following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Column D: Second following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 1.18 1.51 92.85 0.08 0.23 1.09 1.40 Column B: Current reporting year 0.25 5.00 1.18 6.43 92.85 0.23 4.64 1.09 5.97 Column C: Following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Column D: Second following year 0.08 1.00 1.18 2.26 92.85 0.08 0.93 1.09 2.10 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 1.18 1.51 1.96 0.00 0.00 0.02 0.03 Column B: Current reporting year 1.00 30.00 1.18 32.18 1.96 0.02 0.59 0.02 0.63 Column C: Following year 0.08 1.00 1.18 2.26 1.96 0.00 0.02 0.02 0.04 Column D: Second following year 0.08 1.00 1.18 2.26 1.96 0.00 0.02 0.02 0.04 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 1.18 1.51 2.95 0.00 0.01 0.03 0.04 Column B: Current reporting year 0.25 5.00 1.18 6.43 2.95 0.01 0.15 0.03 0.19 Column C: Following year 0.08 1.00 1.18 2.26 2.95 0.00 0.03 0.03 0.07 Column D: Second following year 0.08 1.00 1.18 2.26 2.95 0.00 0.03 0.03 0.07 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 1.18 1.51 7.17 0.01 0.02 0.08 0.11 Column B: Current reporting year 1.00 30.00 1.18 32.18 7.17 0.07 2.15 0.08 2.31 Column C: Following year 0.08 1.00 1.18 2.26 7.17 0.01 0.07 0.08 0.16 Column D: Second following year 0.08 1.00 1.18 2.26 7.17 0.01 0.07 0.08 0.16 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 1.18 1.51 30.21 0.03 0.08 0.36 0.46 Column B: Current reporting year 0.25 5.00 1.18 6.43 30.21 0.08 1.51 0.36 1.94 Column C: Following year 0.08 1.00 1.18 2.26 30.21 0.03 0.30 0.36 0.68 Column D: Second following year 0.08 1.00 1.18 2.26 30.21 0.03 0.30 0.36 0.68 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 1.18 1.51 6.36 0.01 0.02 0.07 0.10 Column B: Current reporting year 1.00 30.00 1.18 32.18 6.36 0.06 1.91 0.07 2.05 Column C: Following year 0.08 1.00 1.18 2.26 6.36 0.01 0.06 0.07 0.14 Column D: Second following year 0.08 1.00 1.18 2.26 6.36 0.01 0.06 0.07 0.14 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 1.18 1.51 5.86 0.00 0.01 0.07 0.09 Column B: Current reporting year 0.25 5.00 1.18 6.43 5.86 0.01 0.29 0.07 0.38 Column C: Following year 0.08 1.00 1.18 2.26 5.86 0.00 0.06 0.07 0.13 Column D: Second following year 0.08 1.00 1.18 2.26 5.86 0.00 0.06 0.07 0.13 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 1.18 6.43 24.37 0.06 1.22 0.29 1.57 Section 8.9: Production ratio or activity index 0.83 36.00 1.18 38.01 100.00 0.83 36.00 1.18 38.01 Section 8.10: Did your facility engage in any source reduction activities?

8.10.1 Source reduction activities 1.00 35.00 1.18 37.18 8.32 0.08 2.91 0.10 3.09 Methods to identify activity 0.08 0.25 1.18 1.51 8.29 0.01 0.02 0.10 0.13 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 60.33 1770.32 174.00 2004.65 21.29 551.86 95.49 668.65 TOTAL ( hr) 1.01 29.51 2.90 33.41 0.35 9.20 1.59 11.14 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments.

Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers.

Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams.

Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields. Proposed Item Management Technical Clerical Total Time Incidence Rate (%) Management Technical Clerical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.66 0.82 100.00 0.08 0.08 0.66 0.82 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.66 0.82 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Signature 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Date signed 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Facility or establishment name 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Street 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 City/ county/ state/ zip code 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Mailing address 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 City/ state/ zip code 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Country ( non US) 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.66 0.82 100.00 0.08 0.08 0.66 0.82 Section 4.3: Technical contact name 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Telephone number 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Email address 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Section 4.4:

Public contact name 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Telephone number 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 TABLE 11 FIRST YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING A PAPER FORM R FOR A NON PBT CHEMICAL Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min)

FORM R PART I: FACILITY IDENTIFICATION INFORMATION Section 4.5: SIC code 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Section 4.6: Latitude Degrees 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Minutes 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Seconds 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Section 4.6: Longitude Degrees 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Minutes 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Seconds 0.08 0.75 0.66 1.49 100.00 0.08 0.75 0.66 1.49 Section 4.7: Dun & Bradstreet number( s) 0.08 10.00 0.66 10.74 83.47 0.07 8.35 0.55 8.96 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 10.00 0.66 10.74 80.47 0.07 8.05 0.53 8.64 Section 4.9: Facility NPDES permit number( s) 0.08 10.00 0.66 10.74 45.97 0.04 4.60 0.30 4.94 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 10.00 0.66 10.74 0.59 0.00 0.06 0.00 0.06 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 10.00 0.66 10.74 100.00 0.08 10.00 0.66 10.74 Section 5.2: Parent company's Dun &

