APPLICATION FORM FOR AN ECOLABEL OF A LUBRICANT

Part 1:General information

1.1Applicant

Name:......

Company number:......

Postal address:......

......

Contact person and function......

Phone no.:......

Facsimile no.:......

E-Mail address:......

Website: ......

Is the company a SME[1] ...... Yes / No If Yes please provide proof of status

Is the company a micro-enterprise1? ...... Yes / No If Yes please provide proof of status

Is the company situated in a developing country (for definition ask the competent body? ...... Yes / No If Yes please provide proof of status

Is the company registered under EMAS or certified under ISO 14001 and has the company in its environmental policy

promised to keep the product group criterion in the standard-contracts period of validity, and is this promise

established in the company’s environmental objectives? ...... Yes / No If Yes please provide proof of status

2 Product information

2.1Registered trade name(s) of product or product range: ......

2.2EU Countries where the product is or will be placed on the market: ......

2.3(EU) Countrie(s) where the product is manufactured: ......

2.4Is the product also registered under another environmental labelling scheme, such as the Blue Engel, Swedish Standard etc.? Yes / No

If yes state which one: ………………………………………..

Category 1 / Category 2 / Category 3 / Category 4 / Category 5

2.5 Tic to which category(ies) the lubricant belong(s).

2.7 A MSDS of the final lubricant must be attached to this application form.Confirm: □ YES

2.8 MSDSs of suppliers of components of the final lubricant must be attached to this application form. Confirm: □ YES

2.9 State that the applied lubricant does not bear neither any R-phrase nor H-statement on Health and Environment (Criterion 1a)Confirm: □ YES

1

European Ecolabel for LubricantsApplication form

Part 3:Substance specific information

3.1 Reactive thickening system in case of greases (An example is given in Annex 2 of the user manual)

  • State whether a reactive thickening system is used in the candidate grease.Yes / No (WHEN NO PROCEED TO 3.2)
  • State the official chemical name(s), the CAS RN number(s) and EC Number(s) of the reactants (the substances you add before the reaction takes place) of the thickening system, the mass in gram (g) that is added to formulate 100 g of the grease (column 4) and tic the reactant used in excess (column 5):

Table 3.1.1 Information on the reactants of the thickening system

Chemical name / CAS RN / EC No / Mass (g) of reactant
added to 100 g of the formulated grease / Tic which reactant is
used in excess
  • Write down the intended chemical reaction of the reactive thickening systems using the chemical names of the reactants stated above

………………………  ………………………………….  ………………………  ……………………… ( …………………………………. )

  • State the chemical name(s), CAS RN and the mass fraction(s) of each substance formed after the intended chemical reaction.

Table 3.1.2 Information on the substances formed after the intended chemical reaction of the thickening systems.

The substance(s) FORMED after the intended chemical reaction / Chemical name / CAS RN of the formed substance / Mass (g) of the substance FORMED
based on 100 g of the formulated grease
The substance(s) remaining
in EXCESS after the intended chemical reaction / Chemical name / CAS RN of the formed substance / Mass (g) of the substance IN EXCESS
based on 100 g of the formulated grease

The information in column 2,3 and 4 of Table 3.1.2 returns fully in table 3.2.1 of section 3.2. The mass (g) of the substance formed based on 100 g of the grease returns as the mass fraction present (w/w%)

3.2Overall assessment of all stated substances and/or brands from the LuSC-list or valid letter of compliance (LoC)

Fill in and complete Table 3.2.1

Table3.2.1State the CAS RN and EC number of ALL substances intentionally added and/or formed after an intended chemical reaction above 0.010% present in the lubricant in the table below. Complete the table by filling in the relevant data in each column.

Nr. / CAS No. / EC No. / Substance/Brand name
(as stated on the LuSC-list or LoC1)
(IUPAC Name/Official Identity Name) / Fraction present2
(% m/m) / Health and Environmental
H-statements / Substance3 is mentioned in one of the list of exemptions?
(Criterion 1b and 2)
(Y/N)
H-statements
(Reg 1272/2008 + updates)
1 / 2 / 4 / 5 / 6b / 7
1
2
3
4
5
6
7
8
9
10
11
12
13
  • 1 Attach a copy of the valid letter of compliance (LoC) to this application form
  • 2 The entries should add up to 100%
  • 3 Substances and Brands stated on the LuSC-list and LoC are complying with this criterion since this is part of the assessment before they are entered on the list or letter.

