TO :
Customer
Purchasing / Being Supplied With
A Restricted Component (Explosives Precursor)…
Sodium Nitrate, CAS# 7631-99-4, Regulatory Tracking # : 60714
Potassium Nitrate, CAS# 7757-79-1, Regulatory Tracking # : 30028
Nitric Acid >= 68%, CAS# 7697-37-2, Regulatory Tracking # : 60521
Hydrogen Peroxide >=30%, CAS# 7722-84-1, Regulatory Tracking # : 60401
FROM :
CUSTOMER SERVICE
Brenntag Canada Inc.
SUBJECT :
Restricted Components (Explosives Precursors) & End-Use Declaration Under
Brenntag Canada National SOP-0108 Management of Certain Controlled Products.
Brenntag Canada Inc., at various locations across Canada, engages for commerce certain products that are, or contain,
substances that may be useful as explosives precursors. Such chemicals in Canada are regulated under the Restricted
Components Regulations, SOR 2008-47, under the Explosives Act.
The purpose of the regulation is to ensure added vigilance and scrutiny over the sale of certain chemicals to ensure they are
not diverted to illegal end-uses.
Under the regulation, it is a duty upon Brenntag Canada to obtain from each customer, at the time of each sale, sufficient
information to validate that the sale will be in conformance with the regulation. To demonstrate this objective, we require
each customer to review and sign the end-use declaration presented on the next page.
Note to Brenntag Customer Service : Before issuing this End-Use Declaration to the customer, please ensure you fill out
Line 2 – Brenntag Canada facility information;
Line 3 – Customer’s Ship-To SAP code;
Line 4 – Product’s SAP Code; and
Line 8 – CSR Information to facilitate customer send-back of the filled out EUD.
The End-Use Declaration must be filled out for each location where the product is being delivered by Brenntag Canada inc.
Presently, such signed End-Use Declarations for restricted components are valid for one year, within the calendar year that it
is issued.
For end-uses other than explosives or reselling, the purchaser must provide both
(1) a copy of the firm’s business licence and
(2) a clear copy of a photo ID issued by the federal or provincial or municipal government or by the employer
of the person signing the End-Use Declaration.
To demonstrate compliance with the requirements of the Restricted Components Regulations, Brenntag Canada Inc.
requires each customer, for each of the customer’s locations where the product is delivered, to (1) prepare and sign an enduse certification, describing the end-use of the product ; and (2) to acknowledge receipt and understanding of the End-Use
Declaration. The end-use declaration must be under your firm’s letterhead and signed by an authorized person.
Upon receipt of the signed end-use declaration (preferably under your firm’s letterhead) Brenntag Canada Inc. will be
enabled to supply the product to you.
[The End-Use Declaration below is a table within MS-Word. It can be cut / copy / pasted onto a new document page with or
without your firm’s letterhead. If your electronic document bears your firm’s letterhead, simply fill out the table and print the
document, sign and date it and fax it to the number shown. If the electronic document does not bear your firm’s letterhead,
print the document on paper that shows the letterhead, sign it and fax it to the number shown. Where possible, it is
appreciated to receive the document, on letterhead, signed and dated, as an attachment to e-mail, sent to the e-mail
address shown below. Otherwise, print this document and fill out the table, sign and date it, and fax it to the number shown.]
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Brenntag Canada Inc. 43 Jutland Road Toronto Ontario M8Z 2G6
Canada
NTL-FCD-0007
Phone: (416) 259-8231 Facsimile: (416) 252-9497 / (416) 259-5333
Rev. 1, 20090219
Page 1 of 2.
End-Use Declaration – Restricted Components (Explosives Precursors)
Prepare under your letterhead.
Must be signed by a person with authority – a Manager or Director, of Operations or Regulatory.
1
End-Use Declaration – Signed and dated In accordance with requirements of Brenntag Canada National SOP-0108. Prepared to meet the requirements of S. 19 and 20 of the
Restricted Components Regulations.
The chemical product(s) being purchased is/are scheduled as restricted components (explosives precursors) per the Restricted Components
Regulations, and could be diverted to illegal end-uses. In accordance with the Restricted Components Regulations of Canada, Brenntag
Canada requires a signed and dated end-use declaration prior to selling or providing any restricted component to any person.
2
Brenntag Canada Inc., at…
Furnishing Brenntag Canada Facility :
(Brenntag Canada CSR To Fill Out)
Location
Address
City / Prov / Postal Code
Enrollment #
3
XP-0700-6-B016-19/02/2009
End-User
Name (Print) :
Company :
SAP Customer Code :
(Brenntag Canada CSR To Fill Out)
Address :
City / Prov / Postal Code :
4
5
Restricted Component Product or
Substance :
Description of End Use /
Description des utilizations finales :
For end-uses other than explosives or
reselling, the purchaser must provide
both
(1) a copy of a business licence and
(2) photo ID issued by the federal or
provincial or municipal
government or by the employer.
6
Product (Check Applicable)
SAP Product Code :
(Brenntag Canada CSR To Fill Out)
Hydrogen Peroxide
Nitric Acid
Potassium Nitrate
Sodium Nitrate
Explosives End-Use (Check)
If the end use for the restricted component is in explosives, purchase must provide licence, permit, certificate issued under the
Explosives Act.
Reseller (Check)
If the restricted product is intended for resale, the purchaser must provide proof of enrolment on the list of sellers.
Other End-Use (Describe) :
Certification
I certify that I am the end user of the chemical product(s) referred to above for the purposes stated in this document. I will not export, resell or
provide any amount thereof outside of Canada, or to any other entity within Canada.
Name (Print) :
Signature :
Position :
Phone :
Fax :
E-Mail :
**7**
Date :
YYYYY / MM / DD
8
To be filled out by Brenntag Canada CSR before issuing to the purchaser.
Once filled out by purchaser, please return to Customer Service at the Brenntag Canada Sales Office.
It is preferred to receive the declaration as an electronic attachment to an e-mail, otherwise a faxed copy will be acceptable.
Fax :
Attention :
E-Mail :
Intended to meet the requirements of Sections 19 and 20 of the Restricted Components Regulations, SOR / 2008-47
CONFIDENTIALITY
Any information exchanged with Brenntag Canada Inc. under the auspices or coverage of the Restricted Components Regulations will be used for no other purpose than to ensure and
demonstrate compliance with the Restricted Components Regulations.
NTL-FCD-0007
Rev. 1, 20090219