                                   Section 1
Company name:

Company address:

Responding official name:
Responding official title:

Certifying official name:
Certifying official title:
Certifying official contact information:
Email:
Telephone:

      I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, I certify that the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

		Certifying official signature						Date
___________________________________________________________________________________

1.a. Manufacture, import, or export of products
Did your company manufacture, import, or export a product (or products) containing mercury or mercury compounds in the years 2010, 2013, and/or 2016?

No; if possible, describe why (e.g., permanently ceased such activity)

Yes

1.b. Manufacturing processes
Did your company use mercury or mercury compounds in a manufacturing process (or processes) (e.g., as commercial chemical products, including catalysts, preservatives, reactants, reagents) in the years 2010, 2013, and/or 2016?

No; if possible, describe why (e.g., permanently ceased such activity)

Yes

IF YOU SELECTED "NO" IN RESPONSE TO QUESTIONS 1.A. AND 1.B., THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.

IF YOU SELECTED "YES" IN RESPONSE TO QUESTIONS 1.A. AND/OR 1.B., THEN PROCEED TO SECTION 2.
                                   Section 2

In the table below, please check the box for each product category for which your company manufactured, imported, or exported a product or products in the years 2010, 2013, and/or 2016. If you manufactured, imported or exported a mercury-containing product that does not fall within the listed product categories, then check the box for "Miscellaneous mercury-added products."
Categories of Mercury-added Products

If you checked a box at left, then proceed to:
Batteries

Section #3
Cosmetics (including skin lightening soaps and creams)

Section #4
Dental amalgam

Section #5
Formulated products (e.g., commercial chemical products, including catalysts, preservatives, reactants, reagents)

Section #6
Lighting, lamps, bulbs (including neon lighting and backlighting displays)

Section #7
Pesticides, biocides, topical antiseptics (including paint)

Section #8
Pumps

Section #9
Measuring instruments (e.g., barometers, thermometers)

Section #10
Switches, relays, sensors, valves (including thermostats)

Section #11
Miscellaneous mercury-added products (e.g., a product containing mercury not otherwise described in the above categories)

Section #12
Products derived from the use of mercury or mercury compounds in a manufacturing process

Section #13

Certain Uses Within Categories of Mercury-added Products:
Please check each of the boxes below that apply to product category(ies) selected above, if the manufactured, imported, or exported product(s):

Is (are) essential for civil protection or military uses;

Is (are) used only for research, calibration of instruments, as a reference standard, or as a vaccine; or

Contain(s) only trace contaminants of mercury.

                             Section 3: Batteries
Did your company manufacture batteries that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of battery per year(s): (Use either metric or U.S. customary units)

      Button cell, silver 			2010 		 2013 		 2016
      Button cell, zinc-air			2010 		 2013 		 2016
      Button cell, alkaline			2010 		 2013 		 2016
      Stacked button cell batteries		2010 		 2013 		 2016
      Manganese oxide			2010 		 2013 		 2016
      Silver oxide 				2010 		 2013 		 2016
      Mercuric oxide			2010 		 2013 		 2016
      Button cell, mercuric oxide		2010 		 2013 		 2016
      Button cell, zinc carbon		2010 		 2013 		 2016
      Large methylmercury batteries	2010 		 2013 		 2016
      Other batteries				2010 		 2013 		 2016
      If "other," then provide a general description of the batteries:

Did your company manufacture any button cell batteries with mercury content of 2% or greater?

No; please proceed to question (2) of this section.

Yes

If yes, then provide the approximate percentage of button cell batteries provided for question (1)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Did your company purchase in the United States mercury or mercury compounds to be used in the production of batteries manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes
Mercury or mercury compounds used by your company to manufacture batteries in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of batteries manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture batteries in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import batteries containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported battery per year(s): (Use either metric or U.S. customary units)

      Button cell, silver 			2010 		 2013 		 2016
      Button cell, zinc-air			2010 		 2013 		 2016
      Button cell, alkaline			2010 		 2013 		 2016
      Stacked button cell batteries		2010 		 2013 		 2016
      Manganese oxide			2010 		 2013 		 2016
      Silver oxide 				2010 		 2013 		 2016
      Mercuric oxide			2010 		 2013 		 2016
      Button cell, mercuric oxide		2010 		 2013 		 2016
      Button cell, zinc carbon		2010 		 2013 		 2016
      Large methylmercury batteries	2010 		 2013 		 2016
      Other batteries				2010 		 2013 		 2016
      If "other," then provide a general description of the batteries:

