|
The Ministers of Health and Environment are inviting the submission of information that is deemed beneficial by interested stakeholders, relating to the extent and nature of the management/stewardship of substances listed under the Challenge. The absence of additional information to improve decision-making will not preclude a decision that safeguards human health and the environment. This Questionnaire applies to organizations that have manufactured, imported, exported or used substances listed under the Challenge whether alone, in a mixture or in a product, including manufactured items. Please refer to the Guidance Document for assistance on completing this Questionnaire. 1.0 Information on the Organization responding to the Challenge
1.1 All facilities covered by this Questionnaire:
[1] 6 digit National Pollution Release Inventory Identification Number
[2] North American Industry Classification System Code [3] Business Registration Number
The full list of Challenge substances can be found on the chemical portal: http://www.chemicalsubstanceschimiques.gc.ca/en/index.html.
For each substance listed in the Challenge, that your organization manufactured, imported, exported, or used, whether alone, in a mixture, or in a product, including manufactured items, complete the following sections (2.0 through 9.0) separately and include data representing each of your organization’s facilities. The Facility ID, assigned in section 1.1, should be used throughout the questionnaire for the questions asking for individual facility data. Indicate the calendar year for which you are submitting information to the Challenge in section 2.0. 2.0 Substance
Indicate the calendar year for which your organization has data and information on this substance and is submitting to the Challenge: _________ Did any of your organization’s facilities import, manufacture or otherwise use the substance whether alone, in a mixture or in a product, including manufactured items on-site, in the calendar year indicated above? Yes No If no, proceed to Section 10.0 of this Questionnaire. If yes, complete all applicable sections in the tables below. 3.0 Submission of Data to Other Sources or for Other Purpose Have you ever previously reported release
information on the substance identified in section 2.0 to another industry
program or federal / provincial government program? Yes No
If yes, provide name of program.
4.0 Management / Stewardship Information Please indicate what programs, practices,
controls or technologies (if available) are currently in place in your
facilities to manage the uses and exposure of substances to workers, the general
population and the environment. If any of these programs, practices, controls
or technology applies to the substance indicated in section 2.0, please provide
details in the last column.
4.1 Potential
Action(s).
Indicate and provide a description of actions
that are being taken or could be taken toward the substitution, control or
virtual elimination of the substance.
5.0 Import, Manufacture or Use In this section, you are asked to provide
information on the manufacture or import, the type or expected use and the
concentration of the substance whether alone, in a mixture or in a product,
including manufactured items.
For any facility involved in the sale or distribution of the substance, or any product containing the substance, provide a list of customers. If you have greater than 20 customers, provide an indication of the customer sector or groups. Attach a separate sheet if necessary. List of customers:
5.1 Import “Import” includes movement
into Canada, including internal company transfers across the Canadian border,
but does not include transit through Canada.
5.1.1 Import of the Substance
5.1.2 Import of a Product containing the Substance
5.2 Manufacture of the Substance “Manufacture” includes to produce or prepare a substance; also includes the incidental production of a substance at any level of concentration as a result of the manufacturing, processing or other uses of other substances, mixtures, or products. 5.2.1 For sale or distribution of the Substance
5.2.2 For sale or distribution as part of a mixture, manufactured item or product
5.2.3 Incidental production of the Substance / By-product
5.2.4 Financial Cost of Substance If the substance identified in section 2.0, was manufactured or imported during any of the calendar years from 2002 through 2006, please provide the following information:
5.3 Use 5.3.1a
5.3.1b
If the substance is consumed in a reaction for any of the processes listed in Section 5.3.1a above, provide the reaction and final end product.
5.3.2 Substance Storage For the substance listed in section 2.0,
indicate, in the units specified:
1) the capacity of the largest single container on site (in Kg): __________________ 2) the maximum expected quantity on site in the calendar year (in Kg): __________________ 3) the normal storage temperature (oC): __________________ 5.3.3 Use in Products Intended for Children 1) Are any of the products containing
the substance assumed or intended for use by children?
