7710-51 Dioxin/Furan Report Form and Instructions

IMPORTANT: Before completing this form, please read the
accompanying instructions carefully.

Page 1 of 6

United StJtes Env,ronmental Protection Agency
Washington, DC 20460

&EPA

,OMB Control No. 2070-NEW

Expiration Date: 11/30/2022

Dioxins/Furans Repo·rt

When completed, send this form to:

For A

Use Onl

Document Control Office (7407)
Information Management Division
Office of Pollution Prevention and Toxics
Environmental Protection Agency
1200 Pennsylvania Ave., NW
Washington, DC 20460
Document Control Number

Docket Number

Part I - General Information

1-,---,--,----,---,-,----,-------------------------------------t
Mark
next to an subsection ou claim as confidential.
Section A - Submitter Identification

(X the ''Confidential'' box

1 a. Person
Submitting
Notice

Name of authorized official

Confldential

Title

Company
Maihng address (number and street)
City, State, and ZIP Code

Section B - Chemical Identity Information (Use a separate form for each chemical reported.)

Mark X the ··confidential'' box next to an subsection ,,::O,,::Uc.,Ce.:l.,:e
a�im'-'-'as<> '--'co
"' "'n�"c::id"'e"'nc::t,.,_iaI"' "-.-----��----""T""-1.

Chemical name and CAS Registry Number

Part II - Process and Release Information
Section A - Flow Diagram

Mark X the ··confidential'' box next to an subsection ou claim as confidential.

,

Complete this section for each unit process. Provide a general process block flow diagram that ider1tifies major unit
operations and treatment processes and indicate the types and points of release of byproducts and residuals. (See
exsmple I attached.)
( 1 I Include intermediates, coproducts and byproducts produced by the process.
(2) Proide a block for each major unit operation (e.g.• reactor. washer. filtration. air emission control. aeration lagoon.
etc.) in the production process and in the residuals management process.
(3) Identify process input such as raw materials. reagents. and solvents by chemical or common name and CAS number.
and indicate the point of introduction with arrows.
(4) For each unit operation in which the temperature is not ambient, specify temperature or temperature range in each
block of the flow diagram.
(5) Specify operating pressure or pressure range in each block of the flow diagram for each unit operation in which the
pressure is not atmospheric.
(6) Identify the composition of the reaction vessel wherever one is used (e.g.• stainless steel, glass-lined).
(7) Number all points in the flow diagram from which the chen1ical substance will be released into the en vironment.
(See example IJ

D Mark (x) this box if

EPA Form 7710-51 (4/08)

ou attach a continuation sheet.

EXAMPLE I - PROCESS BLOCK FLOW DIAGRAM
,

,

PRODUCTION

CHLOROPHENOLS
RECYCLE

,

WATER
HYDROCARBON!
WATER SEPARATOR

SCRUBBER

PHENOL - - - - - - HCI
SCRUBBER

•

WASTEWATER TO
TREATMENT

BY­
PRODUCT
CHLOROPHENOLS
RECYCLE

OFF-GAS
CHLORO­
PHENOLS
RECYCLE

,

PHENOL
CHLORINE
AICI, CATALYST

PURIFI­
CATION
STILL
315 ­
3250 C
10 PSIA

REACTOR
65 TO 18()O C

PRILL
TOWER
150 ­

PENTACHLOROPHENOL

2000 C

SPILLS, FLOOR SWEEPINGS
TO LANDFI LL

0)
STILL BOTTOMS
Tp INCINERATOR
TREATMENT
WASTEWATER FROM

®

WASTEWATER FROM
_OTHER PROCESSES

-

NEUTRALI­
ZATION

PRODUCT:

PENTACHLOROPHENOL

INTERMEDIATES:

NONE

CO-PRODUCTS!BY-PRODUCTS:

HCL

CLARIFIER

1O'b SLUDGE
TO LANDFILL

AERATION
LAGOON

CLARIFIED

TREATED EFFLUENT TO
NPDES DISCHARGE

•

•

Section B -

•

Environmental Release and Disposal

Page 3 of 6

.

. .

You must make separate confidentiality claims for the release number and the amount of the substance released and other release and disposal
information. Mark (x) the "Confidential" box next to each item you claim as confidential.
.
·f 1) - Enter the number of each release point identified in the process dexcription. part II. Section A. .
(2) - Estimate the amount of the chemical substance released directly to the environment or ,nto conuoltech(\Ology (in kg/day. or kg/batch).
(3) - Mark (x) this column if entries in columns p) and/or (2) are confidential
.
.•
(4) - Identify the media (air. land. or wate,) to which the substance will be released from the release point.
(5) - Describe control technology. if any. that will be used to limit the release of the substance tothe environment; For releases disposed of on.
land. characterize the disposal method.
(6) - Mark (x) this column if entries in columns (4) and/or (51 are confidential
(7J - Identify the destination(s) of releases to water.
Release
Number

Amount of subsutflce
released

Conlic1ential

Media 01

(I)

(2)

(3)

(4)

release

Controlte<:hnology

ConIiclential

•

(5)

(6)

•

.