Did your company import any button cell batteries with mercury content of 2% or greater?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the approximate percentage of button cell batteries reported for question (4)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Did your company export batteries containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported battery per year(s): (Use either metric or U.S. customary units)

      Button cell, silver 			2010 		 2013 		 2016
      Button cell, zinc-air			2010 		 2013 		 2016
      Button cell, alkaline			2010 		 2013 		 2016
      Stacked button cell batteries		2010 		 2013 		 2016
      Manganese oxide			2010 		 2013 		 2016
      Silver oxide 				2010 		 2013 		 2016
      Mercuric oxide			2010 		 2013 		 2016
      Button cell, mercuric oxide		2010 		 2013 		 2016
      Button cell, zinc carbon		2010 		 2013 		 2016
      Large methylmercury batteries	2010 		 2013 		 2016
      Other batteries				2010 		 2013 		 2016
      If "other," then provide a general description of the batteries:

Did your company export any button cell batteries with mercury content of 2% or greater?

No; please proceed to question (6) of this section;

Yes

If yes, then provide the approximate percentage of button cell batteries reported for question (5)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                             Section 4: Cosmetics
Did your company manufacture cosmetics that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of cosmetics per year(s): (Use either metric or U.S. customary units)

      Skin care products (creams, soaps, lotions)	2010 		 2013 		 2016
      Other cosmetics				2010 		 2013 		 2016
      If "other," then provide a general description of the cosmetics:

Did your company manufacture any cosmetics with mercury content of greater than 1 ppm?

No; please proceed to question (2) of this section.

Yes

If yes, then provide the approximate percentage of the number provided for question (1)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Did your company purchase in the United States mercury or mercury compounds to be used in the production of cosmetics manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture cosmetics in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of cosmetics manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture cosmetics in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import cosmetics containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported cosmetics per year(s): (Use either metric or U.S. customary units)

      Skin care products (creams, soaps, lotions)	2010 		 2013 		 2016
      Other cosmetics				2010 		 2013 		 2016
      If "other," then provide a general description of the cosmetics:

Did your company import any cosmetics with mercury content of greater than 1 ppm?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the approximate percentage of cosmetics reported for question (4)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Did your company export cosmetics containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported cosmetics per year(s): (Use either metric or U.S. customary units)

      Skin care products (creams, soaps, lotions)	2010 		 2013 		 2016
      Other cosmetics				2010 		 2013 		 2016
      If "other," then provide a general description of the cosmetics:

Did your company export any cosmetics with mercury content of greater than 1 ppm?

No; please proceed to question (6) of this section;

Yes

If yes, then provide the approximate percentage of cosmetics reported for question (5)a. of this section in each of the following years:
2010 __________
2013 __________
2016 __________

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                           Section 5: Dental Amalgam
Did your company manufacture dental cements and fillings that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of dental cements and fillings per year(s): (Use either metric or U.S. customary units)

      Dental cements and fillings		2010 		 2013 		 2016

Did your company purchase in the United States mercury or mercury compounds to be used in the production of dental cements and fillings manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture dental cements and fillings in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of dental cements and fillings manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture dental cements and fillings in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import dental cements and fillings containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported dental cements and fillings per year(s): (Use either metric or U.S. customary units)

      Dental cements and fillings		2010 		 2013 		 2016

Did your company export dental cements and fillings containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported dental cements and fillings per year(s): (Use either metric or U.S. customary units)

      Dental cements and fillings		2010 		 2013 		 2016

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                        Section 6: Formulated Products
Did your company manufacture formulated products (e.g., commercial chemical products, including catalysts, preservatives, reactants, reagents) that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of formulated products per year(s): (Use either metric or U.S. customary units)

      Catalysts				2010 		 2013 		 2016
      Preservatives				2010 		 2013 		 2016
      Reactants				2010 		 2013 		 2016
      Reagents				2010 		 2013 		 2016
      Other formulated products		2010 		 2013 		 2016
      If "other," then provide a general description of the formulated products:

Did your company purchase in the United States mercury or mercury compounds to be used in the production of formulated products manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture formulated products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of formulated products manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture formulated products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import formulated products containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported formulated products per year(s): (Use either metric or U.S. customary units)

