Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
1
United
States
ENVIRONMENTAL
PROTECTION
AGENCY
Washington,
DC
20460
AGENCY
USE
ONLY
OMB
Control
No.:
2060­
0226
Expires:
10/
31/
04
SNAP
INFORMATION
NOTICE
For
Significant
New
Alternatives
Date
of
Receipt:

Date
90
Day
Review
Begins:

Date
Review
Completed:

CBI
Status:
When
completed
send
this
form
via
U.
S.
mail
to:
Or
via
overnight
delivery
to:

SNAP
Document
Control
Officer
SNAP
Document
Control
Officer
Office
of
Air
and
Radiation,
6205
J
U.
S.
EPA
U.
S.
EPA
8th
Floor
1200
Pennsylvania
Ave,
NW
1310
L
St,
NW
Washington,
DC
20460
Washington,
DC
20005
Enter
the
total
number
of
pages
in
your
SNAP
information
Notice:
Document
Control
Number
INTRODUCTION
GENERAL
INSTRUCTIONS
This
form
may
be
used
to
submit
information
under
the
Significant
New
Alternatives
Policy
(
SNAP)
program
for
the
review
of
alternatives
to
class
I
and
class
II
ozone­
depleting
substances
(
ODS)
under
section
612
of
the
Clean
Air
Act.
Submitters
are
required
to
provide
this
information
on
new
substitutes
to
assist
the
Agency
in
assessing
the
acceptability
of
chemicals
or
processes
that
are
considered
alternatives
for
ODSs.
A
separate
notice
must
be
filed
for
each
alternative
you
are
submitting.

All
submissions
must
be
provided
in
three
complete
copies.
If
information
is
to
be
claimed
as
confidential,
all
confidential
information
must
be
excised
from
one
of
the
copies,
which
will
be
placed
in
the
public
docket;
the
other
two
copies
must
include
the
confidential
material.
If
no
claims
of
confidentiality
are
made
for
the
submission,
all
copies
must
be
identical.

The
attached
"
Guidance
Manual
for
the
SNAP
Information
Notice"
is
designed
to
assist
applicants
in
completing
this
form.
The
manual
provides
instructions
on
submitting
a
SNAP
notice,
asserting
confidentiality
claims,
completing
the
notice
form,
sector­
specific
data
requirements,
and
submitting
test
data
and
supplemental
information.

To
facilitate
Agency
review
of
alternatives,
this
form
must
be
filled
out
as
completely
as
possible.
Please
provide
all
information
requested
to
the
extent
that
it
is
known
or
reasonably
ascertainable.
Make
reasonable
estimates
if
actual
data
is
unavailable.

TYPE
OF
NOTICE
(
Check
only
one
box)

Select
the
appropriate
box
identifying
the
type
of
notice
submitted:

Manufacturer
Submission:
New
alternative,
Substance,
or
Formulation___________________________________________

Petition:
New
alternative,
Substance,
or
Formulation__________________________________________________________

Petition:
Revision
of
the
Existing
SNAP
list__________________________________________________________________

Petition:
Request
to
Grandfather
Use
of
An
Unacceptable
Substitute_____________________________________________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
2
Part
1
­
GENERAL
INFORMATION
You
must
provide
the
identity
of
the
alternative
chemical
of
processes
and
the
identity
and
percentages
of
all
components
in
a
blend
and/
or
process,
even
if
you
claim
the
identity
as
confidential.
You
may
authorize
another
person
to
submit
the
identity
for
you,
but
your
submission
will
not
be
complete
and
review
cannot
begin
until
EPA
receives
this
information.

Part
II
­
ALTERNATIVE­
SPECIFIC
INFORMATION
Please
indicate
the
sector(
s)
for
which
you
are
submitting
information
on
the
substitute
by
checking
the
appropriate
boxes:

°
Refrigeration
and
Air
Conditioning

°
Foam
Blowing

°
Solvent
Cleaning

°
Fire
Extinguishing
and
Explosion
Prevention

°
Sterilization

°
Aerosols

°
Adhesives,
Coatings,
and
Inks

°
Tobacco
Expansion

°
Pesticides

You
may
need
additional
copies
of
Part
II
if
there
are
several
manufacturing,
processing,
or
use
operations
that
you
will
describe
in
this
notice.
Please
reproduce
these
sections
as
needed.

