Consumption unit transfer form: solvent degreasing regulations
[see paragraph 6(3) and schedule 5 of solvent degreasing regulations]
Notes:
- This form must be used to make a joint application for a consumption unit transfer.
- A separate joint application for the transfer of consumption units must be made for a given solvent and a specific degreasing process.
Step 1: transferor information
Transferor:
Name of transferor, 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 application on behalf of transferor (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 - transferor
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: transferor facility information
Note: if more than five (5) facilities, attach additional copies of this page.
Facilities:
Number of facilities included in this application: _____
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: transferee information
Transferee:
Name of transferee, company or corporation:
Civic address of principal place of business:
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 application on behalf of transferee (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 5: request for confidentiality - transferee
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 6: transferee facility information
Note: if more than five (5) facilities, attach additional copies of this page.
Facilities:
Number of facilities included in this application: ____
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 7: solvent and degreasing process information
Solvent and degreasing process:
Name of solvent for which consumption units were issued (select one only): tce or perc
name of degreasing process for which consumption units were issued (select one only): vapour degreaser or cold degreaser
year to which the consumption units apply: ______
effective date of consumption unit transfer (dd/mm/yyyy): ___/___/___
consumption units issued to the transferor before transfer: ___ kg
transferor's unexpended consumption units before transfer: ___ kg
unexpanded consumption untis to be transferred: ___ kg
Step 8: signatures
Trasnferor:
I, _____________________, (print name of transferor or person who is authorized to act on behalf of transferor) the transferor declare that the information provided in this solvent degreasing consumption unit transfer application is correct.
Date:
place:
total number of pages in this application:
_____________________________________
signature of transferor, or of person who is authorized to act on behalf of the transferor.
Transferee:
I, _______________, (print name of transferee or person who is authorized to act on behalf of transferee) the transferee undertake to use each transferred consumption unit in the same year and in the same degreasing process for which the transferor's consumption unit was issuedl and, i declare that the information provided in this solvent degreasing consumption unit transfer application is correct.
Date:
place:
______________________________
signature of transferee, or of person who is authorized to act on behalf of the transferee.
This solvent degreasing consumption unit transfer applciation must be submitted for approval before the transfer takes place.
Submit the completed and signed solvent degreasing consumption unit transfer application 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