Guidelines for reduction of dyes released from pulp and paper mills 2013: appendix 4


Appendix 4: Operator Declaration Form on the Implementation of the Guidelines for the Reduction of Dyes Released from Pulp and Paper Mills

This form may be used as a template to show conformance to section 4 “Operator Declaration” of the Guidelines.

Name and civic address of the mill:

____________________________________________________________________

____________________________________________________________________

Declaration:

Our mill is not using any of the substance subject to the guidelines for the reduction of dyes released from pulp and paper mill
Our mill will not be using any of the substance subject to the guidelines for the reduction of dyes released from pulp and paper mill starting (year/month/day) ________________
Our mill currently use at least one of the substances subject to the guidelines for the reduction of dyes released from pulp and paper mill and we plan to comply with the guidelines
Our mill does not plan to comply with the guidelines for the reduction of dyes released from pulp and paper mill

 

_________________________________
_________________________________
Operator Name (print)
Operator Title

 

_________________________________
_________________________________
Telephone
Email

 

_________________________________
_________________________________
Operator Signature
Date of Signature

 

Please return this form to:
Director
Forest Products and Fisheries Act Division
Environment Canada
351 St. Joseph Blvd, Gatineau, Quebec,  K1A 0H3
Email: mapbap@ec.gc.ca

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