一太郎 9/8 文書 · Web viewCompany seal Indicate details of the product under application for certificate in “Fill in this Column.”

一太郎 9/8 文書

　　　　　　　　　　　　　　　付属証明書　　　　　年　　月　　日　

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（社名）

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Company seal

1. Indicate details of the product under application for certificate in “Fill in this Column.”

Shaded areas in “Fill in this Column” do not require entry.

2. Prepare yourself or have other interests prepare the certificates specified in “Documents to be submitted.” Submit these certificates with this document when applying for Eco Mark Product certificate or use.

3. Prepare certificates referring to the examples provided.

4. The issuer(s) in the “Issued by” column must prepare “Documents to be Submitted.”

5. To complete the certificates, “Common criteria”, “Criteria for material” for appropriate material category (A-D), “Criteria on individual products” for each products (A-N), and “Quality criteria” should be filled in. Appropriate certificates should be selected according to the product under application.

Item

Fill in this Column

Issued by

Planned Display of Eco Mark

< > Yes

< > Product < > Packaging

< > Catalogue/leaflet < > User manual

< > Other ( )

< > No (If an Eco Mark is displayed, design drawing must be submitted)

(Select where appropriate If you choose , please submit design drawing given below.)

Applicant

Article 3 of Usage Regulations

Display of intended location of Eco Mark, display of environmental information below mark

Design drawing to be provided (Format free, text)

Article 7 of Usage Regulations

Display of Eco Mark user name and address, display of certificate number

Item

Fill in this Column

Documents to be

Submitted

Issued by

Manufacturer of product

　< > Other companies < > Own company

(Select where appropriate))

If developed by other companies, attach Application Consent Form (Example 1).

Applicant

If a product with Eco Mark certificate under the category is submitted for approval as another brand

Are there any changes in addition to brand name? < > Yes/< > No

(Select where appropriate)

(If only the brand name has been changed, the following items do not have to be proved.)

A copy of notice of Eco Mark certificate review results

Product category match table between the existing eco product and one under application

Documents certifying changes, if any, meet applicable criteria

Subject

< >A. Wooden tiling/blocks ( )

< >B. Steel construction materials( )

< >C. Aggregates ( )

< >D. Cement ( )

< >E. Concrete admixture ( )

< >F. Concrete productｓ

< >G. Pavement materials ( )

< >H. Landscaping/revegetation materials ( )

< >I. Traffic signs/traffic lane lines ( )

< >J. Materials for temporary structures( )

< >K. Road materials ( )

< >L. Sewage/waterworks materials ( )

< >Materials for bridges/rivers/harbors ( )

< >N. Other materials ( )

Select where appropriate, and fill the product number on the Attachment 1 in the parenthesis.

Example: For “Permeable steel sheet piles”, check “B. Steel construction materials” and fill in “2”.

Item

Fill in this Column

Documents to be Submitted

Issued by

4-1.(1) Environmental laws and regulations

Certificate

(Example 2)

Manager of finished product manufacturing/assembly plant

Item

Fill in this Column


Issued by

4-1.2 Composition of materials

　　

< >A. Wood

< >B. Plastic

< >C. Glass

< >D. Fiber

< >E. Others ( )

Select where appropriate, excluding functionally essential small parts on the product.

Item

Fill in this Column


Issued by

4-1.(2) Wood preservatives

(product with “A” selected)

Use of wood termicides, wood preservatives, wood pesticides, and wood fungicides

< > Yes/< > No


　If “Yes,” documents provided in the right column should be submitted.

　　　　

　

Reasons of wood preservative use, documents certifying that preserving agents have attained JWPA certificate

Japan Wood Preserving Association, etc.

4-1.(3) Use of　toxic chemical substances

(product with “B” selected)

　　　

Certificate (Example 3) or result of heavy metal test (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium)

Raw material supplier (raw material/

molding) or third party testing body

4-1.(4) Halogens

(product with “B” selected)

4-1.(5) Safety of glass cullet

(product with “C” selected)

Results of tests based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron, fluorine)

Third party testing body or public institution

4-1.(6) Chemical substance

(product with “D” selected)

Name of dye plant

(If there are multiple plant names, and space is inadequate to list all, write on a separate sheet)

Certificate

(Example 4)　

Applicant

Certificate

(Example 5)

(for each materials of fiber part)

Dye plant manager

A. Wooden tiling/blocks

Item

Fill in this Column


Issued by

4-1. (7) (8)

Ratio of material to the entire product/name of raw materials

　　

Entry Table A1

Applicant

Entry TableA2: List of raw material suppliers (10 or more suppliers)

Applicant

List of certificate of the top 10 raw material suppliers

(Example 6)

Raw material supplier

4-1. (9) Chemical substances of coating

Use of coating

　< >Yes / < >No

If “Yes,” documents provided in the right column should be submitted. The following information should be entered if coating with Eco Mark certificate (Version 1.0) is used.

