EPA Form Number 96 Section 8(d) Health & Safety Data Reporting

OMB Control No. 2070-0046
Expires 10/31/2022
CBI SUBMISSION

United States Environmental Protection Agency
Washington, DC 20460

si
on

This is an original submission:

Section 8(e) Notice
This is an amendment:

X

TSCA Certification

m

is

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 for 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 the person
submitting the claim has:

rS
ub

(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.

fo

Any knowing and willful misrepresentation is subject to criminal penalty pursuant to 18 U.S.C. §
1001.

CROMERR Certification

N

ot

I certify, under penalty of law, that this document and all attachments were prepared under my
direction of 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, 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 fines and imprisonment for knowing violations.
Signature:

Official Title:

ES/Brooke E Plaisance

Tester

Contact Person:

Email Address:

Brooke E Plaisance

[email protected]

Date Signed:

EPA Form Number 9600-030

Section 8(e) Notice Page 2
Part 1

Contact Information

Submission
Information

Case Number:

si
on

Date Submitted:

Submission Alias:

8(e) Mockup
CBI:
YES:

X

NO:

is

Submitter
Information

Company Name:

Address:

Contact Person:

rS
ub

Brooke E Plaisance

m

CDX Test Org

Technical Contact

123 Main St
Virginia Beach, VA, 23462
US

Phone Number:

Email Address:

3375231765

[email protected]
m

CBI:

YES:

X

NO:

fo

Company Name:

CDX Test Org
Contact Person:

ot

Ms Brooke E Plaisance

N

CBI SUBMISSION

Address:

123 Main St
Virginia Beach, VA, 23462
US

Phone Number:

Email Address:

3333333333

[email protected]
m

PART 2

Chemical Reports

Chemical
Identification

Chemical Report Folder Alias:
Testing
Chemical Identifying #:

EPA Form Number 9600-030

CBI:

Section 8(e) Notice Page 3
CASRN: 70321-74-3

CBI SUBMISSION

YES:

X

NO:

Chemical Name

Coconut oil, reaction products with ethylenediamine, ethoxylated,
acetates (salts)
Generic Name

testing
Synonym:

test

Attached
Document(s)

Report Study Title:

Test

SubstantiationChemical Identity
Claim

Submission Type:

Original Document:

Sanitized Document:

Initial Submission

cgi-logo.png

cgi-logo.pdf

Effects:

Endpoints:

Health Effects

Acute Toxicity: dermal

(i) Is this chemical substance publicly known (including by your
competitors) to be in U.S. commerce? If yes, please explain why the
specific chemical identity should still be afforded confidential status
(e.g., the chemical substance is publicly known only as being
distributed in commerce for research and development purposes,
but no other information about the current commercial distribution of
the chemical substance in the United States is publicly available). If
no, please complete the certification statement:
I certify that on the date referenced I searched the internet for
the chemical substance identity (i.e., by both chemical
substance name and CASRN). I did not find a reference to this
chemical substance that would indicate that the chemical is
being manufactured or imported by anyone for a commercial
purpose in the United States. [provide date].

CBI:

YES:

X

NO:

X

NO:

X

NO:

Yes: test
(ii) Does this specific chemical substance leave the site of
manufacture (including import) in any form, e.g., as a product,
effluent, emission? If yes, please explain what measures have
been taken to guard against the discovery of its identity.

CBI:
YES:

test
(iii) If the chemical substance leaves the site in a form that is available
to the public or your competitors, can the chemical identity be
readily discovered by analysis of the substance (e.g., product,
effluent, emission), in light of existing technologies and any costs,
difficulties, or limitations associated with such technologies? Please
explain why or why not.

test

EPA Form Number 9600-030

CBI:
YES:

Section 8(e) Notice Page 4

Substantiation Applicable to Any
CBI Claim

CBI SUBMISSION

(iv) Would disclosure of the specific chemical identity release
confidential process information? If yes, please explain.

CBI:

Test

YES:

(i) Will disclosure of the information claimed as confidential likely cause

CBI:

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.

YES:

X

NO:

X

NO:

X

NO:

Test
(ii) Has your business taken precautions to protect the confidentiality of
the disclosed information? If yes, please explain and identify 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:

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

CBI:
YES:

(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.
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.

NO:

CBI:
YES:

X

NO:

X

NO:

X

NO:

X

NO:

CBI:
YES:

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:

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. ?
Test

EPA Form Number 9600-030

CBI:
YES:

X

Section 8(e) Notice Page 5

CBI SUBMISSION

CBI Instructions
I verify that I have checked the sanitized version of my submission to ensure that all information claimed as CBI has been
redacted throughout this submission AND ATTACHMENTS. EPA makes the sanitized version publicly available. The Agency
is not responsible for any errors made by submitters.

Substantiation Document(s)
Original Substantiation Document:
EPA-Logo.pdf

EPA Form Number 9600-030

Section 8(e) Notice Page 6

CBI SUBMISSION

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. 2070-0046). Responses to this collection of information
are mandatory for certain persons, as specified at 15 USC 2607(e). 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 50 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.

Authority
The Government Paperwork Elimination Act (GPEA) (44 U.S.C. 3504) provides that, when practicable,
Federal organizations use electronic forms, electronic filings, and electronic signatures to conduct official
business with the public. EPA's Cross-Media Electronic Reporting Regulation (CROMERR) (40 CFR part 3)
(Ref. 2), provides that any requirement in title 40 of the CFR to submit a report directly to EPA can be
satisfied with an electronic submission that meets certain conditions once the Agency published a document
in the Federal Register announcing that EPA is prepared to receive certain documents in electronic form.
For more information about CROMERR, go to http://www.epa.gov/cromerr/.

Form Approved OMB Number 2070-0046

EPA Form Number 9600-030