Bradstreet number 0.08 10.00 0.66 10.74 100.00 0.08 10.00 0.66 10.74 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 Section 1.3: Generic chemical name 0.08 0.50 0.66 1.24 0.00 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 0.66 0.99 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 0.66 0.82 33.06 0.03 0.03 0.22 0.27 Section 3.2: Process the toxic chemical 0.08 0.08 0.66 0.82 59.84 0.05 0.05 0.39 0.49 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 0.66 0.82 39.97 0.03 0.03 0.26 0.33 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 1.00 30.00 0.66 31.66 100.00 1.00 30.00 0.66 31.66 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.66 0.99 100.00 0.08 0.25 0.66 0.99 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.66 0.82 28.32 0.02 0.02 0.19 0.23 A. Total release 3.00 195.00 0.66 198.66 71.68 2.15 139.78 0.47 142.40 B. Basis of estimate 0.08 0.25 0.66 0.99 71.61 0.06 0.18 0.47 0.71 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.66 0.82 26.15 0.02 0.02 0.17 0.22 A. Total release 3.00 106.00 0.66 109.66 73.85 2.22 78.28 0.48 80.98 B. Basis of estimate 0.08 0.25 0.66 0.99 73.78 0.06 0.18 0.48 0.73 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.66 0.82 73.56 0.06 0.06 0.48 0.60 5.3.1: Stream or water body name 0.08 0.25 0.66 0.99 26.44 0.02 0.07 0.17 0.26 A. Total release 3.00 111.58 0.66 115.24 26.44 0.79 29.50 0.17 30.47 B. Basis of estimate 0.08 0.25 0.66 0.99 26.42 0.02 0.07 0.17 0.26 C. % from stormwater 0.25 2.00 0.66 2.91 16.64 0.04 0.33 0.11 0.48 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.66 0.82 98.76 0.08 0.08 0.65 0.81 A. Total release 2.00 73.00 0.66 75.66 1.24 0.02 0.91 0.01 0.94 B. Basis of estimate 0.08 0.25 0.66 0.99 1.21 0.00 0.00 0.01 0.01 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.66 0.82 99.76 0.08 0.08 0.65 0.82 A. Total release 2.00 73.00 0.66 75.66 0.24 0.00 0.18 0.00 0.18 B. Basis of estimate 0.08 0.25 0.66 0.99 0.23 0.00 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.66 0.82 98.48 0.08 0.08 0.65 0.81 A. Total release 3.00 96.00 0.66 99.66 1.52 0.05 1.46 0.01 1.51 B. Basis of estimate 0.08 0.25 0.66 0.99 1.51 0.00 0.00 0.01 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.66 0.82 94.51 0.08 0.08 0.62 0.78 A. Total release 3.00 96.00 0.66 99.66 5.49 0.16 5.27 0.04 5.47 B. Basis of estimate 0.08 0.25 0.66 0.99 5.47 0.00 0.01 0.04 0.05 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.66 0.82 98.33 0.08 0.08 0.64 0.81 A. Total release 2.00 73.00 0.66 75.66 1.67 0.03 1.22 0.01 1.26 B. Basis of estimate 0.08 0.25 0.66 0.99 1.65 0.00 0.00 0.01 0.02 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.66 0.82 47.92 0.04 0.04 0.31 0.39 A. Total release 3.00 96.00 0.66 99.66 2.09 0.06 2.00 0.01 2.08 B. Basis of estimate 0.08 0.25 0.66 0.99 2.09 0.00 0.01 0.01 0.02 5.5.3B: Other surface impoundments NA 0.08 0.08 0.66 0.82 47.92 0.04 0.04 0.31 0.39 A. Total release 3.00 96.00 0.66 99.66 2.09 0.06 2.00 0.01 2.08 B. Basis of estimate 0.08 0.25 0.66 0.99 2.09 0.00 0.01 0.01 0.02 5.5.4: Other disposal NA 0.08 0.08 0.66 0.82 90.45 0.08 0.08 0.59 0.74 A. Total release 1.00 35.00 0.66 36.66 9.55 0.10 3.34 0.06 3.50 B. Basis of estimate 0.08 0.25 0.66 0.99 9.48 0.01 0.02 0.06 0.09 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs)

6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 2.00 73.00 0.66 75.66 23.97 0.48 17.50 0.16 18.13 6.1. A. 2: Basis of estimate 0.08 0.25 0.66 0.99 23.93 0.02 0.06 0.16 0.24 6.1. B POTW name 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 POTW address 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 City 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 State 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 County 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 Zip 0.08 0.25 0.66 0.99 23.92 0.02 0.06 0.16 0.24 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 Off site location name 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 Off site address 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 City 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 State 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 County 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 Zip 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 Country ( non US) 0.17 0.50 0.66 1.32 100.00 0.17 0.50 0.66 1.32 Is location under control of reporting facility or parent company? 0.17 0.17 0.66 0.99 100.00 0.17 0.17 0.66 0.99 A: Total transfers 3.00 107.00 0.66 110.66 100.00 3.00 107.00 0.66 110.66 B: Basis of estimate 0.17 0.50 0.66 1.32 99.99 0.17 0.50 0.66 1.32 C: Type of waste treatment/

disposal/ recycling/ energy recovery 0.17 0.50 0.66 1.32 99.97 0.17 0.50 0.66 1.32 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.66 0.82 51.48 0.04 0.04 0.34 0.42 7A. 1a: General waste stream ( enter code) 1.00 10.00 0.66 11.66 48.52 0.49 4.85 0.32 5.66 7A. 1b: Waste treatment method( s)