      Catalysts				2010 		 2013 		 2016
      Preservatives				2010 		 2013 		 2016
      Reactants				2010 		 2013 		 2016
      Reagents				2010 		 2013 		 2016
      Other formulated products		2010 		 2013 		 2016
      If "other," then provide a general description of the formulated products:

Did your company export formulated products containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported formulated products per year(s): (Use either metric or U.S. customary units)

      Catalysts				2010 		 2013 		 2016
      Preservatives				2010 		 2013 		 2016
      Reactants				2010 		 2013 		 2016
      Reagents				2010 		 2013 		 2016
      Other formulated products		2010 		 2013 		 2016
      If "other," then provide a general description of the formulated products:

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                       Section 7: Lighting, Lamps, Bulbs
Did your company manufacture lighting, lamps, or bulbs (including neon lighting and backlighting displays) that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of lighting, lamps, or bulbs per year(s): (Use either metric or U.S. customary units)

      Linear fluorescent			2010 		 2013 		 2016
      Compact fluorescent			2010 		 2013 		 2016
      Cold cathode fluorescent		2010 		 2013 		 2016
      External electrode fluorescent		2010 		 2013 		 2016
      Mercury high pressure vapor		2010 		 2013 		 2016
      High intensity discharge		2010 		 2013 		 2016
      Mercury short arc			2010 		 2013 		 2016
      Neon					2010 		 2013 		 2016
      Other lighting, lamps, bulbs		2010 		 2013 		 2016
      If "other," then provide a general description of the lighting, lamps, or bulbs:

Did your company purchase in the United States mercury or mercury compounds to be used in the production of lighting, lamps, or bulbs manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture lighting, lamps, or bulbs in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of lighting, lamps, or bulbs manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture lighting, lamps, or bulbs in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import lighting, lamps, or bulbs containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported lighting, lamps, or bulbs per year(s): (Use either metric or U.S. customary units)

      Linear fluorescent			2010 		 2013 		 2016
      Compact fluorescent			2010 		 2013 		 2016
      Cold cathode fluorescent		2010 		 2013 		 2016
      External electrode fluorescent		2010 		 2013 		 2016
      Mercury high pressure vapor		2010 		 2013 		 2016
      High intensity discharge		2010 		 2013 		 2016
      Mercury short arc			2010 		 2013 		 2016
      Neon					2010 		 2013 		 2016
      Other lighting, lamps, bulbs		2010 		 2013 		 2016
      If "other," then provide a general description of the lighting, lamps, or bulbs:

Did your company export lighting, lamps, or bulbs containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported lighting, lamps, or bulbs per year(s): (Use either metric or U.S. customary units)

      Linear fluorescent			2010 		 2013 		 2016
      Compact fluorescent			2010 		 2013 		 2016
      Cold cathode fluorescent		2010 		 2013 		 2016
      External electrode fluorescent		2010 		 2013 		 2016
      Mercury high pressure vapor		2010 		 2013 		 2016
      High intensity discharge		2010 		 2013 		 2016
      Mercury short arc			2010 		 2013 		 2016
      Neon					2010 		 2013 		 2016
      Other lighting, lamps, bulbs		2010 		 2013 		 2016
      If "other," then provide a general description of the lighting, lamps, or bulbs:

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
    Section 8: Pesticides, Biocides, Topical Antiseptics (including Paint)
Did your company manufacture pesticides, biocides, or topical antiseptics (including paint) that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of pesticides, biocides, or topical antiseptics per year(s): (Use either metric or U.S. customary units)

      Agricultural applications				2010 		 2013 		 2016
      Interior/exterior paints				2010 		 2013 		 2016
      Other pesticides, biocides, and topical antiseptics	2010 		 2013 		 2016
      If "other," then provide a general description of the pesticides, biocides, or topical antiseptics:

Did your company purchase in the United States mercury or mercury compounds to be used in the production of pesticides, biocides, or topical antiseptics manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture of pesticides, biocides, or topical antiseptics in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of pesticides, biocides, and topical antiseptics manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture pesticides, biocides, or topical antiseptics in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import pesticides, biocides, or topical antiseptics containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported pesticides, biocides, or topical antiseptics per year(s): (Use either metric or U.S. customary units)

      Agricultural applications				2010 		 2013 		 2016
      Interior/exterior paints				2010 		 2013 		 2016
      Other pesticides, biocides, and topical antiseptics	2010 		 2013 		 2016
      If "other," then provide a general description of the pesticides, biocides, or topical antiseptics:

