Document Rj8nwwXGKbp63860Bm100kMgz
Form Approved OMB No. : 2070-0093 Approval Explrot:___
u.S. Environmental Protection Agency
TOXIC CHEMICAL RELEASE INVENTORY REPORTING FORM
Section 313 of the Emergenoy Planning and Community Rlght-to-Know Act of 19B6,
also known as Title III of the Superfund Amendments and Reautnortzatlon Act
EPA FORM
R
PART 1.
FACILITY IDENTIFICATION INFORMATION
(This space for your optional use.)
Public reporting burden tor this
collection ot information la estimated to
vary from 30 to 34 hows par response,
with an average of 32 hours per
response, including time tor reviewing
Instructions, searching axlatlng data
sources, gathering and maintaining the
data needed, and completing and
reviewing tne collection of Information.
Sand comments regarding this burden
estimate or any other aspect ot this
collection of Information, including
suggestions tor reducing this burden, to
Chief. information policy Branch
(PM-223). US EPA. 401 M St.. SW.
Washington. D.C. 20460 Attn; TRI
Burden and to tna Office ot Information
and Regulatory Affairs. Office of
Management and Budget Paperwork
Reduction
Protect
(2070-0093),
Washington. D.C. 20603.
1.1 Are you claiming the chemical identity on page 3 trace secret?
1.
I ] Ye* (Answer oueation 1,2;
[ X ] No (Do not anawer 1.2;
_______________ Attacn auoatantlation forma. I___________Go to oueation 1.3.1
1.2
if`Yea" in 1. i. it tma copy; [ ] Sanitized [ ] Unaanitlzed
1.3 neodrting Year
i9_as_
2. CERTIFICATION (Read and sign after completing aU sections.)
I hereby certify that 1 have rwwwad the attach^ documents and that, to the best of my knowledge and belief, the submitted Information la true and
compff
tuit th* amount* na value* in tht* rtacrt *r* accural* b***0 on raaionabia #*timat* uting oata available to tn* oreoarara Of thl* report.
Name and official title of owner/operator or senior management official
T. G. Brown, Works Manager, ?PG Industries, Lake Charles. La
Signature
Data signed
Faculty or >tabM*nm*nt Nam* PPG Iiiustriss^Inr. -
3.1
Street Address ColuTihia Southern Road
City Westlake
State LA
County
Zip Code 70669
WHERE TO SEND COMPLETED FORMS:
1. U.S. ENVIRONMENTAL PROTECTION AGENCY P.O. BOX 70266 WASHINGTON. DC 20024-0266 ATTN: TOXIC CHEMICAL RELEASE INVENTORY
2. APPROPRIATE STATE OFFICE ($ Instructions Appendix E)
This report contains Information tor (Check one);
3.2
.[x] An entire facility
| Part of a facility.
Technical Contact
3.3
Andy P,. Plaiiche'
3.4
Public Contact V' i 11 i a. rr.
J.
Pesrd
SIC Code (a digit)
3.5 a.2812
3.6
281
Latitude Minutes 13
c. 286 9
Dun & Bradstreat Number (s)
3.7 a.00-808-fii;0-
SPA Identification Numperla) (RCRA l.p. No.
3.8 a.LAD 00 808 *g06
NPOES Penult Number(s)
3.9 ..LA 0000761
Receiving Streams or Water Bodies (enter one name per Pox)
a.Calcasieu River
Telephone Number (include area oode)
(318) 491-4184
Teiaphone Number (Include area cede)
(318)491-4848
NA
Longnuo* Minutes
15
i,
MA.
b. NA
b. Bayou D : I n d e
3.10 Bayou Verdins
i.
3.1
ctlon Well Code (UlC) Identification Number(s)
4.1
Name of Parent Company PPG Indnstrips.____Inc.
Patent Company's Dun 4 Bradatreet Number
4.2 00-134-4803
ERA Form 9350-1 (1-89) Revised--Do not use previous versions.
022^97
SL
(Important: Type or print; read instructions before completing form.)