sequence 1.00 25.00 0.66 26.66 48.52 0.49 12.13 0.32 12.93 7A. 1c: Range of influent concentration 2.00 60.00 0.66 62.66 48.52 0.97 29.11 0.32 30.40 7A. 1d: Waste treatment efficiency estimate 1.00 30.00 0.66 31.66 48.52 0.49 14.56 0.32 15.36 7A. 1e: Based on operating data? 0.17 0.17 0.66 0.99 48.52 0.08 0.08 0.32 0.48 Section 7B: On site energy recovery processes NA 0.08 0.08 0.66 0.82 95.60 0.08 0.08 0.63 0.79 Energy recovery methods 1.00 32.00 0.66 33.66 4.40 0.04 1.41 0.03 1.48 Section 7C: On site recycling processes NA 0.08 0.08 0.66 0.82 90.18 0.08 0.08 0.59 0.74 Energy recovery methods 1.00 38.00 0.66 39.66 9.82 0.10 3.73 0.06 3.89 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.66 0.99 93.89 0.08 0.23 0.62 0.93 Column B: Current reporting year 0.25 5.00 0.66 5.91 93.89 0.23 4.69 0.62 5.54 Column C: Following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Column D: Second following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.66 0.99 93.89 0.08 0.23 0.62 0.93 Column B: Current reporting year 0.25 5.00 0.66 5.91 93.89 0.23 4.69 0.62 5.54 Column C: Following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Column D: Second following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Section 8.1c: Total off site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.66 0.99 93.89 0.08 0.23 0.62 0.93 Column B: Current reporting year 0.25 5.00 0.66 5.91 93.89 0.23 4.69 0.62 5.54 Column C: Following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Column D: Second following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.66 0.99 93.89 0.08 0.23 0.62 0.93 Column B: Current reporting year 0.25 5.00 0.66 5.91 93.89 0.23 4.69 0.62 5.54 Column C: Following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Column D: Second following year 0.08 1.00 0.66 1.74 93.89 0.08 0.94 0.62 1.63 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.66 0.99 5.42 0.00 0.01 0.04 0.05 Column B: Current reporting year 1.00 30.00 0.66 31.66 5.42 0.05 1.63 0.04 1.72 Column C: Following year 0.08 1.00 0.66 1.74 5.42 0.00 0.05 0.04 0.09 Column D: Second following year 0.08 1.00 0.66 1.74 5.42 0.00 0.05 0.04 0.09 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 0.66 0.99 18.52 0.02 0.05 0.12 0.18 Column B: Current reporting year 0.25 5.00 0.66 5.91 18.52 0.05 0.93 0.12 1.09 Column C: Following year 0.08 1.00 0.66 1.74 18.52 0.02 0.19 0.12 0.32 Column D: Second following year 0.08 1.00 0.66 1.74 18.52 0.02 0.19 0.12 0.32 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.66 0.99 10.83 0.01 0.03 0.07 0.11 Column B: Current reporting year 1.00 30.00 0.66 31.66 10.83 0.11 3.25 0.07 3.43 Column C: Following year 0.08 1.00 0.66 1.74 10.83 0.01 0.11 0.07 0.19 Column D: Second following year 0.08 1.00 0.66 1.74 10.83 0.01 0.11 0.07 0.19 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.66 0.99 22.68 0.02 0.06 0.15 0.22 Column B: Current reporting year 0.25 5.00 0.66 5.91 22.68 0.06 1.13 0.15 1.34 Column C: Following year 0.08 1.00 0.66 1.74 22.68 0.02 0.23 0.15 0.39 Column D: Second following year 0.08 1.00 0.66 1.74 22.68 0.02 0.23 0.15 0.39 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.66 0.99 24.58 0.02 0.06 0.16 0.24 Column B: Current reporting year 1.00 30.00 0.66 31.66 24.58 0.25 7.37 0.16 7.78 Column C: Following year 0.08 1.00 0.66 1.74 24.58 0.02 0.25 0.16 0.43 Column D: Second following year 0.08 1.00 0.66 1.74 24.58 0.02 0.25 0.16 0.43 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.66 0.99 28.76 0.02 0.07 0.19 0.28 Column B: Current reporting year 0.25 5.00 0.66 5.91 28.76 0.07 1.44 0.19 1.70 Column C: Following year 0.08 1.00 0.66 1.74 28.76 0.02 0.29 0.19 0.50 Column D: Second following year 0.08 1.00 0.66 1.74 28.76 0.02 0.29 0.19 0.50 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 0.66 5.91 27.65 0.07 1.38 0.18 1.63 Section 8.9: Production ratio or activity index 0.83 36.00 0.66 37.49 100.00 0.83 36.00 0.66 37.49 Section 8.10: Did your facility engage in any source reduction activities?

8.10.1 Source reduction activities 1.00 35.00 0.66 36.66 13.25 0.13 4.64 0.09 4.86 Methods to identify activity 0.08 0.25 0.66 0.99 13.25 0.01 0.03 0.09 0.13 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 59.33 1762.83 97.02 1919.18 23.00 629.49 55.50 708.00 TOTAL ( hr) 0.99 29.38 1.62 31.99 0.38 10.49 0.93 11.80 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments.

Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers.

Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams.

Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields. Proposed Item Management Technical Clerical Total Time Incidence Rate (%) Management Technical Clerical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.81 0.98 100.00 0.08 0.08 0.81 0.98 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.81 0.98 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Signature 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Date signed 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Facility or establishment name 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Street 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 City/ county/ state/ zip code 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Mailing address 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 City/ state/ zip code 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Country ( non US) 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.81 0.98 100.00 0.08 0.08 0.81 0.98 Section 4.3: Technical contact name 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Telephone number 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Email address 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 4.4:

Public contact name 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Telephone number 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 TABLE 12 SUBSEQUENT YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING A PAPER FORM R FOR A PBT CHEMICAL Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min)

FORM R PART I: FACILITY IDENTIFICATION INFORMATION Section 4.5: SIC code 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 4.6: Latitude Degrees 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Minutes 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Seconds 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 4.6: Longitude Degrees 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Minutes 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Seconds 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 4.7: Dun & Bradstreet number( s) 0.08 0.25 0.81 1.14 83.47 0.07 0.21 0.68 0.96 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 0.25 0.81 1.14 80.47 0.07 0.20 0.65 0.92 Section 4.9: Facility NPDES permit number( s) 0.08 0.25 0.81 1.14 45.97 0.04 0.11 0.37 0.53 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 0.25 0.81 1.14 0.59 0.00 0.00 0.00 0.01 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 5.2: Parent company's Dun &