.

.

.

.

.

•

.
.

..

,

.

111 Mark (x) the destination,s)
of releases to water

D

PQTW (publicly owned
Ifed,mem wOfAsJ

D

Navfgable
waterway

D (S/l<'cll_J
.

EPA Form 7710-51 (4/08)

~D Mark (x) in this box if you

O'hel

.

,

.' ,

attach a continuation sheet
..

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Page 4 of 6

Part III -

Production. Import. and Use Information

Mark (xl/he "Confldentia'" box nex//o any item you claim as confidential.

1.

Production volume - Report the production volume dUring the past 12 months of production. Also report the mellimum
production volume for any consecutive 12-month period during the past 3 years of production.
Past 12-month production (kg/year)

2.

Confi··
dentiet

Mallimum 12-month production (kg/year)

Use Informetion - You must make separate confidentiality claims for the description of the category of use. the percent of production
volume devoted to each category. the formulation of the substance, and other use information. Mark (x) the "Confidential" boll nellt to any
item you claim as confidential.
(11(2) (3) (41(51(6) (7) (8) Read

Oesaibe each category of use of the chemical substance by function and application.
Mark (lll this column if entry in column (11 is confidential.
Estimate the percent of 10lal production fOf Ihe past 3 years devoted to each calegory of use.
Mark (ll) Ihis column if enlry in column (3) is confidential.
ESllmale the percenl of the substance as formulated in milltures, suspensions. emulsions. solutions. or gels as manufactured
for commercial purposes at sites under your control associated with each category of use.
Mark (lll this column if enlry in column (5) is confidenlial.
Mark (ll) whether the use is sile·limited. industrial, commercial. or consumer. Mark more Ihan one column if appropriale.
Mark (ll) Ih,s column if enlries in column (7) are confidential.
.
Ihe Instructions Manual for ellamples.
Calegory of use

Confi·
dential

Production
(percent)

(I)

(2)

(3)

Conti· Formulation Confi·
(percent)
dential
dentia'
(4)

(5)

(6)

Mark (xl appropriate column(s)
(7/
ConComSile·
Indus·
limited
Irial
mercial sumer

Confi·
dential

(8)

.

.

•

.

-

.

,

.

o
3.

Mark Ill) this boll if you attach e continuation sheet.

Hazard Information -

0

•

Include in the notice a copy or reasonable facsimile of any hazard warning statement, label,
material safety data sheet, or other information which will be provided to any person regarding
protective equipment or practices for the safe handling. transporl. use. or disposal of Ihe new
,
chemical substance. List In part IV any hazard information you include.
Mark (x) this box if you attach hazard information.
.

EPA Form 7710-51 (4/08)

Page 5 of 6
4.

Occupational Exposure. - You must make separate confidentiality claims· for the. description of worker. actlv.ty. physical form· of the
substances. number of workers exposed. and duration of activIty. Mark (x, the "Confidential" box next to any item you claim as confidential.
(1)- Describe the activities in which workers may be exposed to

the chemical substance. Include activities In which
workers wear protective equipment
(21- Mark (x) this column if entry in column 11) is confidential.
(31- Indicate the physicallorm(s) of the chemical substance at
the time of exposure.
(4) - Mark (x) this column if enll'y in column (31 is confidential

Worker Acti.vity

C'onfi:
dential

Physical
Forms

(1)

(2)

(3)
•

(5)'- Estimate the maximum number of workers involved in
each activity.
(61- Mark (x, this column if entry in column (5) is confidential
(7) and (131 - Estimate the maximum duration of the activity for
any worker in hours per day and days per year.
(9) - Mark Ix) this column if entries in column (7) and/or (8)'are'
. confidential
.
• Confi· Maximum number Confi.
dential
dential
(4)
•

Hrs/day Days/yr

(6)

(8)

(7)

•

,

•

•

•

(5)

.Maximum.durFile Typeapplication/pdfFile Title7710-51 Dioxins/Furans ReportSubject7710-51 Dioxins Furans Report, Toxic Substances Control Act, TSCA eReportingAuthorUSEPAFile Modified2022-06-15File Created1998-09-16