If
you
substitute
is
also
subject
to
review
under
FIFRA,
provide
the
FIFRA
Registration
Number:

_____________________________
Part
III
­
RELEASE
AND
EXPOSURE
DATA
Please
reproduce
additional
copies
of
Part
III
as
necessary.

Part
IV
­
LIST
OF
ATTACHMENTS
Please
attach
additional
sheets
if
you
do
not
have
enough
space
on
the
form
to
fully
answer
a
question.
Label
each
continuation
sheet
with
the
corresponding
section
heading
and
the
question.
In
part
IV,
list
these
attachments
and
any
test
data,
other
data,
or
any
optional
information
that
you
include
in
this
notice.

TEST
DATA
AND
OTHER
DATA
You
are
required
to
submit
all
test
data
in
your
possession
or
control
and
to
provide
a
description
of
all
other
data
known
to
you
if
these
data
are
related
to
the
health
and
environmental
effects
of
the
manufacture,
processing,
distribution
in
commerce
use,
or
disposal
of
the
alternative.
Standard
literature
citations
may
be
submitted
if
they
do
not
appear
in
the
open
scientific
literature.
Complete
test
data
(
in
English),
not
summaries
of
data,
must
be
submitted
if
they
do
not
appear
in
the
open
literature.
The
following
are
test
data
and
other
data
that
might
be
submitted
(
see
the
Guidance
Manual
for
a
more
complete
list
of
data
to
be
submitted.)
Please
indicate
test
data
to
be
included
in
your
submission
notice
by
checking
the
appropriate
boxes:

°
Health
Effects
Data

Yes

No
°
Flammability
Data

Yes

No
°
Environmental
Effects
Data

Yes

No
°
Environmental
Fate
Data

Yes

No
°
Risk
Assessments

Yes

No
°
Test
Data
Not
in
the
Possession/
Control
of
the
Submitter

Yes

No
°
Other
Data

Yes

No
CONFIDENTIALITY
CLAIMS
Anyone
submitting
information
must
assert
a
claim
of
confidentiality
at
the
time
of
submission
for
any
data
which
are
to
be
treated
as
Confidential
Business
Information
(
CBI).
Substantiation
of
this
claim
must
also
be
provided
at
this
time.
All
information
claimed
as
CBI
will
be
treated
in
a
manner
consistent
with
40
CFR
Part
2,
Subpart
B.
Failure
to
assert
a
claim
of
confidentiality
at
the
time
of
submission
may
result
in
disclosure
of
information
by
the
Agency
without
further
notice.

To
assert
a
claim
on
this
form,
circle
or
bracket
the
information
you
claim
as
confidential
and
mark
the
confidential
box
at
the
bottom
of
the
page.
Then
provide
substantiation
of
this
claim
on
an
attachment
to
the
notice.
If
any
information
is
claimed
as
confidential,
you
must
provide
a
"
sanitized"
version
of
this
notice,
including
attachments,
to
EPA
with
our
submission.
For
additional
information
on
claiming
information
as
confidential,
please
see
the
Instructions
Manual.

Information
submitted
as
CBI
may
be
accessed
by
companies
designated
as
Authorized
Representatives
of
the
United
States
Environmental
Protection
Agency
(
EPA)
under
an
EPA
contract
for
the
purpose
of
assisting
EPA
in
the
development
and
implementation
of
national
regulations
for
the
protection
of
stratospheric
ozone,
including
the
development
of
the
SNAP
program.
These
Authorized
Representatives
may
have
access
to
any
information
received
by
the
Stratospheric
Protection
Division
within
EPA
Office
of
the
Atmospheric
Programs
for
use
in
reviewing
the
need
for
possible
control
of
any
substance,
practice,
process
or
activity
that
may
reasonably
be
anticipated
to
affect
stratospheric
ozone.
Access
to
such
information
is
necessary
to
ensure
that
these
companies
can
complete
the
work
required
by
the
contract.

Authorized
Representatives
of
the
Administrator
are
subject
to
the
provisions
of
42
U.
S.
C.
7414(
c)
respecting
confidential
business
information
as
implemented
by
40
CFR
2.301(
h).
Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
3
Part
I
­
GENERAL
INFORMATION
Section
A
­
SUBMITTER
IDENTIFICATION
1.
(
a)
Person
Submitting
Notice
(
in
U.
S.)