Bradstreet number 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 Section 1.3: Generic chemical name 0.08 0.25 0.81 1.14 0.00 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 0.81 1.14 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 0.81 0.98 46.98 0.04 0.04 0.38 0.46 Section 3.2: Process the toxic chemical 0.08 0.08 0.81 0.98 63.81 0.05 0.05 0.52 0.62 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 0.81 0.98 34.60 0.03 0.03 0.28 0.34 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 0.83 30.00 0.81 31.64 100.00 0.83 30.00 0.81 31.64 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.81 1.14 100.00 0.08 0.25 0.81 1.14 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.81 0.98 48.21 0.04 0.04 0.39 0.47 A. Total release 2.50 115.00 0.81 118.31 51.79 1.29 59.56 0.42 61.27 B. Basis of estimate 0.08 0.25 0.81 1.14 51.72 0.04 0.13 0.42 0.59 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.81 0.98 25.44 0.02 0.02 0.21 0.25 A. Total release 1.67 60.00 0.81 62.48 74.56 1.24 44.74 0.60 46.58 B. Basis of estimate 0.08 0.25 0.81 1.14 74.43 0.06 0.19 0.60 0.85 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.81 0.98 71.42 0.06 0.06 0.58 0.70 5.3.1: Stream or water body name 0.08 0.25 0.81 1.14 28.58 0.02 0.07 0.23 0.33 A. Total release 2.50 85.09 0.81 88.40 28.58 0.71 24.32 0.23 25.26 B. Basis of estimate 0.08 0.25 0.81 1.14 28.56 0.02 0.07 0.23 0.33 C. % from stormwater 0.25 2.00 0.81 3.06 18.45 0.05 0.37 0.15 0.56 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.81 0.98 99.69 0.08 0.08 0.81 0.97 A. Total release 1.67 63.00 0.81 65.48 0.32 0.01 0.20 0.00 0.21 B. Basis of estimate 0.08 0.25 0.81 1.14 0.31 0.00 0.00 0.00 0.00 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.81 0.98 99.73 0.08 0.08 0.81 0.97 A. Total release 1.67 63.00 0.81 65.48 0.27 0.00 0.17 0.00 0.18 B. Basis of estimate 0.08 0.25 0.81 1.14 0.26 0.00 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.81 0.98 98.26 0.08 0.08 0.80 0.96 A. Total release 1.67 66.00 0.81 68.48 1.74 0.03 1.15 0.01 1.19 B. Basis of estimate 0.08 0.25 0.81 1.14 1.74 0.00 0.00 0.01 0.02 5.5.1B: Other landfills NA 0.08 0.08 0.81 0.98 90.54 0.08 0.08 0.73 0.89 A. Total release 1.67 66.00 0.81 68.48 9.46 0.16 6.24 0.08 6.48 B. Basis of estimate 0.08 0.25 0.81 1.14 9.45 0.01 0.02 0.08 0.11 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.81 0.98 97.95 0.08 0.08 0.79 0.96 A. Total release 1.67 66.00 0.81 68.48 2.05 0.03 1.35 0.02 1.40 B. Basis of estimate 0.08 0.25 0.81 1.14 2.05 0.00 0.01 0.02 0.02 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.81 0.98 46.03 0.04 0.04 0.37 0.45 A. Total release 1.67 66.00 0.81 68.48 3.98 0.07 2.62 0.03 2.72 B. Basis of estimate 0.08 0.25 0.81 1.14 3.98 0.00 0.01 0.03 0.05 5.5.3B: Other surface impoundments NA 0.08 0.08 0.81 0.98 46.03 0.04 0.04 0.37 0.45 A. Total release 1.67 66.00 0.81 68.48 3.98 0.07 2.62 0.03 2.72 B. Basis of estimate 0.08 0.25 0.81 1.14 3.98 0.00 0.01 0.03 0.05 5.5.4: Other disposal NA 0.08 0.08 0.81 0.98 86.71 0.07 0.07 0.70 0.85 A. Total release 0.83 35.00 0.81 36.64 13.29 0.11 4.65 0.11 4.87 B. Basis of estimate 0.08 0.25 0.81 1.14 13.25 0.01 0.03 0.11 0.15 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs)

6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 1.67 58.00 0.81 60.48 19.01 0.32 11.03 0.15 11.50 6.1. A. 2: Basis of estimate 0.08 0.25 0.81 1.14 18.89 0.02 0.05 0.15 0.22 6.1. B POTW name 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 POTW address 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 City 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 State 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 County 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 Zip 0.08 0.25 0.81 1.14 18.90 0.02 0.05 0.15 0.22 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 Off site location name 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 Off site address 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 City 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 State 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 County 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 Zip 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 Country ( non US) 0.17 0.50 0.81 1.48 100.00 0.17 0.50 0.81 1.48 Is location under control of reporting facility or parent company? 0.17 0.17 0.81 1.14 100.00 0.17 0.17 0.81 1.14 A: Total transfers 2.50 82.00 0.81 85.31 100.00 2.50 82.00 0.81 85.31 B: Basis of estimate 0.08 0.50 0.81 1.39 99.90 0.08 0.50 0.81 1.39 C: Type of waste treatment/

disposal/ recycling/ energy recovery 0.17 0.50 0.81 1.48 99.83 0.17 0.50 0.81 1.47 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.81 0.98 66.44 0.06 0.06 0.54 0.65 7A. 1a: General waste stream ( enter code) 0.83 5.00 0.81 6.64 33.56 0.28 1.68 0.27 2.23 7A. 1b: Waste treatment method( s)