Nr. / Fraction present
(% w/w) / Renewability percentage / EEL classifications3,4
Biodegradation/Bioaccumulation / Aquatic toxicity
Number of total C-atoms
(Ctotal) / Number of renewable C-atoms
(Crenewable) / Renewable mass% of substance
(Cren/Ctot *100%) / Total fraction present
(column 5 x column 8c) / A/B/C/X/- / Source of assessment
(Self-assessment1 or LuSC-list or LoC2) / D/E/F/G/- / State M5 when aq tox classification is G / Source of assessment.
(Self-assessment1 or LuSC-list or LoC)
5 / 8a / 8b / 8c / 8d / 9a / 9b / 10a / 10b / 10c
1
2
3
4
5
6
7
8
9
10
11
12
13
14
  • 1A self-assessment is the EEL assessment of the biodegradation/bioaccumulation potential and aquatic toxicity by the supplier. It should be accompanied by filling in

Section 3.3 and/or 3.4 of this application form and relevant documents should be added e.g. valid standard test reports.

  • 2 LoC = Valid letter of compliance from one of the Ecolabel Competent Bodies
  • 3For the meaning of A,B,C,X,D,E,F and G see the user manual. – means not assessed for this criterion.
  • 4 For an additive on the LuSC list more than one entry may be required for the Biodegradation or Aq. Toxicity classification.
  • 5 M = the multiplication factor of 10 as stated in Directive 2006/8/EC or Regulation 1272/2008

3.3Biodegradability and Bioaccumulation in case of self-assessment

3.3.1 Aerobic biodegradability

No data or test reports need to be submitted when the EEL classification is derived from the LuSC-list or from a valid letter of compliance (LoC) issued by a competent body. For complex mixtures individual information for all intentionally added substances should be given on separate data sheets.

Table 3.3.1 Aerobic biodegradability test results

Substance / Base of self-assessment
(test protocolor
read-across) / Biodegradation test protocol used
(e.g. OECD 301B) / Reference substance
(Stated in the test report) / Concentration(s) of the substance att = 0 (mg/L) / WAF method applied? (Y/N) / Degradation of test result1 after 28 d in % / Good Practice protocol at time of testing / Are test reports attached to the application form?
(Y/N)

1In case the substance is not biodegradable an assessment of the (potential) bioaccumulation needs to be conducted to derive the correct classification. The assessment of the bioaccumulation in that case should be indicated in table 3.3.2.

Comments on results

1

European Ecolabel for LubricantsApplication form

Bioaccumulation (potential) - BCF or log Kow in case the substance is not biodegradable

The logarithm of the n-octanol / water partition coefficient can only be established or estimated for an organic substance other than a surfactant. In case no information is available a OECD 305 (BCF) test report shall be submitted. Weighted average log Kow is only scientifically valid for substances or complex substances (e.g. tall oils), which are a group of homologs.

Table 3.3.2 Bioaccumulation data for non-biodegradable substances. Only fill in the RELEVANT column(s)

Substance / Molecular Mass / Molecular Diameter / Experimental BCF / Calculation methods1 / Basis of bioaccumulating assessment
(BCF < 100 L/kg or
MM >800 D or
MD > 1.5nm or
Polymer or
or
Log Kow <3 or >7) / Is the required evidence attached to the application form?
(Y/N2)
Test protocol used / Good Practice protocol at time of testing / BCF
(L/kg) / CLOGP
vs:….. / KOWWIN
vs:….. / SPARC
vs:…..

1State the version used in the calculation method. Always use the latest version.

2State the reason when not attached to the application document.

Comments on results

3.4Aquatic toxicity data in case of a self-assessment

Aquatic toxicity data from standard tests e.g. OECD 201, 202 and/or 203.

Table 3.4.1 must be filled in when the EEL classification for the aquatic toxicity has been derived by the applicant (Self-classification). The table does not need to be filled in when the EEL classification is derived from the LuSC-list or from a valid letter of compliance (LoC) issued by a competent body. In case the molecular mass, the molecular diameter, the mass fraction below 1000 g/mol of the polymer or the water solubility has been established instead of the aqueous toxicity the results must be stated in Table 3.4.2. For complex mixtures individual information for all intentionally added substances should be given on separate data sheets.

Table 3.4.1 data on the aquatic toxicity of each substance present above 0.1%

Substance/ Brand name / Algae toxicity test results / Daphnia (Crustacean) toxicity test results
Algae toxcicity test protocol used
(e.g. OECD201) / Algae test species used
(State latin name) / WAF method applied?
(Y/N) / 72hEC50
(mg/L) / Good Practice protocol at time of testing / Is test report
Added to the form?
(Y/N) / Daphnia toxicity test protocol used
(e.g. OECD202) / Daphnia test species used
(State Latin name) / WAF method applied?
(Y/N) / Toxicity value / Good Practice protocol at time of testing / Are test reports
added to the form?
(Y/N)
NOEC
(mg/L) / 48hEC50
(mg/L)