______________________________________________________________________________________________________
Name
of
Authorized
Official
Title
______________________________________________________________________________________________________
Company/
Organization
______________________________________________________________________________________________________
Mailing
Address
Telephone
&
Fax
Numbers
______________________________________________________________________________________________________
Email
Address
(
b)
Agent
(
if
applicable)

______________________________________________________________________________________________________
Name
of
Authorized
Official
Title
______________________________________________________________________________________________________
Company/
Organization
______________________________________________________________________________________________________
Mailing
Address
Telephone
&
Fax
Numbers
______________________________________________________________________________________________________
Email
Address
(
c)
Joint
Submitter
(
if
applicable)

______________________________________________________________________________________________________
Name
of
Authorized
Official
Title
______________________________________________________________________________________________________
Company/
Organization
______________________________________________________________________________________________________
Mailing
Address
Telephone
&
Fax
Numbers
______________________________________________________________________________________________________
Email
Address
2.
Technical
Contact
(
in
U.
S.)

______________________________________________________________________________________________________
Name
of
Authorized
Official
Title
______________________________________________________________________________________________________
Company/
Organization
______________________________________________________________________________________________________
Mailing
Address
Telephone
&
Fax
Numbers
______________________________________________________________________________________________________
Email
Address
3.
If
you
have
had
a
prior
communication
with
EPA
concerning
this
notice,
note
the
date
and
type
of
communication
(
letter,
phone,
etc.)
and
the
EPA
staff
person's
name:

Mark
(
X)
if
None
________________

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
4
Part
I
­
GENERAL
INFORMATION
(
continued)

Section
B
­
ALTERNATIVE
IDENTIFICATION
1.
Commercial/
Trade
name
(
s)
of
alternative:

2.
(
a)
Name
of
chemical(
s)
(
preferably
IUPAC
nomenclature
and/
or
process
name.
For
blends,
provide
the
percent
composition
of
each
constituents.
(
b)
Chemical
Abstracts
Service
(
CAS)
registry
number
and
molecular
formula.
(
c)
For
alternative
processes
and
technologies
describe
the
technology
an
d
and
provide
a
diagram
of
the
system.
Also
provide
the
information
on
any
chemical
constituents.
(
d)
If
you
hold
a
patent
on
the
substitute,
provide
the
patent
name
and
number
and
include
a
copy
of
the
patent
as
an
attachment.
If
you
have
submitted
a
patent
application
but
have
not
been
granted
one
yet,
indicate
the
date
submitted
and
the
expected
time
frame
for
a
response.

3.
Generic
chemical
name
(
if
chemical
name
of
substitute
is
declared
Confidential
Business
Information).

4.
Specific
End­
Use
(
a)
Describe
each
end­
use
that
may
be
reasonably
anticipated
for
the
alternative.
Be
sure
to
provide
a
broad
description
(
e.
g.
terpene­
based
semi­
aqueous
solvent
cleaner
for
electronic
parts,
or
HFC
substitute
refrigerant
for
centrifugal
chillers).
(
b)
Identify
the
ODS
and
the
quantity
of
substitute
(
if
applicable)
needed
to
replace
it
for
each
end
use
in
pounds
(
replacement
ratio).

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
5
Part
I
­
GENERAL
INFORMATION
(
continued)

Section
B
­
ALTERNATIVE
IDENTIFICATION
(
Continued)

5.
(
a)
Identify
each
impurity
that
may
reasonably
be
anticipated
to
be
present
in
the
chemical
alternative
as
manufactured
for
commercial
purposes.
If
there
are
unidentified
impurities,
enter
"
unidentified."
(
b)
Provide
the
CAS
Registry
Number
if
available.
(
c)
Estimate
the
maximum
weight
percentage
of
each
impurity.
If
there
are
unidentified
impurities,
estimate
their
total
weight
percentages.

