6 February 2014
Appendix 1 to the Rules of Procedure
MODEL FOR A PETITIONER SUMMARY DATA SHEET (“P-SDS”)1
Specified for the evaluation of new substances in the
positive list of the KTW-guideline, coating guideline,
rubber guideline and lubricant guideline
SUBSTANCE (1)………………………..........................................................................................................
USE OF SUBSTANCE
(2)....................……………………….............................................................………..………
REF.N. (3)...............................................................................……………………..............................
CAS.N.......................................................................................................................……
SOCIETY (4) .......................................................................................................................………………
PERSON RESPONSIBLE FOR THE TECHNICAL DOSSIER....................................……………….
ADDRESS OF THE RESPONSIBLE PERSON....................................................……………………..
...........................................................................................
PHONE.....................................
FAX..............................
E-MAIL..................................……
Where the technical dossier does not contain all the requested data (see below) give reasons:
.............................................................................................................................................................................
...........................................................................................................................
(1)
Indicate first the most common chemical name of the substance or, in the case, of a substance included in the regulation10/2011 the name given in this regulation.
(2)
Specify whether it is monomer or additive.
(3)
REF.N. = Substance Reference Number. Indicate this number if it has been given to the substance
under examination.
(4)
Company on behalf of which the dossier is submitted.
1
Annex 6 of note for guidance for food contact materials: http://www.efsa.europa.eu/en/efsajournal/pub/21r.htm
Umweltbundesamt I Fachgebiet II 3.4 I Heinrich-Heine-Straße 12 I 08645 Bad Elster I www.umweltbundesamt.de1