Guidelines for reduction of dyes released from pulp and paper mills 2013: appendix 5


Appendix 5: Conformity Evaluation Form 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 the section 6 “Report” of the Guidelines.

 

Name and civic address of the mill:
_____________________________________________________________________

_____________________________________________________________________

 

Period covered by the report:
From ___________________ to ___________________

Conformity evaluation of the substances subject to the Guidelines
Name of the substance CAS # Amount used (kg) Retention in final paper product (1) Solids removal efficiency by the wastewater primary treatment system Containment plan in place (yes/no) Environmental release (yes/no).
If yes, specify the amount (kg of the substance)
             
             
             

(1) If the method used to measure dye retention differs from the Appendix 3 method, include a copy of the method used with the report.

I declare this report to be accurate and complete.

 

_________________________________
_________________________________
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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