sequence 0.83 7.00 0.81 8.64 33.56 0.28 2.35 0.27 2.90 7A. 1c: Range of influent concentration 0.83 30.00 0.81 31.64 33.56 0.28 10.07 0.27 10.62 7A. 1d: Waste treatment efficiency estimate 0.83 10.00 0.81 11.64 33.56 0.28 3.36 0.27 3.91 7A. 1e: Based on operating data? 0.17 0.17 0.81 1.14 33.56 0.06 0.06 0.27 0.38 Section 7B: On site energy recovery processes NA 0.08 0.08 0.81 0.98 98.90 0.08 0.08 0.80 0.97 Energy recovery methods 0.83 24.00 0.81 25.64 1.10 0.01 0.26 0.01 0.28 Section 7C: On site recycling processes NA 0.08 0.08 0.81 0.98 93.77 0.08 0.08 0.76 0.92 Energy recovery methods 0.83 27.00 0.81 28.64 6.23 0.05 1.68 0.05 1.78 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.81 1.14 92.85 0.08 0.23 0.75 1.06 Column B: Current reporting year 0.25 5.00 0.81 6.06 92.85 0.23 4.64 0.75 5.63 Column C: Following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Column D: Second following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.81 1.14 92.85 0.08 0.23 0.75 1.06 Column B: Current reporting year 0.25 5.00 0.81 6.06 92.85 0.23 4.64 0.75 5.63 Column C: Following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Column D: Second following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Section 8.1c: Total off site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.81 1.14 92.85 0.08 0.23 0.75 1.06 Column B: Current reporting year 0.25 5.00 0.81 6.06 92.85 0.23 4.64 0.75 5.63 Column C: Following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Column D: Second following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.81 1.14 92.85 0.08 0.23 0.75 1.06 Column B: Current reporting year 0.25 5.00 0.81 6.06 92.85 0.23 4.64 0.75 5.63 Column C: Following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Column D: Second following year 0.08 1.00 0.81 1.89 92.85 0.08 0.93 0.75 1.76 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.81 1.14 1.96 0.00 0.00 0.02 0.02 Column B: Current reporting year 0.83 30.00 0.81 31.64 1.96 0.02 0.59 0.02 0.62 Column C: Following year 0.08 1.00 0.81 1.89 1.96 0.00 0.02 0.02 0.04 Column D: Second following year 0.08 1.00 0.81 1.89 1.96 0.00 0.02 0.02 0.04 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 1.00 0.81 1.89 2.95 0.00 0.03 0.02 0.06 Column B: Current reporting year 0.25 5.00 0.81 6.06 2.95 0.01 0.15 0.02 0.18 Column C: Following year 0.08 1.00 0.81 1.89 2.95 0.00 0.03 0.02 0.06 Column D: Second following year 0.08 1.00 0.81 1.89 2.95 0.00 0.03 0.02 0.06 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.81 1.14 7.17 0.01 0.02 0.06 0.08 Column B: Current reporting year 0.83 30.00 0.81 31.64 7.17 0.06 2.15 0.06 2.27 Column C: Following year 0.08 1.00 0.81 1.89 7.17 0.01 0.07 0.06 0.14 Column D: Second following year 0.08 1.00 0.81 1.89 7.17 0.01 0.07 0.06 0.14 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.81 1.14 30.21 0.03 0.08 0.24 0.35 Column B: Current reporting year 0.25 5.00 0.81 6.06 30.21 0.08 1.51 0.24 1.83 Column C: Following year 0.08 1.00 0.81 1.89 30.21 0.03 0.30 0.24 0.57 Column D: Second following year 0.08 1.00 0.81 1.89 30.21 0.03 0.30 0.24 0.57 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.81 1.14 6.36 0.01 0.02 0.05 0.07 Column B: Current reporting year 0.83 30.00 0.81 31.64 6.36 0.05 1.91 0.05 2.01 Column C: Following year 0.08 1.00 0.81 1.89 6.36 0.01 0.06 0.05 0.12 Column D: Second following year 0.08 1.00 0.81 1.89 6.36 0.01 0.06 0.05 0.12 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.81 1.14 5.86 0.00 0.01 0.05 0.07 Column B: Current reporting year 0.25 5.00 0.81 6.06 5.86 0.01 0.29 0.05 0.36 Column C: Following year 0.08 1.00 0.81 1.89 5.86 0.00 0.06 0.05 0.11 Column D: Second following year 0.08 1.00 0.81 1.89 5.86 0.00 0.06 0.05 0.11 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 0.81 6.06 24.37 0.06 1.22 0.20 1.48 Section 8.9: Production ratio or activity index 0.83 36.00 0.81 37.64 100.00 0.83 36.00 0.81 37.64 Section 8.10: Did your facility engage in any source reduction activities?

8.10.1 Source reduction activities 0.83 35.00 0.81 36.64 8.32 0.07 2.91 0.07 3.05 Methods to identify activity 0.08 0.25 0.81 1.14 8.29 0.01 0.02 0.07 0.09 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 46.75 1270.34 120.00 1437.09 18.16 379.65 65.86 463.67 TOTAL ( hr) 0.78 21.17 2.00 23.95 0.30 6.33 1.10 7.73 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments.

Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams.

Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields.

Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers. Proposed Item Management Technical Clerical Total Time Incidence Rate (%) Management Technical Clerical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? 0.08 0.08 0.45 0.61 100.00 0.08 0.08 0.45 0.61 Section 2.2: Is this copy sanitized or unsanitized? 0.08 0.08 0.45 0.61 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Certification Name and official title 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Signature 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 Date signed 0.25 0.00 0.00 0.25 100.00 0.25 0.00 0.00 0.25 ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Facility or establishment name 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Street 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 City/ county/ state/ zip code 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Facility or establishment name or mailing address ( if different from street address) 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Mailing address 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 City/ state/ zip code 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Country ( non US) 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) 0.08 0.08 0.45 0.61 100.00 0.08 0.08 0.45 0.61 Section 4.3: Technical contact name 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Telephone number 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Email address 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 4.4:

Public contact name 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Telephone number 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 TABLE 13 SUBSEQUENT YEAR REALISTIC DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING A PAPER FORM R FOR A NON PBT CHEMICAL Realistic reporting burden per Form R ( min) Estimated reporting burden per Form R weighted by the incidence rate ( min)

FORM R PART I: FACILITY IDENTIFICATION INFORMATION Section 4.5: SIC code 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 4.6: Latitude Degrees 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Minutes 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Seconds 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 4.6: Longitude Degrees 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Minutes 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Seconds 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 4.7: Dun & Bradstreet number( s) 0.08 0.25 0.45 0.78 83.47 0.07 0.21 0.37 0.65 Section 4.8: EPA identification number ( RCRA I. D. No.) 0.08 0.25 0.45 0.78 80.47 0.07 0.20 0.36 0.63 Section 4.9: Facility NPDES permit number( s) 0.08 0.25 0.45 0.78 45.97 0.04 0.11 0.21 0.36 Section 4.10: Underground injection well code ( UIC) I. D. number( s) 0.08 0.25 0.45 0.78 0.59 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 5: Parent Company Information Section 5.1: Name of parent company 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 5.2: Parent company's Dun &

