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/ • This form may be used to supplement the air emissions statement NOTE: 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 Chemical Name Emissions CAS# or TRI ID Chemical Name 75070 Acetaldehyde 463581 60355 Acetamide 120809 Catechol (1,2-dihydroxylbenzene) 75058 Acetonitrile 133904 Chloramben 98862 Acetophenone 57749 Chlordane 53963 2-Acetylaminofluorene Emissions Carbonyl sulfide 7782505 Chlorine 107028 Acrolein 79118 Chloracetic acid 79061 Acrylamide 532274 2-Chloroacetophenone 79107 Acrylic Acid 108907 Chlorobenzene 107131 Acrylonitrile 510156 Chlorobenzilate 107051 Allyl chloride 67663 Chloroform 92671 4-Aminodiphenyl 107302 Chloromethyl methyl ether 62533 Aniline 126998 Chloroprene 90040 o-Anisidine 218019 Chrysene 1912249 Atrazine 1332214 Asbestos 1319773 Cresols/Cresylic Acid (isomers and mixtures) 95487 o-Cresol 56553 Benz(a)anthracene 108394 m-Cresol 71432 Benzene (including from gasoline) 106445 p-Cresol 92875 Benzidine 98828 Cumene 50328 Benzo(a)pyrene 94757 2,4-Dichlorophenoxyacetic acid 98077 Benzotrichloride 72559 1,1-Dichloro-2,2-bis(p-chlorophenyl)ethylene 100447 Benzyl chloride 334883 Diazomethane 92524 Biphenyl 132649 Dibenzofuran 117817 Bis (2-ethylhexyl) phthalate (DEHP) 96128 1,2-Dibromo-3-chloropropane 542881 Bis (chloromethyl) ether 84742 Dibutylphthalate 75252 Bromoform 106467 1,4-Dichlorobenzene 106990 1,3-Butadiene 91941 3,3'-Dichlorobenzidine 156627 Calcium cyanamide 111444 Dichloroethyl ether [Bis (2-chloroethyl) ether] 133062 Captan 542756 1,3-Dichloropropene 63252 Carbaryl 62737 Dichlorvos (DDVP) 75150 Carbon disulfide 111422 Diethanolamine 56235 Carbon tetrachloride 121697 N,N-Dimethylaniline Voluntary Hazardous Air Pollutant Reporting Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com CAS# or TRI ID Chemical Name Emissions CAS# or TRI ID Chemical Name 64675 Diethyl sulfate 108316 Maleic anhydride 119904 3,3'-Dimethoxybenzidine 67561 Emissions Methanol 60117 Dimethyl aminoazobenzene 72435 Methoxychlor 119937 3,3'-Dimethylbenzidine 74839 Methyl Bromide (Bromomethane) 79447 Dimethylcarbamoyl chloride 74873 Methyl chloride (Chloromethane) 68122 Dimethylformamide 71556 Methyl Chloroform (1,1,1-Trichloroethane) 57147 1,1-Dimethylhydrazine 78933 Methyl ethyl ketone (2-Butanone) 131113 Dimethyl phthalate 60344 Methylhydrazine 77781 Dimethyl Sulfate 74884 Methyliodide (Iodomethane) 534521 4,6-Dinitro-o-cresol, and salts 108101 Methyl isobutyl ketone (Hexone) 51285 2,4-Dinitrophenol 624839 Methyl isocyanate 121142 2,4-Dinitrotoluene 80626 Methyl methacrylate 117840 Dioctyl phthalate 1634044 Methyl tert-butyl ether 123911 1,4-Dioxane (1,4-Diethyleneoxide) 101144 4,4-Methylenebis(2-chloroaniline) 122667 1,2-Diphenylhydrazine 75092 Methylene chloride (Dichloromethane) 106898 Epichlorohydrin 101688 4-4' Methylenediphenyl diisocyanate (MDI) 106887 1,2-Epoxybutane 101779 4,4-Methylenedianiline 140885 Ethyl acrylate 91203 Naphthalene 4 100414 Ethylbenzene 98953 Nitrobenzene 51796 Ethyl carbamate (Urethane) 92933 4-Nitrobiphenyl 75003 Ethyl chloride (Chloroethane) 100027 4-Nitrophenol 106934 Ethylene dibromide (Dibromoethane) 79469 2-Nitropropane 107062 Ethylene dichloride (1,2-Dichloroethane) 684935 N-Nitroso-N-methylurea 107211 Ethylene Glycol[i] 62759 N-Nitrosodimethylamine 151564 Ethyleneimine (Azirdine) 59892 N-Nitrosomorpholine 75218 Ethylene Oxide 56382 Parathion 96457 Ethylene thiourea 82688 Pentachloronitrobenzene 75343 Ethylidene dichloride(1,1-Dichloroethane) 87865 Pentachlorophenol 206440 