A
tP
rtnrAA
REPA FORM
PART II. OFF-SITE LOCATIONS TO WHICH TOXIC CHEMICALS ARE TRANSFERRED IN WASTES
1. PUBLICLY OWNED TREATMENT WORKS (POTWs)
1.1 POTW name
NA
Straet Address
1.2 POTW name
Street Address
City
County
City
State
Zip State
Page 2 of 5 (This space for your optional use.)
County Zip
2. OTHER OFF-SITE LOCATIONS (DO NOT REPORT LOCATIONS TO which WASTES ARE sent only FOR RECYCLING OR REUSE).
2.1 Off-site location name
Chemical Waste Management, Inc.
EPA Identification Number (RCRA ID. No.)
ALD 000622464
Street Address
Alabama Hiehwav 17 a t Milemarker
City
County
Emelle
Sumter
State
Zip
AL 35459
Is location under control of reporting facility or parent company?
163
2.2 Off-site location name
Rollins Environmental Services(TX)Inc
EPA identification Number (RCRA 10. No.)
TXD 055141378
Street Address
2027 Battleground Road
City
County
Deer Park
Harris
State
Zip
TX 77536
is location under control of reporting facility or parent company?
[ ]y [ X]l*>
[ ] Yes
[x]no
2.3 Off-site location name
Waste-Tech Services,
FPA Identification Number (RCRA ID, No,)
LAD 981514441
Inc.
Street Address
Columbia Southern Road
City
Westlake
County
Calcasieu
State
Zip
LA 70669
Is location under control ot reporting facility or parent company?
2.5 Off-site location name
[ ]ve. [ x]no
2.4 Off-site location name
NA
EPA Identification Number (RCRA ID. No.)
Street Address City
County
State
Zip
Is location under control ot reporting facility or parent company?
2.6 Off-site location name
[ ]y.s
[ ] NO
EPA Identification Number (RCRA ID, No,)
EPA Identification Number (RCRA ID. No.)
Street Address
Street Address
City
County
City
County
State
Zip State
Zip
Is location under control ot reporting facility or parent company?
[ ]v.s
[u
Is location under control ot reporting facility or parent company?
[ U [ ] NO
[ ] Check If additional pagaa of Part H are attached. How many?
EPA Form 9350-1 (1-89) Revised--Do not use previous versions.
(Important: Type or print: read instructions before completing form.)
ft PDA
trH
EPA FORM R
part III. CHEMICAL-SPECIFIC INFORMATION
Page 3 of 5
(This space for your optional use.)
1. CHEMICAL IDENTITV(Do not complete this section If you complete Section 2.)
1.1 [Reserved]
1.2
CAS Number (Enter the numoer exactly as it appears on the 313 list. Enter NA it reporting a chemical category.)
67-66-3
Chemical or Chemical Category Name (Enter the name exactly It *ppa*r* on the 313 list.)
1.3 Chloroform
Generic Chemical Name (Complete only if Part l, Section 1.1 IS checked "Yes." Generic name must be structurally descriptive.) 1.4
MIXTURE COMPONENT IDENTITY (Do not complete this section if you complete Section 1.)
2. Generic Chamical Mama Provided by Supplier (Limit the name to a maximum of 70 charactars (e.g., numbers, letters, spaces, punctuation).)
3. ACTIVITIES AND USES OF THE CHEMICAL AT THE FACILITY (Check all that apply.)
Manufacture the chemical:
3.1
ri
a. lX i Produce
If produce or import: f 1 For on-site
c-l J use/processlng
[ d.L
1 For sale/ J distribution
b. [x ] Import
e.[ X ] As a byproduct
f. [ X] As an impurity
Process the 3.2 chemical:
r] a* * J As a reactant
d. [ ] Repackaging only
K f 1 As a formulation "1 J component
[ 1 As an article c-l J component
3.3
Otherwise use the chemical:
f 1 As a chemical 8-1 * processing aid
r1 b.l J As a manufacturing aid
r1 c.l i Ancillary or other use
4. rMAXIMUM AMOUNT OF THE CHEMICAL ON-SITE AT ANY TIME DURING THE CALENDAR YEAR
1 (enter
5. RELEASES OF THE CHEMICAL TO THE ENVIRONMENT ON-SITE
A. Total Release (Ibs/yr)
You may report releases of less than 1.000 lbs. by checking ranges under A.1. (Do not use both A.1 and A.2)
A.1 Reporting Ranges 0 1-499 500-999
A.2 Enter
Estimate
5.1 Fugitive or non-point air emissions 5.2 Stack or point air emissions
5.1a [][][] 38.000 5.2a [][][] 29,000
B. Basis of 1 Estimate 1 (enter code)
5.1b S 5.2b 0
5.3 Discharges to receiving
|
streams or water bodies &-3-1 Ls-1
(Enter letter coda from Part 1
Section 3,10 tor stream(i) in tna box providad.)
