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 Reaction-copy paper Color-reaction paper Self-copying paper

CCP comprises an extremely complex grouping of products. A given CCP can vary greatly as to its constituents, weight and types of paper coatings, paper color, dye colors and combination of dyes used on coatings, solvents and solvent mixtures (including variations from different suppliers), physical form (rolls versus sheets), and final form of the product (i.e, bound with adhesives). To improve quality and performance, the "recipes" used in the manufacture of CCP change frequently. No single product can be identified as a typical formulation of CCP since each product may have its own distinct constituents and different manufacturing processes. Thus the product known as CCP is not a single product but includes thousands of different and often unique products [Mead Corporation 1997 (a NIOSH docket submission)].

Production of CCP grew on an enormous scale after its introduction in 1954. By the 1960s, U.S. sales were about 16,000 tons, and production had started in Europe. In 1962, a Japanese company signed a license agreement with the National Cash Register Company, and by 1970, worldwide production rose to 100,000 tons. In 1991, about 1.8 million tons of CCP (the equivalent of nearly 200 billion 8.5- × 11-in. sheets) [Fetters 1997 (a NIOSH docket submission)] were produced and used [Buring and Hennekens 1991; Murray 1991]. Consumption is divided into three principal regions: North America—800,000 tons, Japan and the Far East—300,000 tons, and Europe—600,000 tons [Murray 1991]. The Association of European Manufacturers of Carbonless Papers [AEMCP 1985] indicated that in 1985 there were more than 50 manufacturers of CCP throughout the world.

By 1979, four companies in Great Britain, four in Japan, five in other European countries, and five major companies in the United States were manufacturing this paper [Calnan 1979]. Currently, 12 plants (5 manufacturers) in the United States [Fetters 1997 (a NIOSH docket submission)] and more than 50 plants around the world [AEMCP 1985] manufacture CCP. U.S. production averaged nearly 1 million tons during the period 1987–1996 [Graves and Tardiff 1999]. Annual global sales exceed $5 billion [Finch 1990].

The production industry employs more than 10,000 workers [Fetters 1997 (a NIOSH docket submission)]. Although the total number of workers potentially exposed to CCP in workplaces other than manufacturing (such as offices, laboratories, other businesses, schools, banking, etc.) is unknown [Pedersen 1998], it is likely to be in the millions. Also unknown is the extent to which the general public is potentially exposed to CCP during business transactions, receipt checking, etc.

About 10 years after the introduction of CCP, medical complaints began to be reported by exposed office workers [North Carolina Medical Journal 1982; Magnusson 1974; Göthe et al. 1981; Buring and Hennekens 1991]. In 1975, OSHA requested information from physicians about any unusual frequency of eye, mucous membrane, or skin irritation associated with CCP similar to the information being reported at that time in Sweden [North Carolina Medical Journal 1982].

Since 1965, various health effects associated with exposure to CCP have been reported in the literature appearing from Denmark, Finland, England, Sweden, Germany, the Netherlands, France, Italy, Belgium, Japan, Norway, and the United States. The National Swedish Board of Occupational Safety and Health