ATMI VPEP Form (Microsoft Word Format)

ATMI American Textile Manufacturers Institute

Voluntary Product Environmental Profile

(rev. 1Oct 1998)

I. PRODUCT/SUPPLIER GENERAL INFORMATION

Product: Supplier:

Supplier Product Number Chemical Family

Product Use:

Technical Information Phone Number

Emergency Phone Number

Is this product or all of its components listed in the TSCA Inventory?No: Yes:

Is this product or any of its components on the German Consumer Goods Ordinance list?No: Yes:

Is this product synthesized from benzidine chemistry (per EPA SNUR 61 FR 52287)?No: Yes:

Is supplier a participant in a program that addresses safety, health, and environmental
issues (such as Responsible Care, ETAD's Dyecare)?No: Yes:

If yes, list:

II. GENERAL HAZARD INFORMATION - FORMULATED PRODUCT

OSHA Hazard? No: Yes:

DOT Regulated No: If yes, proper shipping name:

Hazard Class: UN/NA Number: Packing Group RQ (lbs)

RCRA Hazardous Waste?No: If yes, characteristic/waste code(s):

SARA 311/312 Hazard?No: Acute: Chronic Fire Pressure: Reactive

HMIS or NFPA Ratings:Health: Flammability: Reactivity: Protective Equipment:

III. PRODUCT ANALYSIS DATA

Please enter in the space provided the code which is applicable to this product. / Code C - Substance present in excess of 0.1%
Code P - Substance present in excess of 100 parts per million
Code T - Substance present in less than of 100 parts per million
Code X - Substance not added and not known present

Generic/Class IdentificationMax. Amount & Unit

Algicide/Biocide
Defoamers
Formaldehyde
Surface Active Agent
Indicate Type

IV. PHYSICAL PROPERTIES DATAV. TOXICOLOGICAL INFORMATION

DataSpecie

Physical Form: / Ingestion LD50 (mg/Kg):
Color/Odor: / Dermal LD50 (mg/Kg):
Density: / Inhalation LC50 (mg/Kg):
Flash Point (deg F/deg C) / Skin Irritant:
Method used: / Eye Irritant:
Percent Volatiles (wt %): / Sensitizer:
pH (As Is/Conc.): / Additional Information:
Solubility in water (g/L):
Vapor Pressure (mm Hg):

The instructions and form may not be reproduced in any form whatsoever without the prior written permission of ATMI.

Voluntary Product Environmental ProfileSupplier:

VI. ENVIRONMENTAL DATA

DataSpecie

BOD5 (mg O2/g, Kg or L): / Bacteria Tox IC50 (mg/L):
BOD15 (mg/O2, Kg, or L): / ASRIT EC50 (mg/L):
BOD28 (O2/mg, Kg, or L): / Fish Tox LC50 (mg/L):
COD (mg/O2, Kg, or L): / Fish Tox LC50 (mg/L):
TOC (%): / Daphnia LC50 (mg/L):
Biological Elimination (%): / Additional Data:
Zahn-Wellens:

VII. REGULATORY INFORMATION - COMPONENT LEVEL

Total VOC's by EPA method 24/24A (%)

Total VOC's estimated based on product composition (%):

/ 1* / 2* / 3* / 4*
Regulated Components / CAS # / Max. Wt % / CUSTOMER USE / OSHA / TLV/PEL
(mg/m3 or ppm),
criteria / CAA
HAP / CAA
VOC
1
2
3
4
5
6
5* / 6* / 7* / 8* / 9* / 10* / 11* / 12* / 13* / 14*
State
TAP / NC
PROC / CWA / CERCLA
RQ (lbs) / RCRA
Hazardous
Waste / SARA
302
EHS / SARA
311/312
Category / SARA
313
Report / CA
PROP
65 / STATE
Right-to-Know
1
2
3
4
5
6

The instructions and form may not be reproduced in any form whatsoever without the prior written permission of ATMI.