(~ 1 5.3.2 1 h 1
5.3.3 0
5.3.1a [][][] 5.3.2a [][][] 5.3.3a [][][]
NA 5300
NA
5.3.1b 0 5.3.2b 0 5.3.3b Q
5.4 Underground Injection 5.5 Releeses to land
S.S.1 On-*ite landfill
5.5.2 Land traatmant/appllcatlon farming
5.4a [][][] 5.5.1a MMM 5.5.2a (][][]
NA NA NA
5.4b 0 5.5.1b 0 5.5.2b 0
5.5.3 Surface impoundment
5.5.3a [][][]
NA
5.5.3b 0
5.5.4 Other dixpoeal
5.5.4a [][][]
5.5.4b 0
4
[ ] (Check If additional Information ta provided on Part IV-Supplemental Information.)
EPA Form 9350-1(1-89) Revised--Do not use previous versions.
SL 022499
1
(Important: Type or print; read instructions before completing form.)
** FPA
EPA FORWlR
PART III. CHEMICAL-SPECIFIC INFORMATION (continued)
Page 4 of 5 (This space for your optional use.)
6. TRANSFERS OF THE CHEMICAL IN WASTE TO OFF-SITE LOCATIONS
You may report transfers
.of less than 1.000 lbs. by checking
ranges under A. 1 (Do not use both A.1 and A.2)
A. Total Transfers (Ibs/yr)
A.1 Reporting Ranges
0 1-490 500-990
A.2
Enter Estimate
Discharge to POTW ___ , --
_(enter location number 1,11
6,1,1 from Part II. Section t.) | 1 |.|
1 |
[
3[
3[
3
NA
___ . Other otf-sita location
- ,, , ,6,2.1
(enter location number from Part II, Section 2.) |
2 |.|1
1 |
[
1[
3l
1
1300
r__ ___Other ott-site location
,, (enter location number 1 2 I |o
6.2.2 from Part II, Section 2.) L--J LeJ
t
, ,---Other off-site location
-(enter location number 1 1 |o
6.2.3 from Part II, Section 2.) | * I P
[
3[ 1[
3[ 3[
1 1
770 16,000
B. Basis of Estimate
(enter code) S,,6 6.2.1b @
6.2.2b M 6.2.3b 0
C.Type of Treatment/ Disposal
____ (enter code)____
6.2.1c ImI7 |2 |
6.2.2c Iwb b 1
6.2.3c M|5 j0
[ ] (Check If additional information is provided on Part IV-Suppiemental Information.)
7. WASTE TREATMENT METHODS AND EFFICIENCY
A. General Wastestream
(enter codel
B. Treatment Method
(enter code)
C. Range of Influent
Concentration (enter code)
D. Sequential Treatment? (check if
applicable)
E. Treatment
Efficiency Estimate
F. Based on Operating Data? Yes
No
7.1a 7.2a 7.3a
S 7.1b
7.2b
7.3b
A
7.1 . 0
07.2c
7.3c
7.Id 7.2d 7.3d
[1 [] [1
7.ie 99.99 %
7.2e 99.99 %
7,3e
%
7.4a 7,5a 7,6a 7.7a 7.8a 7.9a 7.10a
7.4b 7.5b 7.6b 7.7b 7.8b 7.9b 7.10b
PA 2
7.4c
7.So 7.6c 7.7c 7.8c 7.9c 7.10c
7.4d [ ]
7.5d [ 1 7.6d [ ] 7.7d [ 3 7.8d l 3 7.9d [ 3 7.10d [ 3
7.4* 99.68 %
7.5e
%
7.6e
%
7.7e
%
7.Be
%
7.9e
7,l0e
%
[ ] (Check If additional information is provided on Part IV-Supplemental Information.)
