EPA Worksheets


Figure 2A. EPCRA Section 313 Non-PBT Chemical Reporting Threshold Worksheet1

Facility Name: ______Date Worksheet Prepared: ______
EPCRA Section 313 Chemical or Chemical Category: ______Prepared By: ______
CAS Registry Number: ______
Reporting Year: ______

Amounts of the EPCRA Section 313 chemical or chemical category manufactured, processed, or otherwise used.

Mixture Name or Other Identifier / Information Source / Total Weight (lb) / Percent EPCRA Section 313 Chemical by Weight / EPCRA Section 313 Chemical Weight (lb) / Amount of the EPCRA Section 313 Chemical or Chemical Category by Activity (lb.):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A)______lb / (B)______lb / (C)______lb

Exempt quantity of the EPCRA Section 313 chemical or chemical category that should be excluded.

Mixture Name as Listed Above / Applicable Exemption (de minimis, articles, facility, activity) / Fraction or Percent Exempt (if Applicable) / Amount of the EPCRA Section 313 Chemical Exempt from Above (lb):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A1)______lb / (B1)______lb / (C1)______lb
Amount subject to threshold: / (A-A1)_____ lb / (B-B1)_____ lb / (C-C1)_____ lb
Compare to threshold for EPCRA section 313 reporting. / 25,000 lbs / 25,000 lbs / 10,000 lbs
If any threshold is exceeded, reporting is required for all activities. Do not submit this worksheet with Form R or Form A; retain it for your records.

Figure 2B. EPCRA Section 313 Reporting Threshold Worksheet for PBT Chemicals with 100 Pound Thresholds

Facility Name: ______Date Worksheet Prepared: ______
EPCRA Section 313 Chemical or Chemical Category: ______Prepared By: ______
CAS Registry Number: ______
Reporting Year: ______

Amounts of the EPCRA Section 313 chemical or chemical category manufactured, processed, or otherwise used.

Mixture Name or Other Identifier / Information Source / Total Weight (lb) / Percent EPCRA Section 313 Chemical by Weight / EPCRA Section 313 Chemical Weight (lb) / Amount of the EPCRA Section 313 Chemical or Chemical Category by Activity (lb.):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A)______lb / (B)______lb / (C)______lb

Exempt quantity of the EPCRA Section 313 chemical or chemical category that should be excluded.

Mixture Name as Listed Above / Applicable Exemption (articles, facility, activity)1 / Fraction or Percent Exempt (if Applicable) / Amount of the EPCRA Section 313 Chemical Exempt from Above (lb):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A1)______lb / (B1)______lb / (C1)______lb
Amount subject to threshold: / (A-A1)_____ lb / (B-B1)_____ lb / (C-C1)_____ lb
Compare to threshold for EPCRA section 313 reporting. / 100 lbs / 100 lbs / 100 lbs
If any threshold is exceeded, reporting is required for all activities. Do not submit this worksheet with Form R; retain it for your records.

Figure 2C. EPCRA Section 313 Reporting Threshold Worksheet for PBT Chemicals with 10 Pound Thresholds

Facility Name: ______Date Worksheet Prepared: ______
EPCRA Section 313 Chemical or Chemical Category: ______Prepared By: ______
CAS Registry Number: ______Reporting Year: ______

Amounts of the EPCRA Section 313 chemical or chemical category manufactured, processed, or otherwise used.

Mixture Name or Other Identifier / Information Source / Total Weight (lb) / Percent EPCRA Section 313 Chemical by Weight / EPCRA Section 313 Chemical Weight (lb) / Amount of the EPCRA Section 313 Chemical or Chemical Category by Activity (lb.):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A)______lb / (B)______lb / (C)______lb

Exempt quantity of the EPCRA Section 313 chemical or chemical category that should be excluded.

Mixture Name as Listed Above / Applicable Exemption (articles, facility, activity)1 / Fraction or Percent Exempt (if Applicable) / Amount of the EPCRA Section 313 Chemical Exempt from Above (lb):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A1)______lb / (B1)______lb / (C1)______lb
Amount subject to threshold: / (A-A1)_____ lb / (B-B1)_____ lb / (C-C1)_____ lb
Compare to threshold for EPCRA section 313 reporting. / 10 lbs / 10 lbs / 10 lbs
If any threshold is exceeded, reporting is required for all activities. Do not submit this worksheet with Form R; retain it for your records.

Figure 2D. EPCRA Section 313 Reporting Threshold Worksheet for Dioxin and Dioxin-Like Compounds Chemical Category

Facility Name: ______Date Worksheet Prepared: ______
EPCRA Section 313 Chemical or Chemical Category: Dioxin and Dioxin-Like Compounds Prepared By: ______

Chemical Category Code: N150______
Reporting Year: ______

Amounts of the EPCRA Section 313 chemical or chemical category manufactured, processed, or otherwise used.

Mixture Name or Other Identifier / Information Source / Total Weight (g) / Percent EPCRA Section 313 Chemical by Weight / EPCRA Section 313 Chemical Weight (g) / Amount of the EPCRA Section 313 Chemical or Chemical Category by Activity (g.):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A)______g / (B)______g / (C)______g

Exempt quantity of the EPCRA Section 313 chemical or chemical category that should be excluded.

Mixture Name as Listed Above / Applicable Exemption (articles, facility, activity)1 / Fraction or Percent Exempt (if Applicable) / Amount of the EPCRA Section 313 Chemical Exempt from Above (g):
Manufactured / Processed / Otherwise Used
1.
2.
3.
4.
Subtotal: / (A1)______g / (B1)______g / (C1)______g
Amount subject to threshold: / (A-A1)_____ g / (B-B1)_____ g / (C-C1)_____ g
Compare to threshold for EPCRA section 313 reporting. / 0.1 gram / 0.1 gram / 0.1 gram
If any threshold is exceeded, reporting is required for all activities. Do not submit this worksheet with Form R; retain it for your records.

Rev. # 1 Mandatoryg Discretionary

Effective Date: August 2004 Page 1 of 6