　< > Certificated brand name ( )

　< > Certificated number ( )


A list of the used amount of concerned substances

(Example 7)

Paint manufacturer

4-1.(10) Halogens

Use of halogens

　< >Yes / < >No


4-1.(11) Packaging material

Name of packaging material:

Way of packaging:

4-1. (11) Halogens used for packaging materials (for plastic packaging material only)

　　

< > Use /< > No use


4-2. (108) Product Quality

Result of tests according to the JIS or JAS

Applicant or third party testing body

B. Steel construction materials

Item

Fill in this Column


Issued by

4-1.(12) Consideration to the reduction of waste generation

　　

Written materials regarding the reduction amount of waste generation in a ton of crude steel production

Applicant

4-1.(13) Balance of materials form production to recycling

　　

Written materials regarding the quantity of new resources used, energy consumption and CO2 emission in a ton of crude steel production

Applicant

4-1.(14) Product specification and construction method (common)

　　

Certificate of product specification including size and used materials

Applicant

Construction method

Applicant

4-1.(14) Permeable steel sheet piled (if applicable)

　　

Certificate to prove that the product is designed to facilitate hydrological circulation between land and water

(for each construction method)

Applicant

4-1.(14) Low displacement steel piles

(if applicable)

　　

Certificate to

prove that the product is with low displacement


Information to confirm about the displacement volume to the surface at the pile body construction stage

Applicant

4-2.(109) Product quality

　　

Certificate or result of tests according to the JIS, etc.


C. Aggregates

Item

Fill in this Column


Issued by

4-1.(15) The percentage of recycled aggregates

　　

< > The percentage of the following

raw material aggregates is 100% by mass of the entire product mass

< > Dismantled concrete blocks

< > General waste, sewage sludge

< > Blast furnace slag, ferro-nickel slag and copper slag


4-1.(15) Recycled aggregates

　　

Raw material certificate

(Example 8)

Raw materials supplier

4-1.(16) Balance of materials form production to recycling

　　



4-1.(17) Elution of harmful substances

　　

“We will conduct the test once a year

during certified period and disclose the result”

< >Declare / < >Not declare


Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron, fluorine)


4-1.(18) Containing of harmful substances

　　

“We will conduct the test once a year

during certified period and disclose the result”



Results of containing tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron, fluorine)


4-1.(110-112) Product quality

　　



*1 In case of using vitrified aggregates or slag aggregates as raw materials, the following eight substances shall be tested: cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron and fluorine.

D. Cement

Item

Fill in this Column


Issued by

4-1.(19) Supply of raw materials

　　


Applicant

4-1.(20) The percentage of recycled materials

　　

　　

Entry table C

Applicant

4-1.(21) CO2 emission amount

　　

Certificate for the production process with heat treatment without using recycled materials, and to compare the value of CO2 emission amount (amount of energy consumption is applicable)

Applicant


　　

　　

Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium)



　　

Results of containing tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, arsenic, total mercury, etc.)



　　



E. Concrete admixture

Item

Fill in this Column


Issued by


　　

Entry table C

Recycled material collector


　　

Certificate or result of tests according to the JIS


F. Concrete products

Item

Fill in this Column


Issued by

4-1.(25) Choice

　　

< >a/< >b

4-1.(25)a. Permeability

　　

Test results of permeability factor


4-1.(25)b. The percentage of recycled materials

　　

Entry table C

Applicant


　　




　　



4-1.(28) Providing information

　　

“The manuals on the right will be

provided to the constructor, the owner of an architectural structure, and the manufacturer of the product.”



