APPLICATION FORM
CONTAINMENT
Application Form: Import or Manufacture a
Persistent Organic Pollutant
under section 31 of the HSNO Act 1996
Completing this form
Use this form to apply for a containment approval if you are importing or manufacturing a persistent organic
pollutant (POP) to be used as an analytical standard or for research in any laboratory.
If you need to use a POP for any other purpose, contact the Environmental Protection Authority (EPA) first.
The risks associated with the life cycle of POPs are well understood. We have approved a standard set of controls
for POPs that are being used for analytical standards or for research in a laboratory, to ensure that users of the
substances comply with the requirements of the Stockholm Convention on POPs. For more information on the
Convention, please refer to the HSNO Act.
 Substances that are POPs are listed in Schedule 2A of the Hazardous Substances and New Organisms
(HSNO) Act 1996.
 You can use this form to apply for more than one POP.
 Any extra information you supply that does not fit in the application form must be clearly labelled and crossreferenced in an appendix. Commercially sensitive information must also be attached as a separate appendix.
 The fee for this application may be found on our website: www.epa.govt.nz.
 If you need help to complete this form, our staff can you help you at any time. Please call +64 4 916 2426 or
email HSApplications@epa.govt.nz.
OFFICE USE ONLY
Application code
Date received
www.epa.govt.nz
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Application for Approval of a Persistent Organic Pollutant in Containment
1. Applicant details
Name of organisation:
Phone:
Email:
Postal address:
Street number and name:
in New Zealand
Suburb:
Town/city:
Post code:
Physical
address:
if different from
postal address
Contact person
This person should have sufficient knowledge to respond to queries; and either have the authority to make
decisions (that relate to processing the application) on behalf of the applicant, or have the ability to go to the
appropriate authority.
Name:
Phone:
Email:
Postal address:
Street number and name:
in New Zealand
Suburb:
Town/city:
Post code:
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Application for Approval of a Persistent Organic Pollutant in Containment
2. Type of application
Complete the list below by ticking all the boxes that apply.
I am applying to use small amounts of any POP as an analytical standard.
I am applying to research a POP, but only in a laboratory.
I want to import the substance(s) only.
I want to manufacture the substance(s) only.
I want to import and manufacture the substance(s).
The substances were imported or manufactured before the commencement of the Stockholm Convention
amendment to the HSNO Act.
Manufacturing
If you want to manufacture the substance, explain the proposed processes – as well as any alternatives. You
need to provide enough information to show whether there are likely to be any hazardous by-products of the
process.
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Application for Approval of a Persistent Organic Pollutant in Containment
3. Information on the substance(s)
All information that is considered commercially sensitive must be attached as an appendix and marked
‘Confidential’. The application form should be cross-referenced to the appendix, and should also be able to
be read as a stand-alone document (which will be publicly available).
The POP(s) is currently held in a laboratory.
I am applying to import/manufacture the POP(s) as a one-off.
I am applying to import/manufacture the POP(s) in an ongoing way. (Your laboratory will be required to notify
the EPA at the time of each new import/manufacture, with information on the quantities and nature of the
substance(s) concerned.)
Identification
Provide details of the amount of each POP your laboratory currently holds, and/or intends to import/manufacture in
the future.
Substance
CAS No.
Aldrin
309-00-2
Alpha
hexachlorocyclohexane
319-84-6
Beta
hexachlorocyclohexane
319-85-7
Chlordane
57-74-9
Chlordecone
143-50-0
DDT
50-29-3
Dieldrin
60-57-1
Endrin
72-20-8
Heptachlor
76-44-8
Hexabromobiphenyl
36355-01-8
Hexabromodiphenyl
ether and
heptabromodiphenyl
ether
Hexachlorobenzene
118-74-1
Lindane
58-89-9
Mirex
2385-85-5
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Held in laboratory
New import


Amount (mg)
Max amount per
year (mg)
New manufacture

Max amount
per year (mg)
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Application for Approval of a Persistent Organic Pollutant in Containment
Pentachlorobenzene
608-93-5
Perfluorooctane sulfonic
acid; its salts
1763-23-1
Perfluorooctane sulfonyl
fluoride
307-35-7
Technical endosulfan
and its related isomers
115-29-7
959-98-8
33213-65-9
Tetrabromodiphenyl
ether and
pentabromodiphenyl
ether
Toxaphene
8001-35-2
Polychlorinated
biphenyls
-
Lifecycle of the chemical
Provide information on what will happen to each substance throughout its whole life, from its introduction into New
Zealand, its uses, through to disposal. The level of information provided needs to reflect the containment character
of the application, but should nevertheless cover the whole lifecycle of the substance(s) – for example, from import/
manufacture, transport, storage and use, through to disposal. You should also indicate whether any measures may
be required in addition to the standard controls approved for these substance(s).
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Application for Approval of a Persistent Organic Pollutant in Containment
4. Information on the proposed containment system
We have approved a standard set of controls for the use of persistent organic pollutants as analytical
standards or for research in a laboratory (refer Appendix 1).
You must provide sufficient information on how you propose to meet the requirements of these controls.
Include information on how you intend to address each of the following issues, having regard to the controls
listed in Appendix 1:
 Methods for preventing the escape of the contained hazardous substance and preventing the
contamination of the facility
 Methods for excluding organisms from the facility or to control organisms within the facility
 Methods for excluding unauthorised people from the facility
 Methods for preventing unintended release of the substance by experimenters
 Methods for controlling the effects of any accidental release of the substance
 Inspection and monitoring requirements of the containment facility.
You also need to provide a management plan, attached as an appendix, which provides details of the
containment proposed.
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Application for Approval of a Persistent Organic Pollutant in Containment
5. Miscellaneous


