Declaration of Stakeholder Interest

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Cobalt-Containing Substances Group

(PDF Version - 72 KB)

Companies that have an interest in substances described in the Cobalt-Containing Substances Group may identify themselves as stakeholders for those substances by completing this form. Stakeholders will be informed of future decisions regarding these substances and may be contacted for further information. 

Identification

 I have an interest in all substances in the Cobalt-Containing Substances Group  I am interested in the following substance(s) in the Cobalt-Containing Substances Group (list the

for the substance(s) of interest): _____________________________________________________________________

Company Name:

_____________________________________________________________________

Federal Business Number^[2]:

_____________________________________________________________________

Head Office Address:

_____________________________________________________________________

Canadian Head Office Address (if different from above):

____________________________________________________________________

Contact Name:  Mr.  Ms.  Dr.

_____________________________________________________________________

Title of Contact:

_____________________________________________________________________

Contact Address (if different from Head Office Address):

_____________________________________________________________________

Telephone Number: ( ______ ) ______ - ________

Fax Number: ( ______ ) ______ - ________

Email Address:

_____________________________________________________________________

Request for Confidentiality

 Pursuant to section 313 of the Canadian Environmental Protection Act, 1999, I request that the following parts of the information that I am submitting be treated as confidential. (Specify the parts [e.g. sections, tables, attachments, previously submitted unpublished studies or data, etc] of the information that you request be treated as confidential.).

_____________________________________________________________________

 I do not request that the information that I am submitting in this declaration be treated as confidential and I consent to it being released without restriction.

_____________________________________________________________________
Name (print)

_____________________________________________________________________
Title

_____________________________________________________________________
Signature

_____________________________________________________________________
Date

Please return this form to the Substances Management Coordinator, Chemical Management Plan.

200 Sacré-Coeur Blvd., 8^th Floor
Gatineau, Quebec
K1A 0H3
Fax: 819-953-7155
Email: Substances@ec.gc.ca

Voluntary Information

In addition to the type of information requested in the mandatory section 71 notice (entitled Notice with respect to certain cobalt-containing substances), interested stakeholders are encouraged to provide any additional information on the substances described in the Cobalt-Containing Substances Group, to help inform the risk assessment process. Organizations that may be interested in submitting additional information include those that manufacture, import, export or use a substance, whether alone, in a mixture, in a product, or in a manufactured item.

Examples of the type of information that could help inform the risk assessment process include, but are not limited to:

• Analogues or alternatives for these substances;
• Quantities of the substances manufactured, imported, used, and/or exported per calendar year, for the last 5 years;
• Customer contact information;
• Supplier information (name, location and contact information);
• Environmental releases; and
• Waste management information.

This information will help the Government of Canada improve decision making for these substances and ensure all activities are considered before moving forward with further actions regarding these substances.

Footnotes

^[1] CAS RN: Chemical Abstracts Service Registry Number. The Chemical Abstracts Service information is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government of Canada when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society
^[2] Federal business number is a nine-digit registration number issued by the Canada Revenue Agency (CRA) to Canadian businesses that register for one or more of the following: corporate income tax; importer/exporter account number; payroll (source) deductions (trust accounts); or goods and services tax. This number can be found on all forms issued to a business by the CRA. The first nine digits that appear on these forms is the Federal business number.