Bradstreet number 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 ITEMS PERTAINING TO SECTION 1: Toxic Chemical Identity Section 1.1: CAS number 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 1.2: Toxic chemical or chemical category name 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 Section 1.3: Generic chemical name 0.08 0.25 0.45 0.78 0.00 0.00 0.00 0.00 0.00 Section 1.4: Distribution of each member of the dioxin and dioxin like compounds category 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 2: Mixture Component Identity Section 2.1: Generic chemical name provided by supplier 0.08 0.25 0.45 0.78 0.00 0.00 0.00 0.00 0.00 ITEMS PERTAINING TO SECTION 3: Activities and Uses of the Toxic Chemical at the Facility Section 3.1: Manufacture the toxic chemical 0.08 0.08 0.45 0.61 33.06 0.03 0.03 0.15 0.20 Section 3.2: Process the toxic chemical 0.08 0.08 0.45 0.61 59.84 0.05 0.05 0.27 0.37 Section 3.3: Otherwise use the toxic chemical 0.08 0.08 0.45 0.61 39.97 0.03 0.03 0.18 0.24 FORM R PART II: CHEMICAL SPECIFIC INFORMATION ITEMS PERTAINING TO SECTION 4: Maximum Amount of the Toxic Chemical On Site at any Time During the Calendar Year Section 4.1: Determine maximum quantity on site 0.83 30.00 0.45 31.28 100.00 0.83 30.00 0.45 31.28 Section 4.1: ( Enter two digit code from instruction package) 0.08 0.25 0.45 0.78 100.00 0.08 0.25 0.45 0.78 ITEMS PERTAINING TO SECTION 5: Quantity of the Toxic Chemical Entering each Environmental Medium On Site Section 5.1: Fugitive or non point air emissions NA 0.08 0.08 0.45 0.61 28.32 0.02 0.02 0.13 0.17 A. Total release 2.50 115.00 0.45 117.95 71.68 1.79 82.43 0.32 84.54 B. Basis of estimate 0.08 0.25 0.45 0.78 71.61 0.06 0.18 0.32 0.56 Section 5.2: Stack or point air emissions NA 0.08 0.08 0.45 0.61 26.15 0.02 0.02 0.12 0.16 A. Total release 1.67 66.00 0.45 68.11 73.85 1.23 48.74 0.33 50.30 B. Basis of estimate 0.08 0.25 0.45 0.78 73.78 0.06 0.18 0.33 0.57 Section 5.3: Discharges to receiving streams or water bodies NA 0.08 0.08 0.45 0.61 73.56 0.06 0.06 0.33 0.45 5.3.1: Stream or water body name 0.08 0.25 0.45 0.78 26.44 0.02 0.07 0.12 0.21 A. Total release 2.50 82.44 0.45 85.39 26.44 0.66 21.80 0.12 22.58 B. Basis of estimate 0.08 0.25 0.45 0.78 26.42 0.02 0.07 0.12 0.21 C. % from stormwater 0.25 2.00 0.45 2.70 16.64 0.04 0.33 0.07 0.45 5.4.1: Underground injection onsite to Class I wells NA 0.08 0.08 0.45 0.61 98.76 0.08 0.08 0.44 0.61 A. Total release 1.67 63.00 0.45 65.11 1.24 0.02 0.78 0.01 0.81 B. Basis of estimate 0.08 0.25 0.45 0.78 1.21 0.00 0.00 0.01 0.01 Section 5.4.2: Underground injection onsite to Class II V wells NA 0.08 0.08 0.45 0.61 99.76 0.08 0.08 0.44 0.61 A. Total release 1.67 63.00 0.45 65.11 0.24 0.00 0.15 0.00 0.16 B. Basis of estimate 0.08 0.25 0.45 0.78 0.23 0.00 0.00 0.00 0.00 Section 5.5: Disposal to land on site 5.5.1A: RCRA Subtitle C landfills NA 0.08 0.08 0.45 0.61 98.48 0.08 0.08 0.44 0.60 A. Total release 1.67 66.00 0.45 68.11 1.52 0.03 1.00 0.01 1.04 B. Basis of estimate 0.08 0.25 0.45 0.78 1.51 0.00 0.00 0.01 0.01 5.5.1B: Other landfills NA 0.08 0.08 0.45 0.61 94.51 0.08 0.08 0.42 0.58 A. Total release 1.67 66.00 0.45 68.11 5.49 0.09 3.62 0.02 3.74 B. Basis of estimate 0.08 0.25 0.45 0.78 5.47 0.00 0.01 0.02 0.04 5.5.2: Land treatment/ application farming NA 0.08 0.08 0.45 0.61 98.33 0.08 0.08 0.44 0.60 A. Total release 1.67 63.00 0.45 65.11 1.67 0.03 1.05 0.01 1.09 B. Basis of estimate 0.08 0.25 0.45 0.78 1.65 0.00 0.00 0.01 0.01 5.5.3A: RCRA Subtitle C surface impoundments NA 0.08 0.08 0.45 0.61 47.92 0.04 0.04 0.21 0.29 A. Total release 1.67 66.00 0.45 68.11 2.09 0.03 1.38 0.01 1.42 B. Basis of estimate 0.08 0.25 0.45 0.78 2.09 0.00 0.01 0.01 0.02 5.5.3B: Other surface impoundments NA 0.08 0.08 0.45 0.61 47.92 0.04 0.04 0.21 0.29 A. Total release 1.67 66.00 0.45 68.11 2.09 0.03 1.38 0.01 1.42 B. Basis of estimate 0.08 0.25 0.45 0.78 2.09 0.00 0.01 0.01 0.02 5.5.4: Other disposal NA 0.08 0.08 0.45 0.61 90.45 0.08 0.08 0.40 0.55 A. Total release 0.83 35.00 0.45 36.28 9.55 0.08 3.34 0.04 3.46 B. Basis of estimate 0.08 0.25 0.45 0.78 9.48 0.01 0.02 0.04 0.07 ITEMS PERTAINING TO SECTION 6: Transfers of the Toxic Chemical in Wastes to Off Site Locations Section 6.1: Discharges to publicly owned treatment works ( POTWs)