Additional comments on algae and daphnia (crustacean) toxicity test results

Fish toxicity test results
Substance/
candidate lubricant / Fish toxicity test protocol used
(e.g. OECD 210) / Fish test species used
(State Latin name) / WAF method applied?
(Y/N) / NOEC/96hEC50 / Good Practice protocol at time of testing? / Are test reports added to the application form?
(Y/N)
NOEC
(mg/L) / 96hLC50
(mg/L)

Additional comments on fish toxicity test results

Substance/ Brand name / Molecular mass
(g/mol) / Molecular diameter
(nm) / Polymer fraction below 1000 g/mol?
(%) / Water solubility test results
Water solubility test
Protocol used
(e.g. OECD105) / WAF method applied?
(Y/N) / Water solubility value stated in test report
(g/L) / Good Practice protocol at time of testing / Is required test report attached to the application form?
(Y/N)

Aquatic toxicity classification of D (not toxic the the aquatic environment) based on other data

In case the molecular mass, the molecular diameter, the mass fraction below 1000 g/mol of the polymer or the water solubility has been established instead of the aqueous toxicity the results are stated in Table 3.4.2:

Table 3.4.2 Additional data on the aquatic toxicity

Additional comments test results

European Ecolabel for LubricantsApplication form

3.5 Total mass fractions present in the candidate lubricant

  • 3.5.1 State the total mass fractions of all stated substances above 0.1% with the same classification on the biodegradation/bioaccumulationwithin the candidate lubricant (from column 9a of Table 3.2.1) for each applied category.

Total mass fraction of each EEL classification on the
biodegradation/bioaccumulation (% w/w) present within the candidate lubricant
Category / A / B / C
1
2
3
4
5

Candidate lubricant complies with EEL requirement on biodegradation? Confirm: □ YES

  • 3.5.2 State the total mass fractions of all stated substances above 0.1% with the same classification on the aquatic toxicity in the candidate lubricant (from column 10a of Table 3.2.1).

Total mass fraction of each EEL classification on the aquatic toxicity (% w/w) present within the candidate lubricant
Category / D / E / F / G
1
2
3
4
5

Candidate lubricant complies with EEL requirement on aquatic toxicity? Confirm: □ YES

  • 3.5.3State the total mass fractions of all stated substances not assessed on the biodegradation/bioaccumulation

(assigned with an “X” or “-“ in column 9a of Table 3.2.1) and aquatic toxicity (assigned with a “-“ in column 10a of Table 3.2.1).

Biodegradation/Bioaccumulation / Aquatic Toxicity
Total mass fraction of unassessed
substances (% w/w) for:
  • The total fraction of unassessed substances in the candidate lubricant does not exceed 0.5% of the total mass of the lubricant? Confirm: □ YES

I declare that the lubricant complies with Criteria 2, 3 and 4of the EEL criteria documentConfirm: □ YES

3.6 Fraction of renewable raw material

  • State the total fraction of renewable raw material in the final lubricant by adding all values from column 8d of Table 3.2.1: ..….. % (w/w)

Total fraction of rewenable raw material present in the candidate lubricant
Category / Fraction
% (w/w)
1
2
3
4
5
  • State from the main components that are derived from renewable material its type, country of origin and whether a primary or secondary resource is used.

Main component that includes renewable C-atoms / Type of renewable C-atoms
(e.g. (from) palm oil, rapeseed oil etc) / Source
(primary or secondary) / Country or region of origin of the
renewable material

I declare that the lubricant complies with criterion 5 of the EEL criteria document. Confirm: □ YES

4 Information on the Minimum technical requirements

Attach all required technical test reports to show that the lubricant fulfils criterion 6 of the EEL criteria document.

  • Are all required technical test reports added to this application form? Confirm: □ YES
  • In case of a hydraulic fluid: a Product Information Sheet stating what elastomers

have been tested according to ISO 15380 must be attached to the application form. Confirm: □ YES

  • In case of an industrial or marine gear oil: a Product Information Sheet stating

which part, I, II or III of DIN 51514 has beentested?Confirm: □ YES

I declare that the lubricant complies with criterion 6 of the EEL criteria document. Confirm: □ YES

Part 5. Information appearing on the eco-label

  • Provide a sample of the product packaging showing the label. Confirm: □ YES

I declare that the lubricant complies with criterion 7 of the EEL criteria document. Confirm: □ YES

Part 3:Confirmation statement

I hereby confirm that I have reviewed this document and that the information submitted is true and that the amounts and values stated are accurate.

Date:......

Name:......

Position in company:......

Company:......

Signature: …………………………………………………………………………………

European Ecolabel for LubricantsApplication form

[1]SMEs and micro-enterprises as defined by Commission Recommendation 2003/361/EC of 6 May 2003 (OJ L 124, 20.5.2003, p.36.)