Attach a glossary of scientific and technical terms used in your application.
Include any other information you consider relevant to your application, which is not already included.
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Application for Approval of a Persistent Organic Pollutant in Containment
6. Summary of information for the public register
The information provided in this section may be used in our public register of substances.
It will also be used to provide information for other government agencies (for example, the Ministry for the
Environment, the Ministry of Health, or the Ministry of Business, Innovation and Employment), who will be
notified of the application.
This information will be used to prepare the public notice of the application. For these reasons, applicants
should ensure that this summary information does not contain any commercially sensitive material.
Name of the substance:
Each substance on the Register must be identified by a unique name. Please provide a name for the
substance(s) covered by this application. A maximum of 80 characters may be used – for example, POP
standards laboratory X 2012
Purpose of the application:
This should include an abstract (in a maximum of 255 characters) giving information on the intended use of the
substance and why an application is needed, based on its hazardous properties.
Executive summary:
We have partially filled out this section for you.

Fill in the table below with the names of the specific persistent organic pollutants your laboratory wishes to
import/manufacture.

Add any additional information at the end.
This application is for approval to import, or manufacture in containment, small amounts of the following persistent
organic pollutants for use as analytical standards or for research in a laboratory:
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Application for Approval of a Persistent Organic Pollutant in Containment
Persistent organic pollutants are toxic and ecotoxic substances – for instance, they will trigger hazard
classifications in Classes 6 and 9 (see the Hazardous Substances (Classification) Regulations 2001). It is
considered that the principal risk arising from them is to the environment as a consequence of their persistence.
However, it is noted that any risks will be mitigated by the containment controls set by the EPA for these
substances when used for the prescribed purposes.
It is considered unlikely that any adverse environmental impact will occur from the use of the substance(s), given
the small quantities involved and given the controls that are in place to limit the likelihood of escape and control the
effects of any accidental release.
Safe handling procedures and health hazard information are provided in safety data sheets.
7. Applicant’s signature
I declare that to the best of my knowledge, the information contained in all sections of this application form, and
supplied in support of this application, is true and accurate.
Name:
Signature:
Date:
Applicant checklist
All parts of this form completed
Appendices attached
Fees enclosed
When you have completed this form, send by post to: The Environmental Protection Authority, Private Bag
63002, Wellington 6140
OR email to: HSApplications@epa.govt.nz
Please allow 30 working days for processing.
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Application for Approval of a Persistent Organic Pollutant in Containment
Appendix 1: Controls applying to the use of POPs as analytical
standards or for research in a laboratory
Interpretation
1. ‘Persistent organic pollutant’ (POP), ‘Laboratory’ and ‘Stockholm Convention’ have the meanings given in
section 2 of the Hazardous Substances and New Organisms Act (the Act).
2. ‘Passenger service vehicle’ has the same meaning as in the Transport Services Licensing Act 1989.
3. ‘Environmentally sound disposal’, in relation to a substance that is a persistent organic pollutant, means
disposal in accordance with directions given by the EPA in the New Zealand Gazette Issue no. 174, 22
December 2004, Hazardous Substances (Storage and Disposal of Persistent Organic Pollutants) Notice 2004.
‘Disposal in an environmentally sound manner’ has the same meaning as ‘environmentally sound disposal’.
General
4. This approval applies only to persistent organic pollutants approved in accordance with section 32 of the Act for
use as analytical standards or for research in a laboratory.
5. The use of persistent organic pollutants as analytical standards or for research in a laboratory shall comply with
the requirements of the management plan submitted by the applicant as part of the application under section 31
of the Act.
6. A laboratory that has approval to import or manufacture a POP for the approved purposes shall not sell, gift or
otherwise transfer the substance to another laboratory that does not have an approval under section 32 of the
Act for those substances; and, unless otherwise authorised by the EPA, shall not transfer the substance to any
other person unless such transfer is for the purpose of environmentally sound disposal.
7. This approval remains in place for five years.
8. There must be general compliance with the requirements of the Hazardous Substance (Exempt Laboratories)
Regulations, with specific regulations referred to below where relevant.
Limiting the likelihood of escape of, or contamination by, a persistent organic
pollutant
9. A POP shall be transported only to a laboratory that has approval to import or manufacture the substance. A
Safety Data Sheet shall accompany each shipment.
10. A POP shall be packaged for transportation in a container within a container (secondary containment) and that