6.1. A: Total quantity transferred to POTWs and basis of estimate 6.1. A. 1: Total transfers 1.67 58.00 0.45 60.11 23.97 0.40 13.90 0.11 14.41 6.1. A. 2: Basis of estimate 0.08 0.25 0.45 0.78 23.93 0.02 0.06 0.11 0.19 6.1. B POTW name 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 POTW address 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 City 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 State 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 County 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 Zip 0.08 0.25 0.45 0.78 23.92 0.02 0.06 0.11 0.19 Section 6.2: Transfers to other off site locations Off site EPA identification number ( RCRA ID No.) 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 Off site location name 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 Off site address 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 City 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 State 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 County 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 Zip 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 Country ( non US) 0.17 0.50 0.45 1.11 100.00 0.17 0.50 0.45 1.11 Is location under control of reporting facility or parent company? 0.17 0.17 0.45 0.78 100.00 0.17 0.17 0.45 0.78 A: Total transfers 2.50 82.00 0.45 84.95 100.00 2.50 82.00 0.45 84.95 B: Basis of estimate 0.17 0.50 0.45 1.11 99.99 0.17 0.50 0.45 1.11 C: Type of waste treatment/

disposal/ recycling/ energy recovery 0.17 0.50 0.45 1.11 99.97 0.17 0.50 0.45 1.11 ITEMS PERTAINING TO SECTION 7 Section 7A: On site waste treatment methods and efficiency NA 0.08 0.08 0.45 0.61 51.48 0.04 0.04 0.23 0.32 7A. 1a: General waste stream ( enter code) 0.83 5.00 0.45 6.28 48.52 0.40 2.43 0.22 3.05 7A. 1b: Waste treatment method( s)

sequence 0.83 7.00 0.45 8.28 48.52 0.40 3.40 0.22 4.02 7A. 1c: Range of influent concentration 0.83 30.00 0.45 31.28 48.52 0.40 14.56 0.22 15.18 7A. 1d: Waste treatment efficiency estimate 0.83 10.00 0.45 11.28 48.52 0.40 4.85 0.22 5.47 7A. 1e: Based on operating data? 0.17 0.17 0.45 0.78 48.52 0.08 0.08 0.22 0.38 Section 7B: On site energy recovery processes NA 0.08 0.08 0.45 0.61 95.60 0.08 0.08 0.43 0.59 Energy recovery methods 0.83 24.00 0.45 25.28 4.40 0.04 1.06 0.02 1.11 Section 7C: On site recycling processes NA 0.08 0.08 0.45 0.61 90.18 0.08 0.08 0.40 0.55 Energy recovery methods 0.83 27.00 0.45 28.28 9.82 0.08 2.65 0.04 2.78 ITEMS PERTAINING TO SECTION 8: Source Reduction and Recycling Activities Section 8.1a: Total on site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.45 0.78 93.89 0.08 0.23 0.42 0.73 Column B: Current reporting year 0.25 5.00 0.45 5.70 93.89 0.23 4.69 0.42 5.35 Column C: Following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Column D: Second following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Section 8.1b: Total other on site disposal or other releases Column A: Prior year 0.08 0.25 0.45 0.78 93.89 0.08 0.23 0.42 0.73 Column B: Current reporting year 0.25 5.00 0.45 5.70 93.89 0.23 4.69 0.42 5.35 Column C: Following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Column D: Second following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Section 8.1c: Total off site disposal to Class I Underground Injection Wells,

RCRA Subtitle C landfills, and other landfills Column A: Prior year 0.08 0.25 0.45 0.78 93.89 0.08 0.23 0.42 0.73 Column B: Current reporting year 0.25 5.00 0.45 5.70 93.89 0.23 4.69 0.42 5.35 Column C: Following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Column D: Second following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Section 8.1d: Total other off site disposal or other releases Column A: Prior year 0.08 0.25 0.45 0.78 93.89 0.08 0.23 0.42 0.73 Column B: Current reporting year 0.25 5.00 0.45 5.70 93.89 0.23 4.69 0.42 5.35 Column C: Following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Column D: Second following year 0.08 1.00 0.45 1.53 93.89 0.08 0.94 0.42 1.44 Section 8.2: Quantity used for energy recovery on site Column A: Prior year 0.08 0.25 0.45 0.78 5.42 0.00 0.01 0.02 0.04 Column B: Current reporting year 0.83 30.00 0.45 31.28 5.42 0.05 1.63 0.02 1.70 Column C: Following year 0.08 1.00 0.45 1.53 5.42 0.00 0.05 0.02 0.08 Column D: Second following year 0.08 1.00 0.45 1.53 5.42 0.00 0.05 0.02 0.08 Section 8.3: Quantity used for energy recovery off site Column A: Prior year 0.08 0.25 0.45 0.78 18.52 0.02 0.05 0.08 0.14 Column B: Current reporting year 0.25 5.00 0.45 5.70 18.52 0.05 0.93 0.08 1.05 Column C: Following year 0.08 1.00 0.45 1.53 18.52 0.02 0.19 0.08 0.28 Column D: Second following year 0.08 1.00 0.45 1.53 18.52 0.02 0.19 0.08 0.28 Section 8.4: Quantity recycled on site Column A: Prior year 0.08 0.25 0.45 0.78 10.83 0.01 0.03 0.05 0.08 Column B: Current reporting year 0.83 30.00 0.45 31.28 10.83 0.09 3.25 0.05 3.39 Column C: Following year 0.08 1.00 0.45 1.53 10.83 0.01 0.11 0.05 0.17 Column D: Second following year 0.08 1.00 0.45 1.53 10.83 0.01 0.11 0.05 0.17 Section 8.5: Quantity recycled off site Column A: Prior year 0.08 0.25 0.45 0.78 22.68 0.02 0.06 0.10 0.18 Column B: Current reporting year 0.25 5.00 0.45 5.70 22.68 0.06 1.13 0.10 1.29 Column C: Following year 0.08 1.00 0.45 1.53 22.68 0.02 0.23 0.10 0.35 Column D: Second following year 0.08 1.00 0.45 1.53 22.68 0.02 0.23 0.10 0.35 Section 8.6: Quantity treated on site Column A: Prior year 0.08 0.25 0.45 0.78 24.58 0.02 0.06 0.11 0.19 Column B: Current reporting year 0.83 30.00 0.45 31.28 24.58 0.20 7.37 0.11 7.69 Column C: Following year 0.08 1.00 0.45 1.53 24.58 0.02 0.25 0.11 0.38 Column D: Second following year 0.08 1.00 0.45 1.53 24.58 0.02 0.25 0.11 0.38 Section 8.7: Quantity treated off site Column A: Prior year 0.08 0.25 0.45 0.78 28.76 0.02 0.07 0.13 0.22 Column B: Current reporting year 0.25 5.00 0.45 5.70 28.76 0.07 1.44 0.13 1.64 Column C: Following year 0.08 1.00 0.45 1.53 28.76 0.02 0.29 0.13 0.44 Column D: Second following year 0.08 1.00 0.45 1.53 28.76 0.02 0.29 0.13 0.44 Section 8.8: Quantity released to the environment as a result of remedial actions, catastrophic events, or one time events not associated with production processes 0.25 5.00 0.45 5.70 27.65 0.07 1.38 0.12 1.57 Section 8.9: Production ratio or activity index 0.83 36.00 0.45 37.28 100.00 0.83 36.00 0.45 37.28 Section 8.10: Did your facility engage in any source reduction activities?