Manuals to indicate the items of 4-1. (28) a.b.c.d.e (manuscript)

Applicant

4-1.(29) Recycling after use

Explanation about separation method and recycling after use

Applicant

4-2.(115-118) Product quality



G. Pavement materials

G-1. Pavement materials (Rubber pavement materials and antifreezing pavement material containing rubber particles)

Item

Fill in this Column


Issued by


　　

Certificate of raw materials/

pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-1.(31) Recycling after use

　　

Certificate to indicate the recycling method after disposal

Applicant

4-1.(32) Balance of materials from obtaining resources to recycling

　　


Applicant


　　

Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29), results of elution test of rubber particles



Manuals to indicate the items of 4-1. (32) (manuscript)

Applicant

4-2. (119) Product quality

　　

Adoption for the traffic volume categories established by the Japan Automobile Tire Manufacturers Association


G-2. Pavement materials (Recycled sub-base materials and recycled asphalt mixture)

Item

Fill in this Column


Issued by


　　

Certificate of raw materials/

pre-treatment

(Example 8)

Recycled material collector


　　

Entry table C

Applicant


　　

Adoption for the guideline of plant recycled pavement technology


H. Landscaping/revegetation materials

Item

Fill in this Column


Issued by


　　

Certificate of raw materials/pre-treatment

(Example 8)



Entry table C

Applicant


　　

　　




　　




　　

　　


Applicant


　　

Manuals to indicate the items of 4-1. (37) (38)

(manuscript)

Applicant

4-1.(41) Packaging of product

Materials of packaging:

Packaging method:

“This product is designed to allow

separation/sorting to facilitate recycling after disposal”

< > Applicable/< >Not applicable


4-1.(41) Use of halogens for packaging

(only for plastic packaging materials)

< >Used/< >Not used



Result of tests according to the JIS or JAS


I. Traffic signs/traffic lane lines

I-1. Traffic sign boards

Item

Fill in this Column


Issued by

4-1.(42) Collection system

　　

Explanatory document about collection system, treatment ability and contents of used products

Applicant

4-1.(43) Materials for reflective sheets

　　

Certificate to indicate that this product is applicable to 4-1.(3)

(Example 3), or result of heavy metal test (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium)

Raw material supplier (raw materials or molding) or third party testing body

4-1.(44) Design of Separation/

sorting

　　

Certificate regarding the applicable part for separation, sorting and switching, and method to change the part

Applicant

4-2.(122-124) Product quality　　



I-2. Traffic sign materials

Item

Fill in this Column


Issued by


　　


(Example 8)



　　

Entry table C

Applicant


　　




　　




　　


Applicant

4-1.(49) Design of Separation/

sorting

　　

Certificate regarding the applicable part for separation, sorting and switching, and method to change the part

Applicant

4-1.(50)

Prescribed

constituents

Addition of chromium, cadmium and arsenic

< >Added/< >Not added


4-1.(51) providing information

“The manuals on the right will be

provided to the constructor, the owner of an architectural structure, and the manufacturer of the product.”



Manuals to indicate the items of 4-1. (51) a.b.c.d.e.f (manuscript)

Applicant



< >Used/< >Not used


4-2.(125,126) Product quality

Alkali-aggregates reaction

Ordinance of Prime Minister’s Office/Ministry of Construction


I-3. Traffic lane lines (Glass beads for road marking paint)

Item

Fill in this Column


Issued by


　　


(Example 8)



　　

Entry table C

Applicant

4-1.(54) Packaging of product

　　

Materials of packaging:

Packaging method:

“This product is designed to allow

separation/sorting to facilitate recycling after disposal”

< > Applicable/< >Not applicable




　　

< >Used/< >Not used



　　

Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron, fluoride)


4-1.(56) Coloring agents

　　

Addition of cadmium, lead, mercury, chromium, arsenic, selenium, and the other chemical compounds




Manuals to indicate the items of 4-1. (55)(56)

(manuscript)

Applicant


Certificate to be applicable to the target standards


J. Materials for temporary structures

Item

Fill in this Column


Issued by


　　


(Example 8)



　　

Entry table C

Applicant


　　




　　



4-1.(61) Prescribed constituents

　　




4-1.(62) Disposable products

“This is the disposable product”

< >Yes /< >No


If “yes”, the attached certificate on the

right is required.

Certificate regarding recycling after use

Applicant


　　

Manuals to indicate the items of 4-1. (59) (60)

(manuscript)

Applicant


In-house standards, etc.