Did your company export pesticides, biocides, or topical antiseptics containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported pesticides, biocides, or topical antiseptics per year(s): (Use either metric or U.S. customary units)

      Agricultural applications				2010 		 2013 		 2016
      Interior/exterior paints				2010 		 2013 		 2016
      Other pesticides, biocides, and topical antiseptics	2010 		 2013 		 2016
      If "other," then provide a general description of the pesticides, biocides, or topical antiseptics:

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
Section 9: Pumps
Did your company manufacture pumps that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of pumps per year(s): (Use either metric or U.S. customary units)

      Pumps					2010 		 2013 		 2016

Did your company purchase in the United States mercury or mercury compounds to be used in the production of pumps manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture pumps in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of pumps manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture of pumps in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import pumps containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported pumps per year(s): (Use either metric or U.S. customary units)

      Pumps					2010 		 2013 		 2016

Did your company export pumps containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported pumps per year(s): (Use either metric or U.S. customary units)

      Pumps					2010 		 2013 		 2016

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                       Section 10: Measuring Instruments
Did your company manufacture measuring instruments that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of measuring instruments per year(s): (Use either metric or U.S. customary units)

      Barometer				2010 		 2013 		 2016
      Fever thermometer			2010 		 2013 		 2016
      Flow meter				2010 		 2013 		 2016
      Hydrometer				2010 		 2013 		 2016
      Hygrometer/psychrometer		2010 		 2013 		 2016
      Manometer				2010 		 2013 		 2016
      Non-fever thermometer		2010 		 2013 		 2016
      Pyrometer				2010 		 2013 		 2016
      Sphygmomanometer			2010 		 2013 		 2016
      Other measuring instruments		2010 		 2013 		 2016
      If "other," then provide a general description of the measuring instruments:

Did your company purchase in the United States mercury or mercury compounds to be used in the production of measuring instruments manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture measuring instruments in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of measuring instruments manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture of measuring instruments in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import measuring instruments containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported measuring instruments per year(s): (Use either metric or U.S. customary units)

      Barometer				2010 		 2013 		 2016
      Fever thermometer			2010 		 2013 		 2016
      Flow meter				2010 		 2013 		 2016
      Hydrometer				2010 		 2013 		 2016
      Hygrometer/psychrometer		2010 		 2013 		 2016
      Manometer				2010 		 2013 		 2016
      Non-fever thermometer		2010 		 2013 		 2016
      Pyrometer				2010 		 2013 		 2016
      Sphygmomanometer			2010 		 2013 		 2016
      Other measuring instruments		2010 		 2013 		 2016
      If "other," then provide a general description of the measuring instruments:

Did your company export measuring instruments containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported measuring instruments per year(s): (Use either metric or U.S. customary units)

      Barometer				2010 		 2013 		 2016
      Fever thermometer			2010 		 2013 		 2016
      Flow meter				2010 		 2013 		 2016
      Hydrometer				2010 		 2013 		 2016
      Hygrometer/psychrometer		2010 		 2013 		 2016
      Manometer				2010 		 2013 		 2016
      Non-fever thermometer		2010 		 2013 		 2016
      Pyrometer				2010 		 2013 		 2016
      Sphygmomanometer			2010 		 2013 		 2016
      Other measuring instruments		2010 		 2013 		 2016
      If "other," then provide a general description of the measuring instruments:

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
                 Section 11: Switches, Relays, Sensors, Valves
Did your company manufacture switches, relays, sensors, or valves that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of switches, relays, sensors, or valves per year(s): (Use either metric or U.S. customary units)

      Tilt switch					2010 		 2013 		 2016
      Vibration switch				2010 		 2013 		 2016
      Float switch					2010 		 2013 		 2016
      Pressure switch				2010 		 2013 		 2016
      Temperature switch				2010 		 2013 		 2016
      Displacement relay				2010 		 2013 		 2016
      Wetted reed relay				2010 		 2013 		 2016
      Contact relay					2010 		 2013 		 2016
      Flame sensor					2010 		 2013 		 2016
      Thermostat					2010 		 2013 		 2016
      Other switches, relays, sensors, valves	2010 		 2013 		 2016
      If "other," then provide a general description of the switches, relays, sensors, or valves:

Did your company purchase in the United States mercury or mercury compounds to be used in the production of switches, relays, sensors, or valves manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture switches, relays, sensors, or valves in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of switches, relays, sensors, or valves manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture of switches, relays, sensors, or valves in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import switches, relays, sensors, or valves containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of imported switches, relays, sensors, or valves per year(s): (Use either metric or U.S. customary units)

