DOMESTIC SUBSTANCES LIST REPORTING
Substances proposed for the Confidential Portion of the Non-domestic Substances List / Report Form
C
DISPONIBLE EN FRANÇAIS
I. Certification Statement:
I hereby certify that, to the best of my knowledge and belief, all information entered on this form, on behalf of the company identified below, is complete and accurate.
Name and Title (Type or Print)
Signature / DATE
YMD
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II. Corporate Headquarters
Corporation
Street
City / Province / Postal Code
Telephone Number / Facsimile Number / E-mail
III. Principal Technical Contact: Name
Address / Telephone Number
Facsimile Number
IV. Specific Substances Name (If specific substances name is not confidential, this form is not applicable)
V. TSCA Accession Number / □PMN Number □EPA Form Number / □CAS Registry Number
VI. Proposed Masked Name for the Confidential Portion of the Non-domestic Substances List
VII. TSCA Inventory Name
VIII. Supporting Documentation
□Number of attachments
The protection of the information identified as confidential on this form will be consistent with the provisions of the Access to information Act of the Canadian Environmental Protection Act, 1999. By claiming block II information as confidential the link of the corporation to the Specific Substance Name and, when provided, the TSCA Accession Number, PMN No., EPA Form No., CAS Registry Number, Proposed Masked Name for confidential portion of the Non-domestic Substances List and the TSCA Inventory Name is confidential.
04-2620E (10/2000) For detailed instruction, see reverse
THE CONFIDENTIAL PORTION OF THE NON-DOMESTIC SUBSTANCES LIST
Environment Canada is in the process of compiling the Domestic Substances List (DSL) and Non-domestic Substances List(NDSL) called for by the Canadian Environmental Protection Act, 1999 (CEPA, 1999). The NDSL will contain the names of substances not on the Domestic Substances List but believed to be in international commerce, although not yet in Canada. Substances specified in this list will require less onerous notification packages, as compared to unlisted substances, when first proposed for manufacture in or import into Canada.
The 1985 TSCA Inventory, published by the U.S. Environmental Protection Agency (EPA), consists of approximately 63,000 Substances used in the United States. This listing has been chosen by Environment Canada as representative of substances that were in Commercial use in an ecozone similar to Canada over the l984-1986 DSL reporting period. The NDSL will be prepared by deleting DSL entries from the 1985 TSCA Inventory.
Some 4,500 entries on the TSCA Inventory are “confidential” substances which are identified using masked names (TSCA Inventory Names) and TSCA accession numbers (rather than the Chemical Abstracts Service Registry Numbers used for non-confidential substances). To accommodate these confidential entries, the NDSL will include a confidential section which will be comprised of substances which submitters can satisfy Environment Canada were on the confidential portion of the 1985 published version of the TSCA Inventory.
SUBSTANTIATING DOCUMENTATION
To assist nominators in the provision of documentation which will satisfy Environment Canada that a substance was on the confidential portion of the published 1985 TSCA Inventory the U.S. Environmental Protection Agency (EPA) has provided Environment Canada with a listing of all 1985 TSCA accession numbers linked to either a U.S. EPA Chemical Substance inventory report Form C (if it was provided as part of the original inventory) or a Premanufacturing Notification (PMN) Number (if the accession number originated upon receipt of a Notice of Commencement).
Provision of a copy of the Inventory Report Form C or the appropriate sections of the PMN will be accepted by Environment Canada as documentation establishing that the identified substance was on the TSCA Inventory. Such copies must (1) have the Form Number or PMN Number, on the original documentation, clearly displayed (numbers are not to be entered by submitters), (2) include the complete substance name identified to EPA, and (3) be identified on the list of TSCA accession numbers being used by Environment Canada for the confidential NDSL.
Nominators are not obliged to use the EPA - generated list, and may choose instead to provide other official supporting information. Such information will include copies of official documentation from the U.S. EPA establishing the link between the specific chemical name, the TSCA accession number and the PMN number, EPA Form C number or the TSCA inventory (masked) name.
COMPLETING THE REPORT FORM
BLOCKI. CERTIFICATION STATEMENT AND SIGNATURE
The Chief Executive Officer (CEO) must sign the certification statement on behalf of the reporting company. The CEO's name and title should be typed or printed on the Name and Title line of BLOCK 1. For multiple nominations, a letter signed by the CEO identifying a designate to sign nomination forms may be provided.
BLOCK II. CORPORATE HEADQUARTERS
Corporate headquarters is the headquarters address of a business entity nominating a substance to the confidential NDSL. The name of the corporation, as well as the full address of the main office, must be included.
BLOCK III. PRINCIPAL TECHNICAL CONTACT
Enter the name, address and telephone number of the person whom Environment Canada may contact for clarification of information submitted on the Report Form.
BLOCK IV. SPECIFIC SUBSTANCE NAME
The Specific Substance Name should be a recognized chemical name, established in accordance with chemical nomenclature rules of either the International Union of Pure and Applied Chemistry (I.U.PA.C.) or the Chemical Abstracts Service(C.A.S.) Collective Index. Ambiguous or incomplete names are not appropriate for substance identification. Information regarding substance name requirements can be found in chapter 5 of the Environment Canada publication Reporting for the Domestic Substances List. The name entered must be the same as the complete substance name on the substantiating documentation.
BLOCK V. NUMERICAL IDENTIFICATION
TSCA ACCESSION NUMBER. EPA assigns a unique five-digit accession number to each confidential chemical identity on the TSCA Inventory. This TSCA Accession Number should be entered in Block V. This number need not be included if a PMN or EPA Form C Number is entered in the appropriate space and a copy of the form provided as substantiating documentation.
PMN OR EPA FORM C NUMBER. Enter a check in the appropriate block to indicate which number is entered in the space below. If a PMN number is entered, a copy of a PMN (EPA Form No. 7710-25) along with copies of correspondence linking the substance identity, to a PMN number is to be provided as substantiating documentation (this will most often be the appropriate sections of the PMN along with copies of EPA correspondence attesting to a PMN number). If an EPA Form C number is entered, a copy of a U.S. EPA Chemical Substance Inventory Report Form C (EPA Form No. 7710-3C) is to be provided as substantiating documentation; the serial number on the EPA Form C should be clearly legible and match the number entered on the form.
CAS REGISTRY NUMBER. If assigned, enter the Chemical Abstracts Service (CAS) Registry Number for the substance provided in BLOCK IV. Include hyphens.
BLOCK VI. PROPOSED MASKED NAME
Enter the proposed masked name for the NDSL in the space provided. Procedures for structuring a proposed masked name for The NDSL are identical to those for the DSL and are included in Appendix III of the Environment Canada guideline document, Reporting for the Domestic Substances List. Failure to submit a proposed masked name according to these guidelines will void the nomination.
BLOCK VIl. TSCA INVENTORY NAME
Enter the name used in the confidential section of TSCA Inventory, to mask the identity of the substance entered in BLOCK IV. This TSCA Inventory Name must be entered when substantiating documentation other than a PMN or Inventory Report Form C is being provided. If providing a PMN or U.S. EPA TSCA Form C (Block V), may be omitted.
BLOCK VIII. SUPPORTING DOCUMENTATION
Please indicate the number of attachments in the box provided under supporting documentation.