K. Road materials

K-1. Road lighting

Item

Fill in this Column


Issued by

4-1.(64) Electricity consumption

　　

The data of comparing electricity consumption of the product with mercury lamps

Applicant

4-1.(65) Light leakage

　　

Certificate regarding the design to reduce light leakage to areas beyond the roadside

Applicant


　　



K-2. High-performance noise reduction equipment

Item

Fill in this Column


Issued by

4-1.(66) Product specification and construction method (common)

　　


Applicant

Construction method, the total height of sound insulation walls before and after installing

Applicant

4-1.(67) Noise reducing effect

　　

Certificate to prove noise reduction


Written materials to confirm the effect quantitatively

Applicant

4-2.(130,131)) Product quality

　　

Calculation form of

structure strength, etc.


K-3. Other road materials

Item

Fill in this Column


Issued by


　　


(Example 8)



　　

Entry table C

Applicant


　　




　　




　　


(manuscript)

Applicant

4-1.(72) Information regarding treatment method after disposal

　　

Manuals to indicate the item of treatment method of waste

(manuscript)

Applicant

4-1.(73) Measures to control the release into the air of

incinerator ash

Figure of the facility to conduct incineration

Applicant

4-2.(132-135)

Product quality

Certificate and result of tests according to the JIS or JAS


L. Sewage/waterworks materials

Item

Fill in this Column


Issued by


　　


(Example 8)



　　

Entry table C

Applicant


　　




　　




　　


Applicant

4-1.(78) Prescribed constituents

　　




4-1.(79) Appropriate treatment and handling at disposal

Average year to use the product

< > 20 years or more

< > Less than 20 years


Certificate to indicate the average year of use the product and its reason (actual results of the product, or the test result of the same type of product)

Applicant



(manuscript)

Applicant



< > Used/< > Not used





M. Materials for bridges/rivers/harbors

Item

Fill in this Column


Issued by


　　

Certificate of raw material/

pre-treatment

(Example 8)


4-1.(83) (86) The percentage of recycled materials

　　

Entry table C

Applicant

4-1.(83)–(85),(87)

Product specification and construction method (common)


Applicant

Construction method, etc.

Applicant

4-1.(83) Impermeable-

type steel erosion control weirs

(if applicable)

　　

< >Double-wall type

< >Steel frame type


Certificate to indicate the reason to utilize earth and sand/gravel generated at the site as hearing materials for 70% or more of the weir volume


Applicant

4-1.(84) Permeable-

type steel erosion control weirs

(if applicable)

　　

Certificate to indicate the reason to allow water, sand and gravel to flow in order to control the lowering of the river bed or the erosion of beaches

(for each construction method),

Certificate to indicate the reason to allow the movement of flora and fauna


Applicant

4-1.(85) Special-type mat cylinders

(if applicable)

　　

Certificate to indicate the reason to utilize earth and sand/gravel generated at the site as hearing materials for 70% or more of the mats or cylinders


Applicant

4-1.(87) Steel sheet piles with pots for bank protection and tree planting

(if applicable)

Certificate to indicate the reason to have landscaping functions to cover the steel sheet pile surface with plants


Applicant

4-2.(137,138)

Product quality



N. Other materials

N-1. Drainage materials/backfill materials

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant


　　


Applicant


　　

Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium)*1


4-1.(91)

　　Containing of harmful substances

Results of containing tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, arsenic, total mercury, etc.)*1


4-1.(92) Dioxins

　　

Test result to show compliance with the Environmental Agency Notification No. 68



Manuals to indicate the items of 4-1. (90)(91)(92)

(manuscript)

Applicant

4-2.(139,140)

Product quality

Certificate to be applicable


*1 In case of using cold molding products, vitrified products and baked products that use vitrified recycled materials only, the following eight substances shall be tested: cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron and fluorine.

N-2. Revegetation base materials

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant


　　

Results of elution tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium)*1


4-1.(96)

　　Containing of harmful substances

Results of containing tests of the product based on the soil contamination requirement (Environmental Ministry Notice No. 29) (cadmium, lead, arsenic, total mercury, etc.)*1


4-1.(97) Dioxins

　　

Test result to show compliance with the Environmental Agency Notification No. 68


4-2.(141,142)

Product quality

Certificate to be applicable


*1 In case of using cold molding products, vitrified products and baked products that use vitrified recycled materials only, the following eight substances shall be tested: cadmium, lead, hexavalent chromium, arsenic, total mercury, selenium, boron and fluorine.

