9600-035 Mercury Electronic Reporting

OMB Control No. 2070-0207 Expires 2/28/2025

MERCURY ELECTRONIC REPORTING
Submission Date:

2021-08-25

Revised Date:

Submitting Official Information
Name of Authorized
Official

(first)

Company Name

CDX Test Org

Position

Email Address

[email protected]

Phone Number

Mailing Address 1

123 Main St

Brooke

(middle)

E

(last)

Plaisance

CBI:

3375231765

Mailing Address 2
City

Virginia Beach

Country

United States

State

VA

Postal Code 23462

(middle)

E

(last)

Technical Contact
Name of Technical
Contact

(first)

Company Name

CDX Test Org

Position

Email Address

[email protected]

Phone Number

Mailing Address 1

123 Main St

Brooke

Plaisance

CBI:

3375231765

Mailing Address 2
City

Virginia Beach

Country

United States

State

VA

Postal Code 23462

My company manufactures (other than imports) elemental mercury

CBI

My company reported amount of manufactured mercury in the most recent Chemical Data Reporting (CDR) reporting
cycle.
During the calendar year 2018, my company stored between 5,000 and 10,000 pounds of elemental mercury on-site.
My company does not store elemental mercury on-site.
During the calendar year 2018, my company stored between and pounds of elemental mercury off-site.
My company does not store elemental mercury off-site.
During the calendar year 2018, my company distributed 1,400 pounds of elemental mercury into domestic commerce.
My company does not distribute elemental mercury.
My company domestically distributed elemental mercury to the following industry: check all that apply ●327910,
Abrasive Product Manufacturing
Additional Information:
test

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

CBI:
Yes

✔

No

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

CBI:
Yes

✔

No

Test

EPA form number 9600-035

1/2

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

CBI:
Yes

✔

No
Test
(iii) B. Does any of the information claimed as confidential otherwise appear in any public documents, including (but not limited
to) safety data sheets; advertising or promotional material; professional or trade publications; state, local, or Federal
agency files; or any other media or publications available to the general public? If yes, please explain why the information
should be treated as confidential.

CBI:
Yes

✔

No

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

CBI:
Yes

✔

No

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

CBI:
Yes

✔

No
Test
(v) Has EPA, another federal agency, or court made any confidentiality determination regarding information associated with
this chemical substance? If yes, please provide the circumstances associated with the prior determination,
whether the information was found to be entitled to confidential treatment, the entity that made the decision, and
the date of the determination.

CBI:
Yes

✔

No

Test

TSCA Certification
I hereby certify to the best of my knowledge and belief that all information entered on this form is complete and accurate. I further certify
that, pursuant to 15 U.S.C. § 2613(c), for all claims for protection of any confidential information made with this submission, all information
submitted to substantiate such claims is true and correct, and that it is true and correct that I have:
(i) taken reasonable measures to protect the confidentiality of the information;
(ii) determined that the information is not required to be disclosed or otherwise made available to the public under any other Federal law;
(iii) a reasonable basis to conclude that disclosure of the information is likely to cause substantial harm to the competitive position of the
person; and
(iv) a reasonable basis to believe that the information is not readily discoverable through reverse engineering.
Any knowing and willful misrepresentation is subject to criminal penalty pursuant to 18 U.S.C. § 1001.
(v)

Signature of authorized
official:

Brooke Plaisance

Date:

2021-08-25

PAPERWORK REDUCTION ACT:
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq.
(OMB Control No. 2070-0207). Responses to this collection of information are mandatory for certain persons, as
specified at 40 CFR 713.7. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The public reporting and
recordkeeping burden for this collection of information is estimated to be 23 hours per response. 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 to the Regulatory Support Division Director, U.S. Environmental
Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control
number in any correspondence. Do not send the completed form to this address.

EPA form number 9600-035

2/2