secondary container shall be sufficient to contain any release if the primary container should leak. The
containers shall comply with the Hazardous Substances (Packaging) Regulations 2001 or Regulation 12 of the
Hazardous Substances (Exempt Laboratories) Regulations 2001, as relevant. Outer packages should be
labelled in accordance with the Hazardous Substances (Identification) Regulations 2001.
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Application for Approval of a Persistent Organic Pollutant in Containment
11. Transport of POPs by land within New Zealand shall comply with all relevant requirements of the Land
Transport Rule: Dangerous Goods 2005 (Rule 45001).
12. Transport of POPs by sea within New Zealand shall comply with all relevant requirements of either the Maritime
Rules: Part 24A – Carriage of Cargoes – Dangerous Goods (MR024A) or the International Maritime Dangerous
Goods Code.
13. Transport of POPs by air within New Zealand shall comply with all relevant requirements of Part 92 of the Civil
Aviation Rules.
14. Within the laboratory, all POPs shall be stored, handled and labelled in accordance with Regulation 10 of the
Hazardous Substances (Exempt Laboratories) Regulations 2001.
15. A person must not carry any quantity of a POP on a passenger service vehicle.
To exclude organisms from the facility
16. The laboratory manager shall at all times ensure that the laboratory is adequately secured so as to exclude
unwanted organisms, and shall monitor for their presence as appropriate.
To exclude unauthorised people from the facility
17. The laboratory manager shall at all times exclude unauthorised persons from the laboratory in accordance with
Regulation 8 of the Hazardous Substances (Exempt Laboratories) Regulations 2001.
To prevent unintended release of a persistent organic pollutant from the facility
18. The design of the laboratory must comply with Regulations 5 to 8 of the Hazardous Substances (Exempt
Laboratories) Regulations 2001.
19. Procedures must be in place to ensure that no person at the facility is exposed to a level of POP that may cause
harm to that person.
20. At all times a POP shall be prevented from entering any surface water or groundwater system.
To control the effects of any accidental release of a persistent organic pollutant
Breach of containment
21. All laboratories must have an emergency response plan, irrespective of the quantities of hazardous substance
present. The plan must meet the requirements of Part 4 of the Hazardous Substances (Emergency
Management) Regulations 2001. The laboratory manager must ensure that all other relevant requirements of
the Emergency Management Regulations are complied with at all times.
22. If for any reason a breach of containment occurs, the laboratory manager shall notify the Ministry of Business,
Innovation and Employment and the EPA within 24 hours of the breach being detected. It is suggested that if a
breach in containment results in contamination of a waterway, the relevant iwi authorities be advised.
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Application for Approval of a Persistent Organic Pollutant in Containment
Disposal
23. The laboratory manager must inform the EPA as soon as there is no longer a requirement to hold any POP for
the approved purposes. The approval holder may at this time—
a. request approval to transfer the substance to another laboratory within New Zealand that, at the time, also
holds approval for the same purposes. The request shall identify the laboratory and the relevant HSNO
approval number, the substance or substances to be transferred, and their amounts; or
b. request approval to transfer the POP to an overseas laboratory in accordance with any relevant
requirements of relevant international conventions to which New Zealand is a party; or
c. arrange for environmentally sound disposal.
Environmentally sound disposal
24. Upon cessation of the requirement to hold any POP for the approved purposes, or upon cessation of this
containment approval, if not transferring the substance in accordance with paragraph 23(a) or 23(b), the
substance must be disposed of in accordance with directions for environmentally sound disposal given by the
EPA by notice in the New Zealand Gazette Issue no 174, 22 December 2004, Hazardous Substances (Storage
and Disposal of Persistent Organic Pollutants) Notice 2004.
25. Environmentally sound disposal also applies to anything that contains a POP following—
a. treatment of any equipment used to contain a POP; or
b. treatment of any spillage of a POP.
Recording, inspection and monitoring requirements
26. A record shall be kept of the quantities of POPs held in the laboratory. The record must be kept for at least 12
months after the substance has been used up or removed from the laboratory.
27. Each time a POP is imported/manufactured, the laboratory shall notify the EPA in writing of the quantities and
nature of the substance(s) concerned.
28. The EPA, or its authorised agent or properly authorised enforcement officers, may inspect the laboratory at any
reasonable time.
Qualifications required of the person responsible for implementing the controls
29. The laboratory must be managed by a laboratory manager with relevant qualifications, skills and knowledge, in
accordance with Regulations 13 and 14 of the Hazardous Substances (Exempt Laboratories) Regulations 2001.
30. All personnel handling any POP must be provided with all relevant information about the POPs they are
handling, as prescribed by Regulation 15 of the Hazardous Substances (Exempt Laboratories) Regulations
2001.
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