United
States
Environmental
Protection
Agency
Washington,
DC
20460
Substantiation
to
Accompany
Claims
of
Trade
Secrecy
Under
the
Emergency
Planning
and
Community
Right­
To­
Know
Act
of
1986
Form
Approved
OMB
No.
2050­
0078
Approval
Expires:

Paperwork
Reduction
Act
Notice
Public
reporting
burden
for
this
collection
of
information
is
estimated
to
vary
from
16
hours
to
38
hours
per
response,
with
an
average
of
26.7
hours
per
response,
including
time
for
reviewing
instructions,
searching
existing
data
sources,
gathering
and
maintaining
the
data
needed,
and
completing
and
reviewing
the
collection
of
information,
including
suggestions
for
reducing
this
burden
to
Director,
Office
of
Environmental
Information,
Collection
Strategies
Division,
Mailcode
2822,
U.
S.
Environmental
Protection
Agency,
1200
Pennsylvania
Avenue
NW,
Washington,
DC
20460;
and
to
the
Office
of
Information
and
Regulatory
Affairs,
Office
Management
and
Budget,
Washington,
DC
20503.

Part
1.
Substantiation
Category
1.1
Title
III
Reporting
Section
(
check
only
one)


303

311

312

313
1.2
Reporting
Year
19____

1.3
Indicate
Whether
This
Form
is
(
check
only
one)

1.3a

Sanitized
(
answers
1.3.1a
below)

1.3.1a
Generic
Class
or
Category
1.3b

Unsanitized
(
answer
1.3.1b
and
1.3.2b
below)

1.3.1b
CAS
Number






­


­

1.3.2b
Specific
Chemical
Identity
Part
2.
Facility
Identification
Information
2.1
Name
2.2
Street
Address
2.3
City,
State,
and
Zip
Code
2.4
Dun
and
Bradstreet
Number


­



­




EPA
Form
9510­
1
(
3/
31/
1997)
Page
1
of
5
Part
3
Responses
to
Substantiation
Questions
3.1
Describe
the
specific
measures
you
have
taken
to
safeguard
the
confidentiality
of
the
chemical
identify
claimed
as
trade
secret,
and
indicate
whether
these
measures
will
continue
in
the
future.

3.2
Have
you
disclosed
the
information
claimed
as
trade
secret
to
any
other
person
(
other
than
a
member
of
a
local
emergency
planning
committee,
officer
or
employee
of
the
United
States
or
a
State
or
local
government,
or
your
employee)
who
is
not
bound
by
a
confidentiality
agreement
to
refrain
from
disclosing
this
trade
secret
information
to
others?


Yes

No
3.3
List
all
local,
State,
and
Federal
government
entities
to
which
you
have
disclosed
specific
chemical
identity.
For
each,
indicate
whether
you
asserted
a
confidentiality
claim
for
the
chemical
identity
and
whether
the
government
entity
denied
that
claim.

Government
Entity
Confidentiality
Claim
Asserted
Confidentiality
Claim
Denied
Yes
No
Yes
No
EPA
Form
9510­
1
(
3/
31/
1997)
Page
2
of
5
3.4
In
order
to
show
the
validity
of
a
trade
secrecy
claim,
you
must
identify
your
specific
use
of
the
chemical
claimed
as
trade
secret
and
explain
why
it
is
a
secret
of
interest
to
competitors.
Therefore:

(
i)
Describe
the
specific
use
of
the
chemical
claimed
as
trade
secret,
identifying
the
product
or
process
in
which
it
is
used.
(
If
you
use
the
chemical
other
than
as
a
component
of
a
product
or
in
a
manufacturing
process,
identify
the
activity
where
the
chemical
is
used.)

(
ii)
Has
your
company
or
facility
identity
been
linked
to
the
specific
chemical
identity
claimed
as
trade
secret
in
a
patent,
or
in
publications
or
other
information
sources
available
to
the
public
or
your
competitors
(
of
which
you
are
aware)?


Yes

No
If
so,
explain
why
this
knowledge
does
not
eliminate
the
justification
for
trade
secrecy.

(
iii)
If
this
use
of
the
chemical
claimed
as
trade
secret
is
unknown
outside
your
company,
explain
how
your
competitors
could
deduce
this
use
from
disclosure
of
the
chemical
identity
together
with
other
information
on
the
Title
III
submittal
form.
EPA
Form
9510­
1
(
3/
31/
1997)
Page
3
of
5
3.4
(
iv)
Explain
why
your
use
of
the
chemical
claimed
as
trade
secret
would
be
valuable
information
to
your
competitors.

3.5
Indicate
the
nature
of
the
harm
to
your
competitive
position
that
would
likely
result
from
disclosure
of
the
specific
chemical
identity,
and
indicate
why
such
harm
would
be
substantial.

3.6
(
i)
To
what
extent
is
the
chemical
claimed
as
trade
secret
available
to
the
public
or
your
competitors
in
products,
articles,
or
environmental
releases?

EPA
Form
9510­
1
(
3/
31/
1997)
Page
4
of
5
3.6
(
ii)
Describe
the
factors
which
influence
the
cost
of
determining
the
identity
of
the
chemical
claimed
as
trade
secret
by
chemical
analysis
of
the
product,
article,
or
waste
which
contains
the
chemical
(
e.
g.,
whether
the
chemical
is
in
pure
form
or
is
mixed
with
other
substances).

Part
4.
Certification
(
Read
and
sign
after
completing
all
sections)

I
certify
under
penalty
of
law
that
I
have
personally
examined
the
information
submitted
in
this
and
all
attached
documents.
Based
on
my
inquiry
of
those
individuals
responsible
for
obtaining
the
information,
I
certify
that
the
submitted
information
is
true,
accurate,
and
complete,
and
that
those
portions
of
the
substantiation
claimed
as
confidential
would,
if
disclosed,
reveal
the
chemical
identity
being
claimed
as
a
trade
secret,
or
would
reveal
other
confidential
business
or
trade
secret
information.
I
acknowledge
that
I
may
be
asked
by
the
Environmental
Protection
Agency
to
provide
further
detailed
factual
substantiation
relating
to
this
claim
of
trade
secrecy,
and
certify
to
the
best
of
my
knowledge
and
belief
that
such
information
is
available.
I
understand
that
if
it
is
determined
by
the
Administrator
of
EPA
that
this
trade
secret
claim
is
frivolous,
EPA
may
assess
a
penalty
of
up
to
$
25,000
per
claim.

I
acknowledge
that
any
knowingly
false
or
misleading
statement
may
be
punishable
by
fine
or
imprisonment
or
both
under
applicable
law.

4.1
Name
and
official
title
of
owner
or
operator
or
senior
management
official
4.2
Signature
(
All
signatures
must
be
original)
4.3
Date
Signed
EPA
Form
9510­
1
(
3/
31/
1997)
Page
5
of
5
