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pdfForm Approved OMB Number: 2025-0009
Approval Expires: 10/31/
DRAFT
Page 1 of 4
TRI Facility ID Number
FORM R Schedule 1
United States
Environmental Protection
Agency
PART II. CHEMICAL-SPECIFIC INFORMATION
(conti nued)
SECTION 5. QUANTITY OF DIOXIN AND DIOXIN-LIKE COMPOUNDS ENTERING EACH ENVIRONMENTAL MEDIUM ON-SITE
5.1
NA
Fugitive or nonpoint air emissions
5.2
NA
5.3
Stack or point
air emissions
Discharges to receiving streams or water bodies
(Enter data for one stream or water body per box)
5.3.1
1
D. Mass (grams) of each compound in the category (1-17)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
If additional pages of Section 5.3 are attached, indicate the total number of pages in this box
and indicate the Section 5.3 page number in this box
EPA Form 9350-3
(Example: 1, 2, 3, etc.)
5.3.2
NA
5.3.3
Form Approved OMB Number: 2025-0009
Approval Expires: 10/31/
DRAFT
Page 2 of 4
TRI Facility ID Number
FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION
(conti nued)
SECTION 5. QUANTITY OF DIOXIN AND DIOXIN-LIKE COMPOUNDS ENTERING EACH ENVIRONMENTAL MEDIUM ON-SITE
5.4 – 5.5 Disposal to land on-site
5.4.1 NA
5.4.2 NA
5.5.1.A NA
5.5.1.B
Class I
Underground
Injection Wells
Class II-V
Underground
Injection Wells
RCRA Subtitle C
landfills
Other landfills
1
C. Mass (grams) of each compound in the category (1-17)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
EPA Form 9350-3
NA
5.5.2
NA
5.5.3A
NA
Land treatment/
RCRA Subtitle C
application farming surface
impoundments
5.5.3B
NA
Other surface
impoundments
5.5.4
NA
Other disposal
Form Approved OMB Number: 2025-0009
Approval Expires: 10/31/
DRAFT
FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION
Page 3 of 4
TRI Facility ID Number
(continued)
SECTION 6. TRANSFERS OF DIOXIN AND DIOXIN-LIKE COMPOUNDS IN WASTES TO OFF-SITE LOCATIONS
6.1. DISCHARGES TO PUBLICLY OWNED TREATMENT WORKS (POTWs)
6.1. __
NA
C. Mass (grams) of Each Compound in the Category (1-17)
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
6.2 TRANSFERS TO OTHER OFF-SITE LOCATIONS
6.2.__
1.
9
2.
9
3.
9
4.
9
9
2.
9
3.
9
4.
9
NA
D. Mass (grams) of each compound in the category (1-17)
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
6.2.__
1.
D. Mass (grams) of each compound in the category (1-17)
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
If additional pages of Section 6.1 or 6.2 are attached, indicate the total number of pages in this box
and indicate the Section 6.1 or 6.2 page number in this box
EPA Form 9350-3
9
(Example: 1, 2, 3, etc.)
Form Approved OMB Number: 2025-0009
Approval Expires: 10/31/
DRAFT
FORM R Schedule 1
PART II. CHEMICAL-SPECIFIC INFORMATION
Page 4 of 4
TRI Facility ID Number
(continued)
SECTIONS 8.1-8.8. WASTE MANAGEMENT QUANTITIES FOR DIOXIN AND DIOXIN-LIKE COMPOUNDS (current year only)
8.1-8.7 Production-related waste managed
8.8
8.1a
Total on-site
disposal to
Class 1
Underground
Injection Wells,
RCRA Subtitle
C landfills, and
other landfills
8.1b
Total other
on-site disposal
or other
releases
8.1c
Total off-site
disposal to
Class 1
Underground
Injection Wells,
RCRA Subtitle
C landfills, and
other landfills
8.1d
Total other
off-site disposal
or other
releases
8.2
Quantity used
for energy
recovery
on-site
8.3
Quantity used
for energy
recovery
off-site
8.4
Quantity
recycled
on-site
8.5
Quantity
recycled
off-site
8.6
Quantity
treated
on-site
8.7
Quantity
treated
off-site
Column f. Mass (grams) of each compound in the category (1-17)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
EPA Form 9350-3
*Includes quantities released to the environment or transferred off-site as a result of remedial actions, catastrophic events, or other one-time events not associated with production processes
Non-production
related waste
managed*
| File Type | application/pdf |
| Author | Cassandra |
| File Modified | 2014-11-17 |
| File Created | 2014-10-29 |