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Triclosan Reporting Form Part 1 - Questions

Notice with respect to triclosan (5-chloro-2-(2,4-dichlorophenoxy)phenol)
Published in the Canada Gazette on February 9, 2013

(Excel Format - 137 KB)

Table of Contents

Introduction

You may respond to the Triclosan section 71 Notice using the Triclosan Reporting Form. Please note that there are 2 parts to the Triclosan Reporting Form that must be filled out and submitted in order for the response to be considered complete:

  1. Triclosan Reporting Form Part 1 - Questions (Submit the Excel format):
    Please complete the applicable sections, as outlined in Schedule 2 to the Notice.

    Note that respondents are encouraged to complete and submit the Triclosan Reporting Form- Part 1 in Excel format, either by email or electronically (via CD, DVD or USB memory stick).
  2. Triclosan Reporting Form Part 2 - Declaration Signature Page (Submit the PDF format):
    In addition to completing Part 1 of the Triclosan Reporting Form, you must also complete and sign the "Triclosan Reporting Form Part 2 - Declaration Signature Page" to declare that the information being submitted is accurate and complete.

    Note that the signed "Triclosan Reporting Form Part 2 - Declaration Signature Page" may be submitted via email, mail or fax.

Please refer to the Triclosan Guidance Document for assistance in completing the section 71 Notice.

Provide the information no later than July 11, 2013, 5 p.m. Eastern Daylight Saving Time to:

Minister of the Environment, to the attention of the Substances Management Coordinator, Chemicals Management Plan
200 Sacré-Cœur Boulevard, Gatineau QC K1A 0H3
Email: Substances@ec.gc.ca
Telephone: 1-800-567-1999 (toll free in Canada) or 819-953-7156 (outside of Canada)
Fax: 1-819-953-7155
Website: Chemical Substances

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Schedule 1

Substance

CAS RN[1] Name of the substance 
3380-34-5 5-chloro-2-(2,4-dichlorophenoxy)phenol 

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Schedule 2

Persons Required to Provide Information

  1. This notice applies to any person who, during the 2011 calendar year, manufactured a total quantity greater than 10 kg, of the substance set out in Schedule 1 to this notice, at any concentration.
  2. This notice applies to any person who, during the 2011 calendar year, imported a total quantity greater than 10 kg of the substance set out in Schedule 1 to this notice whether alone; or at a concentration equal to or above 0.001% by weight in a mixture or in a product.
  3. This notice applies to any person who, during the 2011 calendar year, used a total quantity greater than 10 kg of the substance set out in Schedule 1 to this notice whether alone; or at a concentration equal to or above 0.001% by weight in a mixture or in a product, in the manufacture of a mixture or product.
  4. This notice applies to any person who, during the 2011 calendar year, exported a total quantity greater than 10 kg of the substance set out in Schedule 1 to this notice whether alone; or at a concentration equal to or above 0.001% by weight in a mixture or in a product.
  5. This notice does not apply to the substance set out in Schedule 1, whether alone, in a mixture or in a product that:
    (a) is in transit through Canada; or
    (b) is, or is contained in, a pest control product within the meaning of subsection 2(1) of the Pest Control Products Act where that pest control product is registered under the Pest Control Products Act.
  6. Respondents to this notice who:
    (a) manufactured the substance set out in Schedule 1 shall complete sections 4, 5 and 9 of Schedule 3;
    (b) imported the substance set out in Schedule 1 shall complete sections 4, 5 and 6 of Schedule 3;
    (c) used the substance set out in Schedule 1 shall complete sections 4, 5, 7, 8 and 9 of Schedule 3; or
    (d) exported the substance set out in Schedule 1 shall complete sections 4 and 5 of Schedule 3.

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Identification

Note: The Triclosan Reporting Form Part 2 - Declaration Signature Page must also be submitted in order for the response to be considered complete.