N-3. Non-chloride type antifreezing agents

Item

Fill in this Column


Issued by

4-1.(98) Acetic acid-based materials

　　

List of prescribed constituents of the product

Applicant

4-1.(99) Information for use and handling

　　

Instruction manual and MSDS

Applicant

4-2.(143)

Product quality

　　

Certificate or result of tests according to the JIS or JAS


N-4 Slope protection nets (rock fall protectors and slope fall protectors with less impact

on the environment)

Item

Fill in this Column


Issued by

4-1.(100)(101)

Product specification and construction method (common)

　　


Applicant

Explanatory material for construction method

Applicant

4-1.(100)(101)

Protection of natural slope

(if applicable)

　　

<>Rock fall-protectors with less impact on the environment

<>Slope fall protectors with less impact on the environment


Certificate to indicate the reason to be able to conserve the natural slope without felling trees over 70% or more of the face of slope within the range of the construction target area


Applicant

4-2.(144)

Product

quality

　　



N-5. Buried marker sheets

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-2.(145)

Product quality

Certificate or result of tests according to the JIS, etc


N-6. Protective tube for underground cable

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-2.(146)

Product quality



N-7. Water bars

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-2.(147)

Product quality



N-8. Joint filter/joint bars

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-2.(148)

Product quality



N-9. Foundation improvement materials

Item

Fill in this Column


Issued by


　　


pre-treatment

(Example 8)



　　

Entry table C

Applicant

4-1.(107) 　Containing of harmful substances



4-2.(149)

Product quality



Example 1-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office

Japan Environment Association

XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Applicant

Approval of Eco Mark Use Application

This is to consent to the application for Eco Mark certificate and use of XXX (your company name) (Eco Mark certified) brand name XXXX (certificate no. XX) by XXX (applicant) as brand name XXXX.

Example 2-131　　

　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Manger of finished product manufacturing/assembly plant

Environmental Laws and Agreements Compliance Certificate

This is to certify that (the finished product manufacturer) has been observing the following requirements in the manufacturing of the (product under application for Eco Mark certificate).

The production process has been conforming to relevant environmental laws and regulations and agreements on pollution control for preventing air pollution, water contamination, noise, vibration, odor, and emission of hazardous materials in the past five years (*) since application.

Example of relevant regulations:Air Pollution Control law

Water Pollution Control law

Noise Regulation Law

Vibration Regulation Law

Offensive Odor Control Law

XX Prefecture XX Environment Protection Ordinance

XX City Agreement on Pollution Control

(*) Otherwise, provide a statement indicating no laws and agreements have been violated since the establishment of the company.

If the issuer is other than the plant manager, indicate the issuer is a person who also holds the post of plant manager or who is in an executive position equivalent to plant manager.The certificate is effective, if the date of issue is within about three months before/after application for Eco Mark certificate.　

Example 3-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

　　　　　　　　　　　　　　　　　 * Issuer: Raw material supplier

Certificate*1

(The following should be clarified for materials used in your manufacturing by plastic type (regenerated or virgin).)

Scope: (regenerated or virgin material); Material: ; Manufacturing process:　　　　　　　

4-1. (3) Hazardous substance, etc.

Fill in this Column

Attachment, etc

　Plastic additive

Additive

Use of additive other than below

Yes/No

(PL #　　　　　)

If “yes,” the following should be attached:

Results of heavy metal tests or certificate for registration number of the additive positive list*2

Flame retardant

Use of flame retardant (If “yes,” indicate below.)

Yes/No

If “yes,” a copy of the certificate issued by the Japan Fire Retardant Association

Is PBB, PBDE, or chlorinated paraffin contained?

Yes/No

Stabilizer

Lubricant

Use of stabilizer, lubricant (If “yes,” indicate below)

Yes/No

Is a lead, cadmium, or tin organic compound agent contained?*3

Yes/No

Colorant

Use of colorant (pigment, dye)

Yes/No

(PL #　　　　　)

If “yes,” the following should be attached:

Results of heavy metal tests or certificate for registration number of the additive positive list*2

*1 This certificate should be issued by the manager of each manufacturing process to indicate the use of focused chemicals. The suppliers of each process are not required to issue this certificate. Instead of this certificate, a positive list of resin or a copy of the results of heavy metal test will be accepted for certificate of virgin resin supplier.

*2 Heavy metal tests on products containing additives, colorants (pigment, dye) are admitted.