6.
Byproducts:
(
a)
Describe
any
byproducts
of
degradation
products
resulting
from
the
manufacturer,
processing,
use
or
disposal
of
the
chemical
alternative
or
chemicals
used
in
the
new
alternative.
If
there
are
unidentified
byproducts/
degradation
products
enter
"
unidentified."
(
b)
Provide
the
CAS
Registry
Number
if
available.
(
c)
Indicate
where
the
byproduct/
degradation
product
is
formed
(
e.
g.
during
manufacturing,
during
use,
etc.)
and
the
amount
or
rate
at
which
it
is
formed.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
6
Part
I
I
­
ALTERNATIVE­
SPECIFIC
INFORMATION
Section
A
­
PHYSICAL
AND
CHEMICAL
PROPERTIES
1.
Molecular
weight
2.
Physical
state
at
20

C
3.
Melting
point
4.
Boiling
point
at
1
atm.
Pressure

C
5.
Specific
gravity
g/
ml
6.
Odor
threshhold
mg/
m3
7.
Solubility
using
solvent
@
temperature

C
g/
L
8.
Solubility
in
water
@
temperature

C
9.
Partition
coefficients
Log
K
ow
Log
K

10.
Vapor
pressure
@
20

C
psi
11.
Critical
temperature

C
12.
Critical
pressure
psi
13.
Are
spectra
attached?
14.
Disassociation
constant
15.
Particle
size
distribution
16.
Volatilization
from
soil
17.
Volatilization
from
water
18.
Viscosity
@
20

C
19.
pH@
concentration
20.
Thermal
conductivity
21.
Adsorption
coefficient
22.
Flammability
limits
(
LFL,
UFL)
%
vol
23.
Flash
point
24.
Heat
of
combustion
25.
Maximum
pressure
rise
26.
Maximum
rate
of
pressure
rise
27.
Other
(
specify)

29.
Provide
any
information
on
flammability
concerns.
For
example,
if
any
abatement
techniques
are
being
used
to
minimize
the
risks
associated
with
flammable
substances
or
mixtures,
detail
those
techniques
below.
If
a
substitute
is
flammable,
an
assessment
of
overall
risk
in
each
end­
use
may
be
required.
(
See
Guidance
Manual
for
sector­
specific
data
requirements
for
flammable
substances).
Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
7
Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Part
II
­
ALTERNATIVE­
SPECIFIC
INFORMATION
(
Continued)

Section
B
­
ATMOSPHERIC
INFORMATION
1.
Ozone­
depletion
potential
(
ODP):
(
a)
Provide
the
100
year
ODP
of
the
alternative
relative
to
CFC­
11,
if
known.
If
the
substitute
is
a
blend,
provide
the
ODPs
of
individual
constituents.
(
b)
Provide
source
of
ODP
or
any
additional
data
on
the
ODP
of
the
alternative
(
e.
g.
atmospheric
lifetime,
chlorine
or
bromine
loading
potentials).
Reference
the
source
of
this
information
and
attach
any
supporting
documentation.
Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
8
2.
Global
Warming
Characteristics:
(
a)
Provide
the
alternative's
global
warming
potential
(
GWP)
relative
to
carbon
dioxide
over
100­,
500­,
and
1000­
year
time
horizons,
if
known.
If
the
substitute
is
a
blend,
provide
the
GWPs
of
the
individual
constituents.
(
b)
If
known,
provide
the
alternative's
expected
impact
on
energy
efficiency
relative
to
the
substance
it
is
replacing
(
e.
g.
+/­
X%)
and
results
of
any
testing
or
modeling
done
(
both
theoretical
and
actual
testing).
(
c)
Provide
source
of
GWP
or
any
additional
data
on
the
GWP
of
the
alternative,
including
the
atmospheric
lifetime,
infrared
absorption
spectrum,
and
infrared
absorption
capacity.
If
the
alternative
(
e.
g.
CO
2
captured
from
a
stream
of
waste
gas
as
a
byproduct
of
fermentation).

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Part
II
­
ALTERNATIVE­
SPECIFIC
INFORMATION
(
continued)