Name of the person (e.g. company):                                                                                     
Federal business number:  
Canadian head office street address:  
City:  
Province / State (in North America):  
Postal Code / ZIP:  
Country:  
Mailing address (if different from the street address):   
City:  
Province / State (in North America):  
Postal Code / ZIP:  
Country:  
Contact name for CEPA 1999 section 71 notices:   
Title of the contact:   
Contact’s mailing addresses (if different from above):   
City:  
Province / State (in North America):  
Postal Code / ZIP:  
Country:  
Telephone number:   
Fax number (if any):   
Email (if any):   
Pursuant to section 313 of the Canadian Environmental Protection Act, 1999, I request that the sections specified in this form be treated as confidential. (Y/N):   

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Schedule 3, Section 5

5. For the substance set out in Schedule 1, that a person manufactured, imported, used or exported during the 2011 calendar year, in respect of which the person meets the criteria set out in Schedule 2, the person shall provide the following information:

(a) the quantity of the substance that was manufactured, imported, used or exported, reported in kilograms (rounded to 2 significant digits); and

(b) each applicable six-digit North American Industry Classification System (NAICS3) code(s) with respect to each of the person's activities with the substance or to the mixture or product containing the substance.

Manufactured in 2011

(a) Total quantity in kg Is the quantity confidential? (Y/N) (b) NAICS Codes Is the NAICS confidential? (Y/N) Additional Notes Notes confidential? (Y/N)
           
           
           
           
           

Imported in 2011

(a) Total quantity in kg Is the quantity confidential? (Y/N) (b) NAICS Codes Is the NAICS confidential? (Y/N) Additional Notes Notes confidential? (Y/N)
           
           
           
           
           

Used in 2011

(a) Total quantity in kg Is the quantity confidential? (Y/N) (b) NAICS Codes Is the NAICS confidential? (Y/N) Additional Notes Notes confidential? (Y/N)
           
           
           
           
           

Exported in 2011

(a) Total quantity in kg Is the quantity confidential? (Y/N) (b) NAICS Codes Is the NAICS confidential? (Y/N) Additional Notes Notes confidential? (Y/N)
           
           
           
           
           

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Schedule 3, Section 6

6. (1) For the substance set out in Schedule 1 that a person imported during the 2011 calendar year, in respect of which the person meets the criteria set out in Schedule 2, the person shall provide the following information:

(a) the applicable Consumer and Commercial code(s), set out in section 10 that apply to the substance, or to the mixture or product containing the substance;

(b) for each applicable Consumer and Commercial Code, the quantity of the substance that was imported, reported in kilograms (rounded to 2 significant digits); and

(c) for each applicable Consumer and Commercial Code, the concentration or range of concentrations of the substance by weight (w/w%) in the mixture or product containing the substance.

6. (2) Where Consumer and Commercial Code C999 is applicable for paragraph (1)(a), a written description of the substance, mixture or product must be provided.

(a) Consumer and Commercial Code(s) Isthe code confi-dential? (Y/N) If C999 is applicable, provide a written des-cription  Is the des-cription of C999 confi-dential? (Y/N) (b) Quantity imported in kg  (rounded to 2 significant digits) Is the quantity confi-dential? (Y/N) (c) Concentration or range of concentrations of the substance by weight (w/w%) Addi-tional Notes Notes confi-dential? (Y/N)
Concen-tration or lower end of range Top end of range Other non-numeric specifi-cation Is the concen-tration confi-dential? (Y/N)
                       
                       
                       
                       
                       

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Schedule 3, Section 7

7.(1) For the substance set out in Schedule 1 that a person used during the 2011 calendar year, in respect of which the person meets the criteria set out in Schedule 2, the person shall provide the following information:

(a) the applicable Consumer and Commercial Code(s), set out in section 10 that apply to the mixture or product that was manufactured containing the substance;

(b) for each applicable Consumer and Commercial Code, the quantity of the substance that was used, reported in kilograms (rounded to 2 significant digits); and

(c) for each applicable Consumer and Commercial Code, the concentration, or range of concentrations, of the substance by weight (w/w%) in the mixture or product containing the substance.

7. (2) Where Consumer and Commercial Code C999 is applicable for paragraph (1)(a), a written description of the substance, mixture or product must be provided.