Yes No 2) Can the substance be expected to be released from the product during intended use by consumers? Yes No If no, proceed to 6.0. If yes, specify the product type or name(s) along with the HS code.
5.4 Substitutes For each substance or use of the substance, whether alone, in a mixture or in a product, including manufactured items, provide the following information on substitutes:
1
Substitution ratio should take into account technical characteristics imparted
to products in which it is used and re-engineering or reformulation
consideration,
5.4.1 Barriers to Substance Substitution Outline the barriers to the elimination of this
substance including cost, process changes etc.
Did the facility release, including intentional
or non-intentional, the substance whether alone, in a mixture or in a product,
including manufactured items, in the calendar year indicated in section 2.0?
Yes
No
If no, proceed to Section 7.0 of this
Questionnaire.
If yes, and this information was
reported to another program identified in Section 3.0, proceed to Section 7.0 of
this Questionnaire. If any of this information was not reported, please
complete the applicable tables below using the following methods of estimation
codes to describe how each quantity reported was determined.
Method of Estimation Codes:
M1 ontinuous Emission
Monitoring System
M2 Predictive Emission Monitoring
M3 Source Testing
C Mass Balance
E1 Site-specific and Published
Emission Factors
E2 Published Emission Factors
O Engineering estimates
Factors
Please refer to the accompanying instruction
insert for a definition and complete description of the method of estimation
codes. Please indicate and include both routine and accidental or non-routine
releases.
6.1 Releases to Air
6.2 Releases to Surface Waters
6.3 Releases to Land
For all On-Site releases reported above,
describe what, if any, remediation techniques/measures are in place for
unintentional releases.
7.0 On-Site and Off-Site Waste Transfers and Disposals Did the facility transfer the substance whether alone, in a mixture or in a product, including manufactured items on-site and/or off-site for disposal in the calendar year indicated in section 2.0? Yes c No
If no, proceed to Section 8.0 of this Questionnaire. If yes, report below the quantity of all
off-site transfers of the substance for disposal for the calendar year
identified in section 2.0, as well as the method of estimation. Report only
the net mass of the substance that was sent off-site, not the total mass of the
mixture containing the substance. Report transfers to the first off-site
location only and not any subsequent transfers by the waste disposal company.
7.1 On-Site Waste Disposal
7.2 Off-Site Waste Disposal
7.3 Off-Site Waste Transfers for Treatment Prior to Final Disposal
8.0 Off-Site Transfers for Recycling Did the facility transfer the substance whether
alone in a mixture or in a product, including manufactured
items off-site for
recycling in the calendar year indicated in section 2.0?
Yes c No
If no, proceed to Section 9.0 of this Questionnaire. If yes, report below the quantity of all
off-site transfers of the substance for recycling for the calendar year
identified in section 2.0, in the appropriate field. Report only the net mass
of the substance that was sent off-site, not the total mass of the mixture
containing the substance. Report transfers to the first off-site location only
and not any subsequent transfers by the recycling facility.
9.0 Off-Site Transfers for Export Did the facility transfer the substance whether
alone, in a mixture or in a product, including manufactured items, off-site for
export in the calendar year indicated in section 2.0?
Yes c No
If no, proceed to Section 10.0 of this
Questionnaire.
If yes, report below the quantity of all
off-site transfers of the substance for export in the calendar year indicated in
section 2.0, and the destination of the export in the appropriate field.
10.0 Certification I hereby certify that the information provided in this Questionnaire is true, accurate and complete.
Disclaimer: Although care has been taken to ensure that the information found on this website accurately reflects the requirements prescribed in the Canadian Environmental Protection Act (1999), you are advised that, should any inconsistencies be found, the legal documents, printed in the Canada Gazette, will prevail. |
| Help
| Search
| Canada Site |
|
||
The Green LaneTM, Environment Canada's World Wide Web site
|
||
|
||
|