Toxic Chemical Release Inventory Reporting Forms and Instructions

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Form Approved OMB Number: 2070-0093 (IMPORTANT: Type or print; read instructions before completing form) Approval Expires: 01/31/2006 Page 2 of 5 FORM R PART II. TOXIC CHEMICAL RELEASE INVENTORY REPORTING FORM TRI Facility ID Number Toxic Chemical, Category or Generic Name SECTION 1. TOXIC CHEMICAL IDENTITY (Important: DO NOT complete this section if you completed Section 2 below.) 1.1 CAS Number (Important: Enter only one number exactly as it appears on the Section 313 list. Enter category code if reporting a chemical category.) 1.2 1.3 1.4 NA Toxic Chemical or Chemical Category Name (Important: Enter only one name exactly as it appears on the Section 313 list.) Generic Chemical Name (Important: Complete only if Part 1, Section 2.1 is checked “yes”. Generic Name must be structurally descriptive.) Distribution of Each Member of the Dioxin and Dioxin-like Compounds Category. (If there are any numbers in boxes 1-17, then every field must be filled in with either 0 or some number between 0.01 and 100. Distribution should be reported in percentages and the total should equal 100%. If you do not have speciation data available, indicate NA.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 2.1 SECTION 2. MIXTURE COMPONENT IDENTITY SECTION 3. ACTIVITIES AND USES OF THE TOXIC CHEMICAL AT THE FACILITY (Important: Check all that apply.) (Important: DO NOT complete this section if you completed Section 1 above.) Generic Chemical Name Provided by Supplier (Important: Maximum of 70 characters, including numbers, letters, spaces and punctuation.) 3.1 Manufacture the toxic chemical: 3.2 Process the toxic chemical: Otherwise use the toxic chemical: 3.3 a. Produce b. Import If produce or import c. d. e. f. For on-site use/processing For sale/distribution As a byproduct As an impurity a. b. c. d. e. As a reactant As a formulation component As an article component Repackaging As an impurity a. b. c. As a chemical processing aid As a manufacturing aid Ancillary or other use SECTION 4. MAXIMUM AMOUNT OF THE TOXIC CHEMICAL ONSITE AT ANY TIME DURING THE CALENDAR YEAR 4.1 SECTION 5. (Enter two digit code from instruction package.) QUANTITY OF THE TOXIC CHEMICAL ENTERING EACH ENVIRONMENTAL MEDIUM ONSITE A. Total Release (pounds/year*) (Enter a range code** or estimate) B. Basis of Estimate (enter code) C. % From Stormwater 5.1 Fugitive or non-point NA air emissions 5.2 Stack or point NA air emissions 5.3 Discharges to receiving streams or water bodies (enter one name per box) Stream or Water Body Name 5.3.1 5.3.2 5.3.3 If additional pages of Part II, Section 5.3 are attached, indicate the total number of pages in this box and indicate the Part II, Section 5.3 page number in this box. (example: 1,2,3, etc.) EPA Form 9350 -1 (Rev. 02/2004) - Previous editions are obsolete. *For Dioxin or Dioxin-like compounds, report in grams/year. ** Range Codes: A= 1-10 pounds; B= 11-499 pounds; C= 500-999 pounds.
Page 1 and 2: Toxic Chemical Release Inventory Re
Page 3 and 4: Toxic Chemical Release Inventory Re
Page 5 and 6: More Information or Assistance TRI
Page 7 and 8: Important Information for Reporting
Page 9 and 10: Toxics Release Inventory Reporting
Page 11 and 12: Toxics Release Inventory Reporting
Page 13 and 14: TRI Reporting Software Toxics Relea
Page 15 and 16: Chemical and Industry Guidance Docu
Page 17 and 18: III. Industry-Specific Guidance EPA
Page 19: Form Approved OMB Number: 2070-0093
Page 23 and 24: Form Approved OMB Number: 2070-0093
Page 29 and 30: (IMPORTANT: Type or print; read ins
Page 31 and 32: IMPORTANT: Type or print; read inst
Page 33 and 34: A. General Information Reporting to
Page 35 and 36: General Information may request doc
Page 37 and 38: General Information < Use for motor
Page 39 and 40: General Information A.8 How to Obta
Page 41 and 42: B. Facility Eligibility Determinati
Page 43 and 44: Facility Eligibility Determination
Page 63 and 64: C. Instructions for Completing EPA
Page 65 and 66: Instructions for Completing Part I
Page 67 and 68: Part II. Chemical Specific Informat
Page 69 and 70: Instructions for Completing Part II
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Instructions for Completing Part II
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Example 14: Container Residue Instr
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D. Facility Eligibility Determinati
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E. Instructions for Completing EPA
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Instructions for Completing Part I
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Section 2. Mixture Component Identi
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Table I. SIC codes 10 Metal Mining
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Table I 2542 Office and store fixtu
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Table I 3431 Enameled iron and meta
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Table I 3873 Watches, clocks, clock
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Table II. EPCRA Section 313 Chemica
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Table II quantities. Phosphorus (ye
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Table II De Minimis CAS Number Chem
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Table II N171 Ethylenebisdithiocarb
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Table III. State Abbreviations Alab
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Table IV. Federal Information Proce
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Table IV YI YM ZA ZI Yugoslavia Yem
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Appendix A. Federal Facility Report
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Appendix A More Help is Available!
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Appendix B. Reporting Codes For EPA
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Appendix B F99 Other Incineration/T
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Appendix B Reporting the Waste Mana
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Appendix B Section 7B. On-site Ener
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Appendix C. Facility Data Profiles
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Appendix C C. Common Errors in Comp
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Appendix C ” Generic chemical nam
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Appendix C ” Any time a reported
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Appendix C ” M95 Transfer to Wast
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Appendix C 25. EPA has corrected th
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Appendix C one of the activity(ies)
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Appendix C 89. You reported a negat
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Appendix D. Supplier Notification R
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Appendix D “ 0.1 percent if the E
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Appendix D Sample Notification Lett
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Appendix E. How To Determine Latitu
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Appendix E (5) To determine the inc
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Appendix F. State Designated Sectio
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Appendix F Illinois Ms. Deirdre McQ
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Appendix F New Hampshire Ms. Wallen
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Appendix F Texas U.S. Postal Servic
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Appendix G. Section 313 EPA Regiona
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Appendix H. Other Relevant Section
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Appendix I. Sample Revision and Wit
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Index A Activity Exemptions 15 Acti
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United States Environmental Protect
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