*3 Tributyltin, triphenoltin, dibutyltin, diphenyltin, monophenyltin compounds

　　

　

　 Example 4-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Applicant

Production Process Certificate

This is to certify that the fiber materials used for the product are as follows:

(Check the Yes/No items, and if yes, attach the corresponding documents.)

Processing

Performed

If yes, documents to be submitted

Mildew proof finishing

< > Yes < > No

Certificate (MSDS) of agent used for finishing (chemical substances used)

Flame proof finishing

< > Yes < > No

Quantity used ( ) Unit ( )

Fluorescent whitening

< > Yes < > No


Softening

< > Yes < > No


Sanitization

< > Yes < > No


Product bleaching

< > Yes < > No


Fireproofed finishing

< > Yes < > No

Certificate (MSDS) of agent used for finishing (chemical substances used) or certificate that the product is flame-retarding part or product (copy of certificate of Japan Flame Retardant Association).

Product under application for Eco Mark certificate is:< > wool < >non-wool　　(Select where appropriate)

　If it is wool product, the following certificate is required.

Process using dieldrin/DTTB

< > Yes < > No

Documents certifying compliance with MHW Ordinance No.34 of the concerned product.

Total pages: 2　

Example 5-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

· *Issuer: Dye plant manager

Dye Supplier Certificate

This is to certify that the dyes supplied for fiber material (fiber material item no.) is as follows.

*If there are several fabrics to be certified, indicated the item numbers of all three fabrics.

The following dyes in (1), (2), and (3) are not added as ingredients.

Fabrics shall not include chrome dye. (This item need not be included for lamb wool.)

(1) Azo dyes which may generate the following carcinogenic amines in degradation

　　(Stating that more than one of the amines in below exceeding 30mg per kg in the product have been detected by the analysis method set down in the Public Testing method Corpus based on Article 35 of the German Food and Household Goods Law.)

Carcinogenicity Rank (A1)

92-67-1

4-aminobiphenyl

C1(EU),1(NTP,IARC)

92-87-5

Benzidine

C1(EU),1(NTP,IARC)

95-69-2

4-chloro-o-toluidine

2A(NTP,IARC)

91-59-8

2-naphthylamine

C1(EU),1(NTP,IARC)

Carcinogenicity Rank (A2)

97-56-3

o-aminoazotoluene

C2(EU), 2B(NTP,IARC)

99-55-8

2-amino-4-nitrotoluene

3(NTP,IARC)

106-47-8

4-chloroaniline


615-05-4

2,4-diaminoanisole

2B(NTP,IARC)

101-77-9

4,4'-diaminodiphenylmethane


91-94-1

3,3-dichlorbenzidine


119-90-4

o-dianisidine; 3,3'-Dimethoxybenzidine


119-93-7

o-tolidine; 3,3'-Dimethylbenzidine


838-88-0

4,4'-diamino-3,3'-dimethyldiphenylmethane


120-71-8

p-cresidine

2B(NTP,IARC)

101-14-4

4,4'-diamino-3,3'-dichlorodiphenylmethane

C2(EU), 2A(NTP,IARC)

101-80-4

4,4'-diaminodiphenylether

2B(NTP,IARC)

139-65-1

4,4'-diaminodiphenylsulfide

2B(NTP,IARC)

95-53-4

o-toluidine


95-80-7

2,4-diaminotoluene


137-17-7

2,4,5-trimethylaniline

90-04-0

o-anisidine


95-68-1

2,4-xylidine

3(NTP,IARC)

87-62-7

2,6-xylidine

2B(NTP,IARC)

60-90-3

4amino-azo-benzen　

C2(EU)

(2) Carcinogenic dyes

569-61-9

C.I. BASIC RED 9

CI 42500

C2(EU), 2B(NTP,IARC),

Oeko-Tex

2475-45-8

C.I. DISPERSE BLUE 1

CI 64500

C2(EU), 2B(NTP,IARC),

Oeko-Tex

3761-53-3

C.I. ACID RED 26

CI 16150

2B(NTP,IARC), Oeko-Tex

6459-94-5

C.I. ACID RED 114

CI 23635

2B(NTP,IARC)

