AES-06 Voluntary Hazardous Air Pollutant Reporting {52057}

AES-06 VOLUNTARY HAZARDOUS AIR POLLUTANT REPORTING State Form 52057 (3-05) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT IDEM - Office of Air Quality Technical Support and Modeling Section - Mail Code 61-51 100 N. Senate Avenue Indianapolis, IN 46204-2251 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) http://www.emissions.IN.gov/ NOTE: · This form may be used to supplement the air emissions statement Part A: Contact Information Part A is intended to provide basic information about the company submitting this form. 1. Company Name: 2. Source ID: Part B: Emissions Summary Part B is where Hazardous Air Pollutants can be voluntarily reported. Please indicate the units of measure. CAS# or TRI ID 75070 60355 75058 98862 53963 107028 79061 79107 107131 107051 92671 62533 90040 Acetaldehyde Acetamide Acetonitrile Acetophenone 2-Acetylaminofluorene Acrolein Acrylamide Acrylic Acid Acrylonitrile Allyl chloride 4-Aminodiphenyl Aniline o-Anisidine Chemical Name Emissions CAS# or TRI ID 463581 120809 133904 57749 79118 532274 108907 510156 67663 107302 126998 218019 95487 108394 106445 98828 94757 72559 334883 132649 96128 84742 106467 91941 111444 542756 62737 111422 121697 Chemical Name Carbonyl sulfide Catechol (1,2-dihydroxylbenzene) Chloramben Chlordane Chloracetic acid 2-Chloroacetophenone Chlorobenzene Chlorobenzilate Chloroform Chloromethyl methyl ether Chloroprene Chrysene o-Cresol m-Cresol p-Cresol Cumene 2,4-Dichlorophenoxyacetic acid 1,1-Dichloro-2,2-bis(p-chlorophenyl)ethylene Diazomethane Dibenzofuran 1,2-Dibromo-3-chloropropane Dibutylphthalate 1,4-Dichlorobenzene 3,3'-Dichlorobenzidine Dichloroethyl ether [Bis (2-chloroethyl) ether] 1,3-Dichloropropene Dichlorvos (DDVP) Diethanolamine N,N-Dimethylaniline Emissions 7782505 Chlorine 1912249 Atrazine 1332214 Asbestos 56553 71432 92875 50328 98077 100447 92524 117817 542881 75252 106990 156627 133062 63252 75150 56235 Benz(a)anthracene Benzene (including from gasoline) Benzidine Benzo(a)pyrene Benzotrichloride Benzyl chloride Biphenyl Bis (2-ethylhexyl) phthalate (DEHP) Bis (chloromethyl) ether Bromoform 1,3-Butadiene Calcium cyanamide Captan Carbaryl Carbon disulfide Carbon tetrachloride 1319773 Cresols/Cresylic Acid (isomers and mixtures) Voluntary Hazardous Air Pollutant Reporting Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com CAS# or TRI ID 64675 119904 60117 119937 79447 68122 57147 131113 77781 534521 51285 121142 117840 123911 122667 106898 106887 140885 100414 51796 75003 106934 107062 107211 151564 75218 96457 75343 206440 50000 76448 118741 87683 58899 77474 67721 822060 680319 110543 302012 Diethyl sulfate Chemical Name Emissions CAS# or TRI ID 108316 67561 72435 74839 74873 71556 78933 60344 74884 108101 624839 80626 101144 75092 101688 101779 91203 98953 92933 100027 79469 684935 62759 59892 56382 82688 87865 108952 106503 75445 Methanol Methoxychlor Chemical Name Maleic anhydride Emissions 3,3'-Dimethoxybenzidine Dimethyl aminoazobenzene 3,3'-Dimethylbenzidine Dimethylcarbamoyl chloride Dimethylformamide 1,1-Dimethylhydrazine Dimethyl phthalate Dimethyl Sulfate 4,6-Dinitro-o-cresol, and salts 2,4-Dinitrophenol 2,4-Dinitrotoluene Dioctyl phthalate 1,4-Dioxane (1,4-Diethyleneoxide) 1,2-Diphenylhydrazine Epichlorohydrin 1,2-Epoxybutane Ethyl acrylate Ethylbenzene Ethyl carbamate (Urethane) Ethyl chloride (Chloroethane) Ethylene dibromide (Dibromoethane) Ethylene dichloride (1,2-Dichloroethane) Ethylene Glycol[i] Ethyleneimine (Azirdine) Ethylene Oxide Ethylene thiourea Ethylidene dichloride(1,1-Dichloroethane) Fluoranthene Formaldehyde Heptachlor Hexachlorobenzene Hexachorobutadiene 1,2,3,4,5,6-Hexachlorocyclohexane Hexachlorocyclopentadiene Hexachloroethane Hexamethylene-1,6-diisocyanate Hexamethylphosphoramide Hexane Hydrazine Methyl Bromide (Bromomethane) Methyl chloride (Chloromethane) Methyl Chloroform (1,1,1-Trichloroethane) Methyl ethyl ketone (2-Butanone) Methylhydrazine Methyliodide (Iodomethane) Methyl isobutyl ketone (Hexone) Methyl isocyanate Methyl methacrylate 4,4-Methylenebis(2-chloroaniline) Methylene chloride (Dichloromethane) 4-4' Methylenediphenyl diisocyanate (MDI) 4,4-Methylenedianiline Naphthalene 4 Nitrobenzene 4-Nitrobiphenyl 4-Nitrophenol 2-Nitropropane N-Nitroso-N-methylurea N-Nitrosodimethylamine N-Nitrosomorpholine Parathion Pentachloronitrobenzene Pentachlorophenol Phenol p-Phenylenediamine Phosgene 1634044 Methyl tert-butyl ether 7803512 Phosphine 7723140 Phosphorus 85449 Phthalic anhydride 1336363 Polychlorinated biphenyls (Aroclors) 1120714 1,3-Propane sultone 57578 123386 114261 78875 75569 75558 91225 106514 beta-Propiolactone Propionaldehyde Propoxur (Baygon) Propylene dichloride (1,2-Dichloropropane) Propylene Oxide 1,2-Propylenimine (2-Methyl aziridine) Quinoline Quinone 7647010 Hydrochloric acid gas only) 7664393 Hydrogen fluoride (Hydrofluoric acid) 123319 78591 Hydroquinone Isophorone Voluntary Hazardous Air Pollutant Reporting Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com CAS# or TRI ID 100425 96093 79345 127184 108883 95807 584849 95534 120821 79005 79016 95954 88062 121448 540841 108054 593602 75014 75354 Styrene Styrene Oxide Chemical Name Emissions CAS# or TRI ID 108383 106423 N010 N020 N040 N078 N090 N096 N100 N106 N230 N420 N450 N458 N495 m-Xylene p-Xylene Chemical Name Emissions 1746016 2,3,7,8-Tetrachlorodibenzo-p-dioxin 1,1,2,2-Tetrachloroethane Tetrachloroethylene Toluene 2,4-Toluenediamine 2,4-Toluene diisocyanate o-Toluidine 1,2,4-Trichlorobenzene 1,1,2-Trichloroethane Trichloroethylene 2,4,5-Trichlorophenol 2,4,6-Trichlorophenol Triethylamine 2,2,4-Trimethylpentane Vinyl acetate Vinyl bromide Vinyl chloride Vinylidene chloride Antimony Compounds Arsenic Compounds Beryllium Compounds Cadmium Compounds Chromium Compounds (including Cr+6) Cobalt Compounds Coke Oven Emissions Copper Compounds Cyanide Compounds1 Glycol Ethers Lead Compounds Manganese Compounds Mercury Compounds Fine Mineral Fibers2 Nickel Compounds Polycyclic Organic Matter3 7550450 Titanium tetrachloride 8001352 Toxaphene (chlorinated camphene) 1582098 Trifluralin 262124 132649 N725 1336363 Polychlorinated biphenyls (total) Polychlorinated dibenzodioxins (total) Polychlorinated dibenzofurans (total) Radionuclides (Including Radon)4 Selenium Compounds 1330207 Xylenes (isomers and mixtures) 95476 o-Xylene NOTE: For all listings above which contain the word "compounds" and for glycol ethers, the following applies: unless otherwise specified, these