Section
C
­
OTHER
STATUTES
AND
STANDARDS
1.
Describe
whether
an
d
how
the
alternative
is
regulated
under
other
environmental
regulatory
statutes,
for
example
other
titles
under
the
Clean
Air
Act
(
CAA),
the
Clean
Water
Act
(
CWA),
the
Safe
Drinking
Water
Act
(
SDWA),
the
Resource
Conservation
and
Recovery
Act
(
RCA),
the
Federal
Insecticide,
Fungicide
and
Rodenticide
Act
(
FIFRA),
the
Toxic
Substances
Control
Act
(
TSCA),
the
Comprehensive
Environmental
Response,
Compensation
and
Liability
Act
(
CERCLA),
the
Emergency
Planning
and
Community
Right­
to­
Know
Act
(
EPCRA,
also
known
as
SARA
Title
III),
and
state
and
local
laws.
List
any
concentration­
based
or
other
numerical
standards
to
which
the
alternative
is
subject
under
the
above
standards
and
regulations.
Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
9
2.
Describe
whether
and
how
the
alternative
is
regulated
under
health
and
safety
related
statutory
authorities,
such
as
those
implemented
by
the
Food
and
Drug
Administration
(
FDA),
the
Occupational
Safety
and
Health
Administration
(
OSHA),
the
Department
of
Transportation
(
DOT),
and
state
and
local
laws.
List
any
concentration­
based
or
other
numerical
standards
to
which
the
alternative
is
subject
under
the
above
statutes
and
regulations.
Also
list
any
other
standard­
setting
organizations
such
as
the
National
Fire
Prevention
Association
(
NFPA)
or
the
American
Society
of
Heating,
Refrigerating,
and
Air
Conditioning
Engineers
(
ASHRAE),
by
which
the
substitute
is
evaluated.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Part
II
­
ALTERNATIVE­
SPECIFIC
INFORMATION
(
continued)

Section
D
­
COST
AND
AVAILABILITY
OF
THE
ALTERNATIVE
1.
Estimate
the
cost
per
pound
for
the
substitute
chemical.
For
alternative
processes
and
technologies,
describe
installation
costs
associated
with
the
alternative.
Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
10
2.
Provide
information
on
production
of
the
substitute.
Include
estimates
on:
(
a)
Year
substitute
will
be
available
if
not
currently
produced.
(
b)
Total
pounds
production
per
year
(
current
figure).
(
c)
Years
to
maximum
market
penetration.
(
d)
Maximum
total
production
per
year
at
market
saturation.
(
e)
Estimated
percentage
of
market
at
market
saturation.

3.
Describe
any
new
equipment
an
d
use
profiles.
If
retrofitting
of
existing
equipment
is
required,
detail
changes
in
technologies
needed
to
use
the
alternative
and
address
any
materials
compatibility
issues.
Provide
information
on
each
end­
use
and
capital
costs
associated
with
the
substitute
or
alternative
process.
Include
cost
of
equipment
and/
or
any
new
materials,
equipment
lifetime,
changes
in
labor
and
energy
costs.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
11
Part
III
­
RELEASE
AND
EXPOSURE
DATA
Section
A
­
TOXICITY
AND
HAZARD
INFORMATION
For
chemical
alternatives
and
for
chemicals
used
with
alternative
processes,
summarize
below
(
and
attached
supporting
information)
the
acute
and
chronic
toxicity
of
the
substitute
and
of
its
constituent
chemicals
on
any
organism
(
e.
g.
human
and/
or
other
mammals,
fish,
wildlife,
and
plants),
if
available.
Include
any
data
on
impurities
and
degradation
products
if
known.
Also
include
information
on
any
"
Allowable
Exposure
Limits"
(
AELs)
that
have
been
set
for
the
substitute.
In
addition,
please
attach
a
copy
or
facsimile
of
any
hazard
warning
statement,
label,
material
safety
data
sheet,
or
other
information
which
will
be
provided
to
any
person
who
is
reasonably
likely
to
be
exposed.
(
See
Guidance
Manual
for
sector­
specific
data
requirements).

Section
B
­
ENVIRONMENTAL
RELEASE
AND
DISPOSAL
AT
MANUFACTURE
For
each
manufacturing
site:

(
a)
Identify
all
site
locations
(
i.
e.
name
and
address)
for
each
chemical
manufacturing
process.
(
b)
Identify
all
site
locations
for
manufacturing
of
products
using
substitutes
(
e.
g.
refrigerators
containing
the
substitutes).
(
c)
Identify
the
points
of
release
and/
or
exposure
during
the
manufacture
of:
(
i)
the
substitute
and/
or
(
ii)
products
containing
the
substitutes.
(
d)
Provide
information
on
the
magnitude
of
release
if
available,
along
with
the
media
to
which
the
substitute
is
released
(
e.
g.
indoor
air,
outdoor
air,
water,
land).