2602-46-2

C.I. DIRECT BLUE 6

CI 22610

C2,R3(EU),2A(NTP,IARC), Oeko-Tex

1937-37-7

C.I. DIRECT BLACK 38

CI 30235

C2,R3(EU),

2A(NTP,IARC), Oeko-Tex

573-58-0

C.I. DIRECT RED 28

CI 22120

C2,R3(EU) , Oeko-Tex

2932-40-8

C.I. DISPERSE YELLOW 3

CI 11855

Oeko-Tex

(3) Skin sensitizing dyes

2475-46-9


CI 61505

ETAD, Oeko-Tex

12222-75-2


ETAD, Oeko-Tex


ETAD, Oeko-Tex


ETAD, Oeko-Tex

2832-40-8


CI 11855

ETAD, Oeko-Tex

730-40-5

C.I. DISPERSE ORANGE 3

CI 11005

ETAD, Oeko-Tex


ETAD, Oeko-Tex

2872-52-8

C.I. DISPERSE RED 1

CI 11110

ETAD, Oeko-Tex

2475-45-8


CI 64500

Oeko-Tex

3179-90-6


CI 62500

Oeko-Tex

3860-63-7


CI 63305

Oeko-Tex


Oeko-Tex


CI 11080

Oeko-Tex


Oeko-Tex

2872-48-2

C.I. DISPERSE RED 11

CI 62015

Oeko-Tex

C.I. DISPERSE RED 17

CI 11210

Oeko-Tex

119-15-3


CI 10345

Oeko-Tex


CI 10375

Oeko-Tex


Oeko-Tex


Oeko-Tex

Indicate that the issuer is the plant manager or someone in an executive position equivalent to plant manager.

Product Weight Certificate

Date

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　(Company name)

　Product type　(　　　　　　　)　　　

Submit the form for each product type. If the weight percentage of materials is identical among several product types, notes should be added.

Part

Raw material

(Example; thinned wood, waste wood, etc.)

Name of raw material supplier

Weight percentage (%) in the entire product

Wooden Part

Wooden Part

Wooden Part

Total of wooden part

Other materials

( )

( )

( )

( )

* In case that there are 10 or more raw material suppliers, you should submit Entry Table B (List of raw material suppliers).

* Total weight percentage (%) of each part in the entire product should be 100%.

Entry Table A2-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Applicant

Raw Material Certificate Table

The following list includes reused/unused wood and waste plant fibers.

No.

Reused/unused wooden material


e.g.

Thinned wood

XX Forest Association, XX Prefecture

Example 6 (Thinned wood) -131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Raw material supplier

Raw Material Certificate

This is to certify that the following thinned wood materials are supplied to (Eco Mark product manufacturer) as reused/unused wood. Photographs of the concerned forest should be attached.

Place of production

Example: city, prefecture, country

Type of tree

Amount

Year of tree planting

Percentage of thinned trees

e.g.: 20%

300 trees/1500 trees (per 1 ha)

Which time of thinning?

e.g.: First thinning in 1980

Percentage of thinned trees: 30%

　 500 trees/2000 trees (per 1 ha)

　　Second thinning in 2004

Tip end diameter*

Average distribution　　　　cm to cm

　　* Information should be entered as a reference.

Percentage of thinned trees: (Number of trees thinned per hectare)/

(Number of trees planted per hectare) x 100　

Place of production: Place where woods were harvested.

Example 6 (Waste wood) -131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　



This is to certify that the following waste wood materials are supplied to (Eco Mark product manufacturer) as reused/unused wood or plant fibers.

Waste Wood

Details of waste wood material

Content

< > Used wood

　Recycled material: (　　　　　　　　　　　　)

　　　　　　　　　e.g.　packaging material

%

< > Remainder material generated in wood processing plants

< > Shavings generated in plywood and lumber plants

< > Low quality chips not used as raw material for paper

< > Other ( )

%

< > Trimmed branches

%

< > Bark

%

< > Other ( )

%

Total

100%

If “Trimmed branches”, “Bark”, or “Other”, generation process, tree type, and other details should be given. (Separate forms are allowable.)

* Check appropriate items and fill in blanks.

Example 6 (Construction waste wood) -131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　



This is to certify that the following construction waste wood materials are supplied to (Eco Mark product manufacturer) as reused/unused wood.

Const- ruction waste wood

Details of construction waste wood

< > Wood from dismantled buildings (Wood and wooden materials disposed as waste in construction work as dismantling of buildings)

< > Wood and wooden materials produced by construction of new buildings and building extensions

< > Wood and wooden materials produced by renovation

< > Wood and wooden materials disposed as waste in construction related to other work

Generation process, tree type, and other details should be given. (Separate forms are allowable.)

