Form EPA Form 7740-8 EPA Form 7740-8 Form U

Please complete Form U using EPA’s NEW eIUR

software, available as a download at

www.epa.gov/oppt/iur.

PAGE 1 of ____
(IMPORTANT: Type only, read instructions before completing form)

FOR EPA USE ONLY

FORM
U

2006

U.S. Environmental Protection Agency

Washington, DC 20460

Partial Updating of TSCA Inventory Data Base

Site Report

(Section 8(a) Toxic Substances Control Act, 15 U.S.C. 2607(a))

Report Number
Mark “X” here if this is a
revision to the previous report

CERTIFICATION
Certification Statement: I hereby certify to the best of my knowledge and belief that Parts I and II have been completed in
compliance with the requirements of 40 CFR 710.52(c)(1), (2), and (3); Part III of this form has been completed in compliance
with the requirements of 40 CFR 710.52(c)(4); and any confidentiality claims are true and correct as to that information for
which they have been asserted.
Signature

Date signed

Name (printed)

Official Title

PART I. SITE IDENTIFICATION INFORMATION

SECTION A. COMPANY INFORMATION*

1.A.1

Company Name

1.A.2

Company Dun & Bradstreet Number

SECTION B. SITE INFORMATION*

1.B.1

Site Name

1.B.2

Site Dun & Bradstreet Number

1.B.3

Street Address (Line 1)

1.B.4

Street Address (Line 2)

1.B.5

City

1.B.6

County / Parish

1.B.7

State

1.B.8

Zip code

EPA Facility Identification Number

For EPA Use Only
Leave Blank

SECTION C. TECHNICAL CONTACT INFORMATION*

1.C.1

Name

1.C.3

Email Address

1.C.4

Mailing Address (Line 1)

1.C.5

Mailing Address (Line 2)

1.C.6

City

1.C.7

State

1.C.2

Telephone

1.C.8

Zip Code

* Confidentiality claims for information in Part I, Sections A, B, and C, are made, as necessary, for each chemical substance on subsequent pages.

EPA Form Number <7740-8> (Rev 06/07/06) - Previous editions are obsolete

Form Approved OMB Number: 2070-0162 (expiration May 2009)

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FOR EPA USE ONLY

PART II. MANUFACTURING INFORMATION
CBI⊥

SECTION A. CHEMICAL IDENTIFICATION

2.A.1

Chemical Identifying Number

2.A.3

Chemical Name

2.A.2

ID Code

SECTION B. MANUFACTURING INFORMATION
CBI

2.B.1
2.B.2
2.B.3

Company Information

2.B.4
2.B.5

Site Limited (Y/N)
Activity
(Check all that apply)

a. Physical Form

Site Information⊥
Technical Contact Information

b. Percent of
Production
Volume in Each
Physical Form

Check
All That
Apply

2.B.10
2.B.11

Dry Powder
Pellets or Large
Crystals

2.B.6

Manufactured Production
Volume (LB)

2.B.12

Water or Solvent
Wet Solid

2.B.7

Imported Production Volume (LB)

2.B.13

Other Solid

2.B.8

Number of Workers (code)

2.B.14

Gas or Vapor

2.B.9

Maximum Concentration (code)

2.B.15

Liquid

Manuf acture

CBI

Percent

CBI

Import

PART III. PROCESSING AND USE INFORMATION
Complete Part III, Sections A and B if the sum of the production volumes noted in Blocks 2.B.6 and 2.B.7 is 300,000 pounds or more.

SECTION A. INDUSTRIAL PROCESSING AND USE DATA
a. Type of Process or
Use

Code

CBI

b. (5-digit) NAICS
Code

Code

CBI

c. Industrial Function
Category

Code

CBI

N/A

d. Percent Production
Volume

Percent

e. Number of
Sites

CBI

Code

CBI

f. Number of
Workers

Code

CBI

3.A.1
3.A.2
3.A.3
3.A.4
3.A.5
3.A.6
3.A.7
3.A.8
3.A.9
3.A.10
SECTION B. COMMERCIAL AND CONSUMER USE DATA
a. Commercial and Consumer
Product Category

Code

CBI

b. Used in Products
Intended for Children

Y/N/NRO

CBI

3.B.1
3.B.2
3.B.3
3.B.4
3.B.5
3.B.6
3.B.7
3.B.8
3.B.9
3.B.10
⊥

Substantiation required for CBI claims on chemical identity and site information.

N/A

c. Percent Production Volume
associated with each category

Percent

CBI

d. Maximum Concentration
associated with each category

Code

CBI

Concerning EPA Disclosure Information
If you submit information to EPA and claim any of it as confidential, EPA will publicly disclose that information only as
allowed by the procedures set forth in 40 CFR Part 2. If no such claim accompanies the information when it is received, EPA may
make that information public without further notice to you.
Confidentiality Statements
Information reported to EPA on the above form may be claimed as confidential by checking the appropriate CBI boxes. The
person signing the certification statement attests to the truth of the following four statements concerning all information claimed as
confidential:
1. My company has taken measures to protect the confidentiality of the information and intends to continue to take such
measures.
2. The information is not, and has not been, reasonably obtainable by other persons without our consent (other than through
discovery based on a showing of special need in a judicial or quasi-judicial proceeding).
3. The information is not publicly available elsewhere.
4. Disclosure of the information would cause substantial harm to our competitive position.
Paperwork Reduction Act Notice
The annual public burden for this collection of information, which is approved under OMB Control Number 2070-0162, is
estimated to be approximately 265 hours per response for manufacturers of inorganic chemical substances and 560 hours per response
for manufacturers of organic chemical substances. According to the Paperwork Reduction Act, "burden" means the total time, effort,
or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency.
For this collection it includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for
the purposes of collecting, validating, and verifying information; processing and maintaining information; and disclosing or providing
information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be
able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or
otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB number. The OMB control number for this collection appears above. In
addition, the OMB control numbers for EPA's regulations, after initial display in the final rule, are listed in 40 CFR part 9.
Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested
methods for minimizing respondent burden (including the use of automated collection techniques) to: Director, Collection Strategies
Division, U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Ave, N.W., Washington, D.C. 20460.
Include the OMB control number in any correspondence, but do not submit the completed form to this address. The requested
information should be submitted in accordance with the instructions accompanying the form, or as specified in the corresponding
regulation.
Submitting Form U
Submissions sent via the U.S. Postal Service:

Submissions sent by Courier or Hand Delivery

IUR Submissions Coordinator (7407M)
U. S. Environmental Protection Agency
Office of Pollution Prevention and Toxics
Ariel Rios Building
1200 Pennsylvania Avenue, N.W.
Washington, DC 20460

IUR Submissions Coordinator
U.S. EPA - OPPT
EPA East Building
Room 6428
1201 Constitution Ave., N.W.
Washington, DC