Epa Form R - Part Ii - Chemical-Specific Information (Continued)

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Form Approved OMB Number: 2070-0093
Page 4 of 5
(IMPORTANT: Type or print; read instructions before completing form)
Approval Expires: 01/31/2006
TRI Facility ID Number
FORM R
PART II. CHEMICAL-SPECIFIC INFORMATION (CONTINUED)
Toxic Chemical, Category or Generic Name
SECTION 6.2 TRANSFERS TO OTHER OFF-SITE LOCATIONS (CONTINUED)
A. Total Transfers (pounds/year*)
B. Basis of Estimate
C. Type of Waste Treatment/Disposal/
(enter range code**or estimate)
(enter code)
Recycling/Energy Recovery (enter code)
1.
1.
M
1.
2.
2.
M
2.
3.
3.
M
3.
4.
4.
M
4.
Off-Site EPA Identification Number (RCRA ID No.)
6.2
Off-Site Location Name
Off-Site Address
Country
State
Zip
County
City
(Non-US)
Is location under control of reporting facility or parent company?
No
Yes
A. Total Transfers
(pounds/year*)
B. Basis of Estimate
C. Type of Waste Treatment/Disposal/
(enter range code**or estimate)
(enter code)
Recycling/Energy Recovery (enter code)
1.
1.
M
1.
2.
2.
M
2.
3.
3.
M
3.
4.
4.
M
4.
SECTION 7A. ON-SITE WASTE TREATMENT METHODS AND EFFICIENCY
Check here if no on-site waste treatment is applied to any
Not Applicable (NA) -
waste stream containing the toxic chemical or chemical category.
a. General
b. Waste Treatment Method(s) Sequence
c. Range of Influent
d. Waste Treatment
e. Based on
Waste Stream
[enter 3-character code(s)]
Concentration
Efficiency
Operating Data?
(enter code)
Estimate
1
2
7A.1b
7A.1c
7A.1d
7A.1e
7A.1a
Yes
No
4
5
3
%
7
8
6
7A.2a
7A.2b
1
7A.2c
7A.2d
7A.2e
2
3
Yes
No
4
5
%
6
7
8
1
7A.3b
7A.3a
2
7A.3c
7A.3d
7A.3e
3
4
Yes
No
5
%
6
7
8
7A.4b
7A.4c
7A.4d
7A.4e
7A.4a
1
2
3
Yes
No
4
5
%
6
7
8
7A.5c
7A.5d
7A.5e
7A.5a
7A.5b
2
1
Yes
No
3
5
4
%
6
8
7
If additional pages of Part II, Section 6.2/7A are attached, indicate the total number of pages in this box
and indicate the Part II, Section 6.2/7 page number in this box:
(example: 1,2,3,etc.)
*For Dioxin or Dioxin-like compounds, report in grams/year
EPA Form 9350 -1 (Rev. 02/2004) - Previous editions are obsolete.
**Range Codes: A=1 - 10 pounds; B=11 - 499 pounds C= 500-999 pounds.

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