For construction waste wood, separate documents should be submitted to demonstrate that materials subject to preservatives, termicides, and pesticides are differentiated and eliminated during recycling. (e.g. differentiation and elimination manual, work flow)


　 Example 6 (Less useful wood-1/3) -131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　



This is to certify that the following less useful wood materials are supplied to (Eco Mark product manufacturer) as reused/unused wood or plant fibers.

Less useful wood

Raw material types of less useful wood

Content

< > Abandoned lumber in the forest

%

< > Shrub

%

< > Root

%

< > Wood obtained from logs damaged by disease, pests, disasters

%

< > Bent logs

%

< > Small-diameter log

%

< > Bamboo cut down in bamboo groves for the purpose of maintenance and preservation of the surrounding environment.

%

< > Other

%

Total

100%

Example 6 (Less useful wood-2/3) -131

[Details]　(Other than bamboo)

Type of forest

< > Natural forests　< > Plantation forests

Sustainable managed forests*1)

Acquisition of third party certificate (a copy of certificate should be applied)

< >Yes (name　　　　　　　　　 ) < >No

Place of production

Type of tree

Amount

Year of planting*2)

Tip end diameter*3)

　　　　 cm

　*1) Fill in the blank if small diameter logs are used as raw materials, and appropriate case.

　*2) Fill in the blank if the forest is a plantation.

　*3) Fill in the blank if small diameter logs are used.

Generation process, etc. should be given. (Separate forms are allowable.)

Details of logging or cutting should be given if small diameter logs are used. (e.g. clear cutting, patch logging, and strip logging etc.)

　　　　　　　　　　　　　　　　　　　　

*


Example 6 (Less useful wood-3/3)-131

[Details] (Bamboo)

Bamboo type

Place of production and Surrounding conditions

(Place of production/Example)

- City, Prefecture, Country

(Surrounding conditions)

- Forest or agricultural lands. Bamboo groves invade those lands and suppress appropriate growing. (Describe specifically)

Explanation that felling is performed for the purpose of maintenance and preservation

To solve the problem stated above, explain what actions are taken.

Management plan

State annual number of times felling is performed, as well as the owner and manager of bamboo forest.

Amounts

Place of production: Place where bamboos were harvested.

End of the document

Example 7-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

*Issuer: Paint manufacturer

Certificate of Chemical Substance

This is to certify that paints supplied for (product under application for Eco Mark certificate) meet Criterion 4-1.(8) in terms of chemicals listed in Attachment 1. Details are given in the following table.

Substance Name

Total value of cadmium, mercury, hexavalent chromium and lead

%

Lead

%

Arsenic

□Below standard／□Above

Antimony


Tributyltin

□No contained ／ □Contained

Triphenyltin


Alkylphenol


Nonyl phenol


4-octyl phenol


Bisphenol-A


Butyl benzyl phthalate


Diethyl phthalate


Formaldehyde



Toluene


Xylene


Dthylbenzene


Styrene


Di-n-butyl phthalate


Tetradecane


Di-2-ethlhexyl phthalate


Acetaldehyde


Example 8-131

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Date

　　 Director

Eco Mark Office


XXXXX XXXXX

Company name

　　　Seal

　

　　　　　　　　　　　　　　　　　　　　　　　　* Issuer: Raw material supplier


This is to certify that we are supplying (the Eco Mark product manufacturer) with ( *1).

In *1, specific name of raw material should be given.

Product Weight Certificate

Date

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　(Company name)

　Product type　(　　　　　　　)　　　

Submit the form for each product type. Fill in the weight to be used for manufacturing of 1 ton products.

Part

Raw material

(Example; Blast-furnace slag, etc.)


Product weight (ton, weight percentage)

Recycled material

Recycled material

Recycled material

Total of recycled material

Other materials

( )

( )

( )

( )

( )

Date of issue of this certificate

Issuer of certificate

Address to send this certificate



Date:

(Company name)





Seal

Entry Table C-131

Brand name:

　　　

Eco Mark Product Category N0.131

Civil Engineering

Products





Seal

Entry Table A1-131





The plant shall specify the applicable �laws and agreements.

Ordinances or agreements shall be specified if any is effective in the local�community in which the plant is located.









Be sure to indicate name corresponding to Example 1 fabric item number










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131(Certificate)