      Tilt switch					2010 		 2013 		 2016
      Vibration switch				2010 		 2013 		 2016
      Float switch					2010 		 2013 		 2016
      Pressure switch				2010 		 2013 		 2016
      Temperature switch				2010 		 2013 		 2016
      Displacement relay				2010 		 2013 		 2016
      Wetted reed relay				2010 		 2013 		 2016
      Contact relay					2010 		 2013 		 2016
      Flame sensor					2010 		 2013 		 2016
      Thermostat					2010 		 2013 		 2016
      Other switches, relays, sensors, valves	2010 		 2013 		 2016
      If "other," then provide a general description of the switches, relays, sensors, or valves:

Did your company export switches, relays, sensors, or valves containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide the total amount of mercury or mercury compounds in each of the following types of exported switches, relays, sensors, or valves per year(s): (Use either metric or U.S. customary units)

      Tilt switch					2010 		 2013 		 2016
      Vibration switch				2010 		 2013 		 2016
      Float switch					2010 		 2013 		 2016
      Pressure switch				2010 		 2013 		 2016
      Temperature switch				2010 		 2013 		 2016
      Displacement relay				2010 		 2013 		 2016
      Wetted reed relay				2010 		 2013 		 2016
      Contact relay					2010 		 2013 		 2016
      Flame sensor					2010 		 2013 		 2016
      Thermostat					2010 		 2013 		 2016
      Other switches, relays, sensors, valves	2010 		 2013 		 2016
      If "other," then provide a general description of the switches, relays, sensors, or valves:

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
               Section 12: Miscellaneous Mercury-Added Products
Did your company manufacture mercury-added products not otherwise described in the categories described in the table in Section 2 that contain mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Did your company purchase in the United States mercury or mercury compounds to be used in the production of mercury-added products manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture mercury-added products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of mercury-added products manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture mercury-added products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury-added products containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Did your company export mercury-added products containing mercury or mercury compounds in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.
Section 13: Products Derived from the Use of Mercury or Mercury Compounds in a Manufacturing Process
Did your company manufacture mercury-added products derived from the use of mercury or mercury compounds in a manufacturing process including, but not limited to acetaldehyde production in which mercury or mercury compounds are used as a catalyst; vinyl chloride monomer production; sodium or potassium methylate or ethylate; or production of polyurethane using mercury containing-catalysts in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Did your company purchase in the United States mercury or mercury compounds to be used in the production of mercury-added products derived from the use of mercury or mercury compounds in a manufacturing process manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (3) of this section.

Yes

If yes, then provide the total amount of domestically purchased mercury or mercury compounds used by your company to manufacture such mercury-added products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury or mercury compounds to be used in the production of mercury-added products derived from the use of mercury or mercury compounds in a manufacturing process manufactured by your company in 2010, 2013, or 2016?

No; please proceed to question (4) of this section.

Yes

If yes, then provide the total amount of imported mercury or mercury compounds used by your company to manufacture such mercury-added products in each of the following years: (Use either metric or U.S. customary units)
2010 __________
2013 __________
2016 __________

Did your company import mercury-added products derived from the use of mercury or mercury compounds in a manufacturing process in 2010, 2013, or 2016?

No; please proceed to question (5) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Did your company export mercury-added products derived from the use of mercury or mercury compounds in a manufacturing process in 2010, 2013, or 2016?

No; please proceed to question (6) of this section.

Yes

If yes, then provide a general description of the product and the total amount of mercury or mercury compounds used per year(s): (Use either metric or U.S. customary units)

						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016
						2010 		 2013 		 2016

Additional comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IF THERE ARE NO ADDITIONAL COMMENTS, THEN PLEASE PROCEED TO ANY ADDITIONAL CATEGORIES YOU CHECKED IN THE TABLE IN SECTION 2.
IF YOUR COMPANY DID NOT MANUFACTURE, IMPORT, OR EXPORT ANY ADDITIONAL PRODUCT(S) CONTAINING MERCURY OR MERCURY COMPOUNDS OR USE MERCURY OR MERCURY COMPOUNDS IN A MANUFACTURING PROCESS(ES), THEN DO NOT COMPLETE ANY ADDITIONAL SECTIONS OF THIS QUESTIONNAIRE.

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