(a) Consumer and Commercial Code(s) that apply to the mixture or product that was manufactured containing the substance Is the code confi-dential? (Y/N) If C999 is appli-cable, provide a written des-cription  Is the des-cription of C999 confi-dential? (Y/N) (b) Quantity used in kg  (rounded to 2 signi-ficant digits) Is the quantity confi-dential? (Y/N) (c) Concentration or range of concentrations of the substance by weight (w/w%) Is the concen-tration confi-dential? (Y/N) Addi-tional Notes Notes confi-dential? (Y/N)
Concen-tration or lower end of range Top end of range Other non-numeric specifi-cation
                       
                       
                       
                       
                       

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Schedule 3, Section 8

8. For the substance set out in Schedule 1 that a person used during the 2011 calendar year, in respect of which the person meets the criteria set out in Schedule 2, the person shall provide the name, head office street and mailing addresses, contact name, phone number and email of the supplier(s).

Supplier name Head Office Street Address Mailing Address City Province / State  Postal Code / ZIP  Country Contact Name Phone Number Email Is the supplier confi-dential? (Y/N) Addi-tional Notes Notes confi-dential? (Y/N)
                         
                         
                         
                         
                         

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Schedule 3, Section 9

9. (1) For the substance set out in Schedule 1 that a person manufactured or used during the 2011 calendar year, in respect of which the person meets the criteria set out in Schedule 2, the person shall provide the following information:

(a) the names, and street addresses of the facility or facilities where the substance was manufactured or used;

(b) for each facility, a description of environmental monitoring activities for the substance, including monitoring frequency and methodology;

(c) for each facility, whether used storage or transportation containers containing the substance, either alone or in a mixture, were cleaned on site by indicating yes or no;

(d) for each facility, a description of the waste management practices, policies or technological solutions in place to prevent or minimize releases of the substance to the environment, including unintended releases; or to prevent or minimize the potential exposure of individuals in Canada to the substance;

(e) for each facility, the total quantity of the substance that was released from the facility to air, water or land, reported in kilograms (rounded to 2 significant digits);

(f) for each facility, the source of releases to air, water or land;

(g) for each facility, the total quantity of the substance that was treated on-site, or was transferred to an off-site hazardous or non-hazardous waste-management facility, reported in kilograms (rounded to 2 significant digits); and

(h) name, street address, contact name and phone number for off-site hazardous or non-hazardous waste management facility to which the substance or used containers containing the substance, were transferred.

9. (2) For the purpose of paragraph (1)(e) and (1)(f), releases to water include discharges to surface water or wastewater collection or treatment systems; and discharges to land include underground injection and discharges to groundwater.

(a) Facility Name                                                                                                                                    
Facility Street Address            
Facility City            
Facility Province            
Is the Facility confidential? (Y/N)            
(b) Description of environmental monitoring            
Is the environmental monitoring confidential? (Y/N)            
(c) Used storage or transportation containers were cleaned on site? (Y/N)            
Is cleaning on site or not confidential? (Y/N)            
(d) Description of the waste management solutions to prevent the potential exposure of individuals to the substance            
Are the waste management solutions confidential? (Y/N)            
(e) Total quantity released in kg (rounded to 2 significant digits) Air            
Water            
Land            
Is the quantity confidential? (Y/N)            
(f) Source of releases to air, water or land Air            
Water            
Land            
Is the source confidential? (Y/N)            
(g) Total quantity in kg (rounded to 2 significant digits) On-site waste treatment            
Off-site hazardous waste            
Off-site non-hazardous waste            
Is the quantity confidential? (Y/N)            
(h) Name of Off-site Waste-Management Facilities            
Street Address            
City            
Province / State             
Postal Code/ZIP             
Country            
Contact Name            
Phone Number            
Is the off-site waste managment facility confidential? (Y/N)            
Additional Notes            
Notes confidential? (Y/N)            

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Consumer and Commercial Codes

10. For the purpose of sections 6 and 7, refer to the List of Consumer and Commercial Codes and their Corresponding Descriptions.

Footnote

[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.

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2024-05-15