Fluoranthene 108952 Phenol 50000 Formaldehyde 106503 p-Phenylenediamine 75445 Phosgene 76448 Heptachlor 118741 Hexachlorobenzene 7803512 Phosphine 87683 Hexachorobutadiene 7723140 Phosphorus 58899 1,2,3,4,5,6-Hexachlorocyclohexane 85449 Phthalic anhydride 77474 Hexachlorocyclopentadiene 1336363 Polychlorinated biphenyls (Aroclors) 67721 Hexachloroethane 1120714 1,3-Propane sultone 822060 Hexamethylene-1,6-diisocyanate 57578 beta-Propiolactone 680319 Hexamethylphosphoramide 123386 Propionaldehyde 110543 Hexane 114261 Propoxur (Baygon) 302012 Hydrazine 78875 Propylene dichloride (1,2-Dichloropropane) 7647010 Hydrochloric acid gas only) 75569 Propylene Oxide 7664393 Hydrogen fluoride (Hydrofluoric acid) 75558 1,2-Propylenimine (2-Methyl aziridine) 123319 Hydroquinone 91225 Quinoline 78591 Isophorone 106514 Quinone Voluntary Hazardous Air Pollutant Reporting Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com CAS# or TRI ID Chemical Name Emissions CAS# or TRI ID Chemical Name 100425 Styrene 108383 m-Xylene 96093 Styrene Oxide 106423 Emissions p-Xylene 1746016 2,3,7,8-Tetrachlorodibenzo-p-dioxin N010 Antimony Compounds 79345 1,1,2,2-Tetrachloroethane N020 Arsenic Compounds 127184 Tetrachloroethylene N040 Beryllium Compounds 7550450 Titanium tetrachloride N078 Cadmium Compounds 108883 Toluene N090 Chromium Compounds (including Cr+6) 95807 2,4-Toluenediamine N096 Cobalt Compounds 584849 2,4-Toluene diisocyanate 95534 o-Toluidine Coke Oven Emissions N100 Copper Compounds 8001352 Toxaphene (chlorinated camphene) N106 Cyanide Compounds1 120821 1,2,4-Trichlorobenzene N230 Glycol Ethers 79005 1,1,2-Trichloroethane N420 Lead Compounds 79016 Trichloroethylene N450 Manganese Compounds 95954 2,4,5-Trichlorophenol N458 88062 2,4,6-Trichlorophenol 121448 Triethylamine N495 Nickel Compounds Polycyclic Organic Matter3 1582098 Trifluralin 540841 Mercury Compounds Fine Mineral Fibers2 2,2,4-Trimethylpentane 1336363 Polychlorinated biphenyls (total) 108054 Vinyl acetate 262124 Polychlorinated dibenzodioxins (total) 593602 Vinyl bromide 132649 Polychlorinated dibenzofurans (total) 75014 Vinyl chloride 75354 Vinylidene chloride Radionuclides (Including Radon)4 N725 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 listings are defined as including any unique chemical substance that contains the named chemical (i.e., Antimony, arsenic, etc.) as part of that chemical's infrastructure. 1 X'CN where X=H' or any other group where a formal dissociation may occur. For example KCN or Ca(CN)2 includes mineral fiber emissions from facilities manufacturing or processing glass, rock, or slag fibers (or other mineral derived fibers) of average diameter 1 micrometer or less. 3 limited to, or refers to, products from incomplete combustion of organic compounds (or material) and pyrolysis processes having more than one (1) benzene ring, and which have a boiling point greater than or equal to 100 degrees Celsius. Primary constituents of the polycyclic organic matter category include: CAS Pollutant Acenaphthene 0083329 Acenaphthylene 0208968 Anthracene 0120127 Benz(a)anthracene 0056553 Benzo(a)pyrene 0050328 Benzo(b)fluoranthene 0205992 Benzo(ghi))perylene 0191242 Benzo(k)fluoranthene 0207089 Chrysene 0218019 Dibenz(a,h)anthracene 0053703 Fluoranthene 0206440 Fluorene 0086737 Indeno(1,2,3-cd)pyrene 0193395 Naphthalene 0091203 Phenanthrene 0085018 Pyrene 0129000 2 4 a type of atom which spontaneously undergoes radioactive decay. Voluntary Hazardous Air Pollutant Reporting Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com