1*Hazardous as defined by OSHA (29 CFR XVII part 1910, Subpart Z)

2*ACGIH Threshold Limit Value or Permissible Exposure Limit

3*Hazardous Air Pollutant, including all chemicals listed in the
1990 Clean Air Act (Note: No de minimus level for HAPs)

4*VOC as defined by 40 CFR 51.100

5*South Carolina Standard 8 TAP, and for Title 15A of North
Carolina Administrative Code 2D.1104 and 2H.0610

6*Photochemically Reactive Organic Compounds, Title 15A of
North Carolina Administrative Code Section .0518

7*Priority pollutants as specified by 40 CFR 401.15

8*CERCLA Hazardous Substances List (40 CFR 302.4, 355 & 372). Reporting Quantity of the formulated product based on that specified for the regulated component and the % present in the product

9*RCRA Harzarous Waste (40 CFR Part 261)

10*SARA Extremely Hazardous Substance. Section 302

11*SARA Section 311 and 312 Hazard (A-Acute, C-Chronic, F=Flammable,R=Reactive, P=Pressure, NR=Not Regulated)

12*SARA Toxic Chemical Section 313 (40 CFR 372 &
amendents published in the Federal Register)

13*Carcinogins and Reproductive Toxins listed under California
Propisition 65

14*Chemicals whose disclosure is required by the various state right
to-know regulations (Specifically MA, NJ, and PA)

The instructions and form may not be reproduced in any form whatsoever without the prior written permission of ATMI.

Abbreviations: NA=Not Applicable NE=Not Evaluated NK=Not Known NR=Not Regulated

The instructions and form may not be reproduced in any form whatsoever without the prior written permission of ATMI.

Voluntary Product Environmental ProfileSupplier:

VIII. METALS ANALYSIS VIII. METALS ANALYSIS

Metal / Maximum Value / Data
Rationale / Metal / Maximum Value / Data
Rationale
AsArsenic / BaBarium
CdCadmium / CoCobalt
CrChromium / CuCopper
FeIron / HgMercury
MgMagnesium / MnManganese
NiNickel / PbLead
SbAntimony / SeSelenium
SnTin / ZnZinc

IX. SUBMITTAL INFORMATION IX. SUBMITTAL INFORMATION

Submitted by: / Phone: / Fax:
Title: / E-mail: / Date:

INSTRUCTIONS FOR COMPLETING FORM

Please provide the requested information and complete all areas with data or one of the abbreviations listed. Please do not use "See MSDS" as a response. If a paper version of this form is being submitted, additional pages may be added for items such as lengthy chemical names.
The receiver of this form respects the need to maintain proprietary information. Please give as much information as possible, such as chemical class or functional groups.
For Section III, percentages such as >1 and <99 are not useful. Please provide the maximum value. The codes correspond to the following: C (Component) - Present at levels >= 0.1%; P (Present) - Present at levels >=100 ppm to 0.1%; T (Trace) – Present at levels < 100 ppm; X (Not Present) - The substance has not been added to the product and there is no reason to expect it to be present. (This defines the DeMinimis Level)
In Section IV, V, and VI, ranges of values may be entered for the items requiring numeric data (i.e., pH, solubility, COD, etc.).
In Section VII, list all regulated chemicals contained in the product, including State Right-to-Know hazardous substances, even if they are not OSHA hazards. For weight %, enter the maximum value for the component in the product.
Explanations of the information requested in Section VII and the abbreviations to be used are given below the tables. The response types are given below. If you are unsure of what information is being requested, please contact the company requesting the information for clarification.

1*Y/N8*Number

2*Number, units, and type (e.g., STEL, TWA)9*Y/N

3*Y/N10*Y/N

4*Y/N11*A/C/F/R/P (may be more than one), or NR

5*NC, SC, Both, None12*Y/N

6*Y/N13*Y/N

7*Y/N14*State Abbreviation (i.e., MA, NJ, PA)

In Section VIII (Metal Analysis), values are not to be listed as "none" or "0%". If data is not available, please list as NE. Enter the maximum value, not a range of values. If the value is lower than the detection limit, enter the limit and specify LDL. The space provided permits the reporting of SARA reportable metal content. If detailed analyses of the priority pollutant metals are available, please attach as a separate sheet.

The instructions and form may not be reproduced in any form whatsoever without the prior written permission of ATMI.