7... 7.2f
TM 7
7 51
7.6f
7 7f
7-w
7.9f 7.10f
[ X] [ ] [ X] [ ]
[ ] [x]
[X ] [ ]
[ ][ ]
[ ]l ] [ 3[ 3
[3(1
[111
[ 3[ 3
8. OPTIONAL INFORMATION ON WASTE MINIMIZATION
(Indicate actions taken to reduce the amount of the chemical being released from the facility. See the instructions for coded
items and an explanation of what information to include.)
____________
A. Type of Modification (enter code)
B. Quantity of the Chemical In Wastes Prior to Treatment or Disposal
C. Index
D, Reason for Action (enter code)
Current reporting year (Ibs/yr)
Prior year (Ibs/yr)
I Or percent . change
M NA
%
EPA Form 9350-1 (1-89) Revised - Do not use previous versions.
SL 022500
r
(Important: Type or print; read instructions before completing form.)
EPA
REPA FORM
PART IV. SUPPLEMENTAL INFORMATION
Use this section If you need additional space for answers to questions in Part III. Number the lines used sequentially from lines in prior sections (e.g.. 5.3.4. 6.1.2. 7.11)
Page 5 of 5
ADDITIONAL INFORMATION ON RELEASES OF THE CHEMICAL TO THE ENVIRONMENT ON-SITE (Part III. Section 5.3)
You may report releases of less than 1,000 lbs. by checking ranges under A.1.
(Do not use both A.1 and A.2)
A. Total Release (Ibs/yr)
A.1 Reporting Ranges
0 1-499 500-999
A.2 Enter Estimate
5.3 Discharges to
receiving streams or
water bodies
5.3.
----,
[][)[]l_J 5.3---------a
B. Basis of Estimate
(enter code in box
provided)
5.3_______tO
C.% From Stormwater 5.3_____ c
(Enter latter code from Part 1
1)
Section 3.10 for atroam(s) met
I
[][][]the box provided.)
-------------------1
5.3____ a
5.3.____bD 5.3.____ c
[][][]5.3---------a
5.3. _D
5.3.____ c
ADDITIONAL INFORMATION ON TRANSFERS OF THE CHEMICAL IN WASTE TO OFF-SITE LOCATIONS (Part III. Section 6)___________________________ _________________
You may report transfers of less than 1.000 lbs. by checking ranges under A.1. (Do not use both A.1 and A.2)
A.Total Transfers (Ibs/yr)
A.1 Reporting Ranges
0 1-409 500-999
A.2 Enter Estimate
B. Basis of Estimate
(enter code in box
provided)
C. Type of Treatment/ Disposal
Discharge to POTW
..
(enter location number
6.1,from Part II, Section
[][][]
6.2.
Other off-site location (enter location number from Part II, Section 2
[][][]
62
:,BDOther off-site location
(enter location number
[Hill' ----------from Part ll. Section 2
6.2.
Other otf-site location (enter location number . from Part II, Section 2
[](][]
6.2.
6.2.i
6.2.
6.2.
ADDITIONAL INFORMATION ON WASTE TREATMENT METHODS AND EFFICIENCY (Part III. Section 7)
A. General
Wastestream (enter code
in box provided)
B. Treatment
Method (enter code in box provided)
C. Range of influent Concentration I enter code)
D. Sequential Treatment? (check if
applicable)
E. Treatment Efficiency Estimate
F. Based on Operating Data? Yes
No
a 7.
HD
--`
(] []
[]
7.
?-------fl H ]
-'MM
% .'[ H )
1 HD
[] tl
-'[ H )
ni
_>
HI
.<[ 1 [1
-'[ 1 [ ) .-I H )
7.
[]
-'MM
[ ] -'[ ][ ]
EPA Form 9350-1(1-89) Revised--Do not use previous versions.
SL 022501