8.10.1 Source reduction activities 0.83 35.00 0.45 36.28 13.25 0.11 4.64 0.06 4.81 Methods to identify activity 0.08 0.25 0.45 0.78 13.25 0.01 0.03 0.06 0.10 Section 8.11: Is additional information on source reduction, recycling or pollution control activities included with this report? 0.00 0.00 0.00 TOTAL ( min) 46.83 1269.94 66.00 1382.77 19.68 422.76 37.76 480.20 TOTAL ( hr) 0.78 21.17 1.10 23.05 0.33 7.05 0.63 8.00 Section 5.5.3B is a new data element field for RY 2003. The incidence rate was split between 5.5.3A and 5.5.3B because it is assumed half of the facilities will file for RCRA Subtitle C impoundments and half of the facilities will file for other surface impoundments.

Section 7A. 1e: The technical burden for typing is doubled because a typical facility reports two waste streams.

Section 8.1 was split into 8.1 a, b, c, and d for RY 2003; therefore, data for 8.1 in RY 2002 were applied to all of the new fields.

Section 6.2: Technical burdens for typing and management review burdens are doubled for all data elements in this section, except total transfers, because a normal facility reports two off site transfer locations. The total transfers field burden is already adjusted for the additional calculation time based on the economy of scale associated with reporting two transfers. Proposed Item Management Technical Total Time Management Technical Total Time ITEMS PERTAINING TO SECTION 1: Reporting Year Section 1: Reporting Year yes 0.12 0.25 0.37 0.12 0.25 0.37 ITEMS PERTAINING TO SECTION 2: Trade Secret Information Section 2.1: Are you claiming the toxic chemical identified on page 2 trade secret? yes 0.04 0.08 0.12 0.04 0.08 0.12 Section 2.2: Is this copy sanitized or unsanitized? yes 0.04 0.08 0.12 0.04 0.08 0.12 ITEMS PERTAINING TO SECTION 3: Certification Name and official title NA NA NA NA NA NA Signature NA NA NA NA NA NA Date signed NA NA NA NA NA NA ITEMS PERTAINING TO SECTION 4: Facility Identification Section 4.1 TRI facility ID number yes 0.12 0.25 0.37 0.00 0.00 0.00 Facility or establishment name yes 0.12 0.25 0.37 0.00 0.00 0.00 Street yes 0.12 0.25 0.37 0.00 0.00 0.00 City/ county/ state/ zip code yes 0.12 0.25 0.37 0.00 0.00 0.00 Facility or establishment name or mailing address ( if different from street address) yes 0.12 0.25 0.37 0.00 0.00 0.00 Mailing address yes 0.12 0.25 0.37 0.00 0.00 0.00 City/ state/ zip code yes 0.12 0.25 0.37 0.00 0.00 0.00 Country ( non US) yes 0.12 0.25 0.37 0.00 0.00 0.00 Section 4.2: This report contains information for ( check a or b; check c or d if applicable) yes 0.04 0.08 0.12 0.04 0.08 0.12 Section 4.3: Technical contact name yes 0.12 0.25 0.37 0.00 0.00 0.00 Telephone number yes 0.12 0.25 0.37 0.00 0.00 0.00 Email address yes 0.12 0.25 0.37 0.00 0.00 0.00 Section 4.4: Public contact name yes 0.12 0.25 0.37 0.00 0.00 0.00 Telephone number yes 0.12 0.25 0.37 0.00 0.00 0.00 Section 4.5: SIC code yes 0.12 0.25 0.37 0.00 0.00 0.00 Section 4.6: Latitude Degrees yes 0.35 0.75 1.10 0.00 0.00 0.00 Minutes yes 0.35 0.75 1.10 0.00 0.00 0.00 Seconds yes 0.35 0.75 1.10 0.00 0.00 0.00 Section 4.6: Longitude Degrees yes 0.35 0.75 1.10 0.00 0.00 0.00 Minutes yes 0.35 0.75 1.10 0.00 0.00 0.00 TABLE 14 FIRST AND SUBSEQUENT YEAR SCALED DATA ELEMENT SPECIFIC TRI REPORTING BURDEN ESTIMATES ASSOCIATED WITH FILING FORM R ELECTRONICALLY FOR A PBT CHEMICAL ( INCIDENCE RATE NOT Scaled reporting burden per Form R ( min)