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
12
Part
III
­
RELEASE
AND
EXPOSURE
DATA
Section
C­
OCCUPATIONAL
EXPOSURE
AT
MANUFACTURE
For
each
manufacturing
site
(
manufacturing
of
substitutes
and/
or
products
containing
substitutes):

(
a)
Describe
the
activities
in
which
workers
may
be
exposed
to
chemicals.
(
b)
Describe
any
protective
equipment
and
engineering
controls
used
to
protect
workers
(
e.
g.
goggles,
gloves,
chemical
hoods).
(
c)
Indicate
the
physical
form
of
chemicals
at
the
time
of
handling/
exposure
(
e.
g.
solid,
liquid,
gas).
(
d)
Estimate
average
and
maximum
numbers
of
workers
involved
in
each
activity.
(
e)
Estimate
average
and
maximum
duration
of
activity
for
any
worker,
in
terms
of
(
1)
hour/
day
and
(
2)
days/
year.
(
f)
Enter
the
contact
pathway
(
e.
g.
ingestion,
inhalation,
dermal).
(
g)
Estimate
the
average
and
high­
end
exposure
concentrations
(
separated
by
a
/),
being
sure
to
provide
units
of
measure.

Section
D
­
ENVIRONMENTAL
RELEASE
AND
DISPOSAL
IN
END­
USE
For
each
end­
use
of
a
substitute:

(
a)
Provide
the
estimated
amount
(
in
kg/
day)
of
each
chemical
released
directly
to
the
environment
(
e.
g.
as
a
hazardous
waste
or
wastewater
effluent)
at
a
site
using
the
substitute
(
e.
g.
in
products
containing
the
substitute
and
processes
using
the
substitute).
(
b)
Identify
the
media
(
indoor
air,
outdoor
air,
land,
water)
to
which
the
chemical
will
be
released
from
that
release
point.
(
c)
Describe
the
control
technology
used
to
limit
release;
estimate
the
amount
released
to
the
environment
with
the
control
technology
in
place
to
limit
release.
If
the
substitute
is
to
be
disposed
of,
indicate
the
method
and
location
of
disposal.
(
d)
Are
releases
covered
under
RCRA?
If
so,
identify
the
RCRA
hazardous
waste
codes.
(
e)
Identify
the
appropriate
number
of
sites
expected
to
use
the
substitute.
(
f)
Provide
information
on
recycling
of
the
substitute.
Describe
any
associated
costs
and
equipment.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
13
Part
III
­
RELEASE
AND
EXPOSURE
DATA
(
continued)

Section
E
­
OCCUPATIONAL
EXPOSURE
AT
END­
USE
For
all
end­
use
scenarios
of
the
substitute
(
end­
uses
utilizing
the
substitute
in
products
and/
or
processes):

(
a)
Describe
the
activities
in
which
workers
may
be
exposed
to
chemicals.
(
b)
Describe
any
protective
equipment
or
engineering
controls
used
to
protect
workers
(
e.
g.
goggles,
gloves,
chemical
hoods).
(
c)
Indicate
the
physical
form
of
chemicals
at
the
time
of
handling/
exposure
(
e.
g.
solid,
liquid,
gas).
(
d)
Estimate
average
and
maximum
numbers
of
workers
involved
in
each
activity.
(
e)
Estimate
average
and
maximum
duration
of
activity
for
any
worker,
in
terms
of
(
1)
hours/
day
and
(
2)
days/
year.
(
f)
Enter
the
contact
pathway
(
e.
g.
ingestion,
inhalation,
dermal).
(
g)
Estimate
the
average
and
high­
end
exposure
concentrations
(
separated
by
a
/),
being
sure
to
provide
units.

Section
F
­
CONSUMER
EXPOSURE
For
each
end­
use
of
a
substitute:

(
a)
Identify
the
potentially
exposed
population
(
e.
g.
indoor
residents).
(
b)
Identify
the
exposure
medium
(
e.
g.
air).
(
c)
Enter
the
contact
pathway
(
e.
g.
ingestion,
inhalation,
dermal).
(
d)
Enter
the
exposure
point
of
concentration.
Provide
(
1)
average
and
(
2)
high­
end
estimates.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
14
Part
III
­
RELEASE
AND
EXPOSURE
DATA
(
continued)

Section
G
­
GENERAL
POPULATION
EXPOSURE
(
optional)

For
manufacturing
of
substitutes
and
products
containing
substitutes:

(
a)
Identify
and
number
potential
exposure
points.
(
b)
For
each
exposure
point
described
in
(
a),
identify
the
potentially
exposed
population
(
e.
g.
residents
at
the
fenceline).
(
c)
Identify
the
contact
pathway
(
e.
g.
ingestion,
inhalation,
dermal).
(
d)
Identify
the
exposure
medium
(
e.
g.
air,
water).
(
e)
Enter
the
exposure
point
concentration
(
mg/
m3).
Provide
(
1)
average
and
(
2)
high­
end
estimates.

Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
15
Part
IV
­
LIST
OF
ATTACHMENTS
List
below
any
attachments
that
complete
the
responses
to
the
questions
on
this
form
or
that
provide
additional
information
that
may
assist
EPA's
review
of
the
alternative
under
Section
612
of
the
Clean
Air
Act.
Also,
provide
citation
for
information
already
submitted
to
EPA
as
part
of
past
regulatory
and
information
activities,
as
well
as
for
other
information
that
could
not
be
included
with
this
submission.
If
you
have
attached
continuation
pages,
describe
the
Part,
Section
and
question
number
being
continued.
Attach
additional
pages
if
necessary.

Attachment
Name
Question
#
Number
of
Pages
CBI
Mark
(
X)
this
box
if
this
page
contains
CBI
__________

Form
1265­
93
(
Revised
5/
04)
Previous
editions
are
obsolete
16
Part
V
­
CERTIFICATION
I
certify
to
the
best
of
my
knowledge
and
belief
that:

1.
All
information
provided
in
this
notice
is
complete
and
truthful
as
of
the
date
of
the
submission.

2.
I
am
submitting
with
this
notice
all
test
data
in
my
possession
or
control
and
a
description
of
all
other
data
known
to
or
reasonably
ascertainable
by
me.

3.
If
this
is
a
submission
of
a
new
alternative,
the
company
name
in
Part
I,
Question
1a
of
this
notice:
(
a)
intends
to
manufacture,
formulate,
import,
market,
or
use
a
new
alternative
to
a
Class
I
or
Class
II
ozonedepleting
substance
which
is
identified
in
Part
I,
Section
B,
Question
2.
(
b)
seeks
an
acceptability
determination
on
a
new
alternative(
s)
to
a
Class
I
or
Class
II
ozone­
depleting
substance,
which
is
identified
in
Part
I,
Section
B,
Question
2.

4.
The
accuracy
of
the
statements
made
in
this
notice
reflects
my
best
prediction
of
the
anticipated
facts
regarding
the
alternative
described
herein.
Any
knowing
and
willful
misinterpretation
is
subject
to
criminal
penalty
pursuant
to
section
113(
c)
of
the
Clean
Air
Act
and
18
U.
S.
C.
§
1001.

Signature
and
Title
of
Authorized
Official
(
Original
Signature
Required):
Date
Signature
of
Agent
(
Where
Applicable):
Date
For
persons
filing
a
SNAP
Information
Notice,
the
reporting
burden
is
estimated
to
average
150
hours
per
year.
For
persons
filing
a
TSCA/
SNAP
Addendum,
the
reporting
burden
is
estimated
to
average
46
hours
her
year.
Burden
means
that
total
time,
or
financial
resources
expended
by
persons
to
generate,
maintain,
retain,
or
disclose
or
provide
information
to
or
for
a
Federal
agency.
This
includes
the
time
needed
to
review
instruction;
develop,
acquire,
install,
and
utilize
technology
and
systems
for
the
purposes
of
collecting,
validating,
and
verifying
information;
adjust
the
existing
ways
to
comply
with
any
previously
applicable
instructions
and
requirements;
train
personnel
to
be
able
to
respond
to
a
collection
of
information;
search
data
sources;
complete
and
review
the
collection
of
information;
and
transmit
or
otherwise
disclose
the
information.
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.

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,
including
through
the
use
of
automated
collection
techniques
to
the
U.
S.
Environmental
Protection
Agency,
Attn:
Director,
Collection
Strategies
Division,
Office
of
Information
Collection,
1200
Pennsylvania
Avenue,
NW,
Mail
Code
2822T,
Washington
DC,
20460.
Please
include
the
EPA
Docket
ID
Number
OAR­
2004­
0077
and
OMB
Control
Number
2060­
0226
in
any
correspondence.
Do
not
send
the
completed
form
to
this
address.
