Annual solvent sales report form: solvent degreasing regulations
[see paragraph 8(a) and schedule 7 of solvent degreasing regulations]
Year for which annual solvent sales report is being made: _____
Step 1: seller information
Seller:
Name of seller, company or corporation:
Civic address of principal place of business:
Number and street:
city:
province:
postal code:
Postal address of principal place of business (if different from the civic address):
Number and street:
city:
province:
postal code:
Telephone number (include area code): ( )
fax number (if any - include area code): ( )
e-mail address (if any):
Person authorized to submit notice on behalf of seller (if applicable):
Name:
title:
name of company:
Civic address of principal place of business:
Number and street:
city:
province:
postal code:
Postal address of principal place of business (if different from the civic address):
Number and street:
city:
province:
postal code:
Telephone number (include area code): ( )
fax number (if any - include area code): ( )
e-mail address (if any):
Step 2: request for confidentiality
Note: indicate if a request for confidentiality is being made under section 313 of the canadian environmental protection act (cepa), 1999 and the reason for the request.
Do you request confidentiality under section 313 of cepa 1999?
Yes or no
Reason:
Step 3: seller facility information
Note: if more than five (5) facilities, attach additional copies of this page.
Facilities:
Number of facilities included in this report: ___
Civic address of facility 1:
Number and street:
city:
province:
postal code:
Postal address of facility 1 (if different from the civic address):
Number and street:
city:
province:
postal code:
Civic address of facility 2:
Number and street:
city:
province:
postal code:
Postal address of facility 2 (if different from the civic address):
Number and street:
city:
province:
postal code:
Civic address of facility 3:
Number and street:
city:
province:
postal code:
Postal address of facility 3 (if different from the civic address):
Number and street:
city:
province:
postal code:
Civic address of facility 4:
Number and street:
city:
province:
postal code:
Postal address of facility 4 (if different from the civic address):
Number and street:
city:
province:
postal code:
Civic address of facility 5:
Number and street:
city:
province:
postal code:
Postal address of facility 5 (if different from the civic address):
Number and street:
city:
province:
postal code:
Step 4: solvent information
Notes:
- Solvent, recycled solvent and reclaimed solvent are to be reported separately.
- All quantities are to be reported in kilograms.
- Make and attach additional copies of pages where additional space is required.
Solvent sold (if applicable):
date of sale:
purchaser's name:
civic address:
tce (kg):
perc (kg):
total (kg):
Solvent returned by purchasers (if applicable):
date of return:
purchaser's name:
civic address:
tce (kg):
perc (kg):
total (kg):
Step 4: solvent information (cont'd)
Reclaimed solvent sold (if applicable):
date of sale:
purchaser's name:
civic address:
tce (kg):
perc (kg):
total (kg):
Reclaimed solvent returned by purchasers (if applicable):
date of return:
purchaser's name:
civic address:
tce (kg):
perc (kg):
total (kg):
Step 5: signature
I, __________________, (print name of seller or person who is authorized to act on behalf of seller) declare that the information provided in this solvent degreasing annual sales report is correct.
Date:
place:
total number of pages in this report:
_____________________________
signature of seller, or of person who is authorized to act on behalf of the seller.
This solvent degreasing annual solvent sales report must be submitted no later than 30 days after the end of the year in which the sale occurs.
Submit the completed and signed solvent degreasing annual solvent sales report by mail to:
Solvent Degreasing Coordinator
Products Division, Chemicals Sector Directorate
Environment Canada
351 St. Joseph Blvd
Gatineau, Quebec
K1A 0H3
For assistance, call: 1-888-391-3426 or email: products.produits@ec.gc.ca
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