Eco Mark Product
Category No.111
Version2
Date:
(Company name)
Company seal
Brand name:
<Preparing Attached Certificates>
1. Indicate details of the product under application for certification 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 certification 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. This cover must be filled in.
Item
Fill in this Column
Planned Display of Eco Mark
(Select where appropriate If you choose <Yes>,
please submit design drawing given below.)
Article 3 of Usage Regulations
Display of intended location of Eco
Mark, display of environmental
information below mark
Article 7 of Usage Regulations
Display of Eco Mark user name
and
address,
display
of
certification number
Item
Issued by
< > Yes
< > Product < > Packaging
< > Catalogue/leaflet < > User manual
< > Other (
)
< > No (If an Eco Mark is displayed, design
drawing must be submitted)
Applicant
Design drawing to be provided (Format free,
text)
Fill in this Column
Documents to be
Submitted
Issued by
If developed by other
< > Own company companies, attach
Applicant
Application Consent
(Select where appropriate)
Form (Example 1).
A copy of notice of
Eco Mark
examination results
< >Unapplicable
Product
category
If a product with Eco < >Applicable
match
table
Are there any changes in addition to
Mark certification
between the
brand
name?
< > Yes < > No
under the category is
existing products
(Select where appropriate)
submitted for
and one under
approval as another (If only the brand name has been changed,
application
brand
the following items do not have to be Documents
proved.)
certifying changes,
if any, meet
applicable criteria
Manufacturer
product
of
< > Other companies
111 (Certificates) -
1
Item
6.(1) Category of
applied product
Documents to be
Submitted
Fill in this Column
Issued by
JISA 5908
< > Parting board
JISA 5905
< >Insulation board (IB)
< >Medium Density Fiber Board (MDF)
< >Hard board (HB)
< >Base < >Single wood sheet
< >Decorative
(Select where appropriate)
Entry Table A
Entry Table B: A list
of the raw material
vendors
Applicant
(If vendors are over
10)
4-1.(1)(2)(3)(9)
Ratio of material
to the entire product,
name of materials,
prescription
constituents
4-1.(3) adhesives/
additives
4-1.(4) Wood
preservatives
Applicant
List of certification of
Raw material
the top 10 vendors
supplier
(Example 2)
Use of halogens
< >Yes/< >No
(Select where appropriate)
Use
of
wood
termicides,
wood
preservatives, wood pesticides, and wood
fungicides
< >Yes/< >No
(Select where appropriate)
Test
result
of
hexavalent
Wood from dismantled buildings are
chromium
and Third
party
< >Used / < >Not Used
4-1.(5)Wood
from
arsenic based on the testing body or
dismantled buildings
detailed enforcement public
If “Used,” documents provided in the right
regulations of the organization
column should be submitted.
Soil
Pollution
Control Law
Results
of
tests
according to the JISA
1460,
1901
and
similar methods, or
4-1.(6) Formaldehyde
a certificate or copy Applicant
emissions
indicating emissions or third party
from the product is
graded as F**** or
out of Ministerial
regulations
Addition of toluene and xylene
4-1.(7) Toluene and
< >Yes / < >No
xylene
(Select where appropriate)
111 (Certificates) -
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Item
Documents to be
Submitted
Fill in this Column
Issued by
Use of coating
< >Yes / < >No
If “Yes,” documents provided in the right
column should be submitted. The following A list of the Usage
4-1.(8)Chemical
information should be entered if coating amount of concerned
Paint
substances of coating with Eco Mark certification (Version 1.0) is substances
manufacturer
used.
(Example 3)
Certification brand name (
)
Certification number
(
)
(Select where appropriate)
4-1.(9)Decorative
work
Use of halogens
< >Yes / < >No
(Select where appropriate)
4-1.(10)
Environmental laws
and regulations
4-1.(11)Energy
saving
Certificate
Example 4
Manager
of
final product
manufacturing
plant
Fill in process outline and energy use
during the manufacturing process (from the
receipt of material).
* A separate form can be used for the
process outline.
Energy use
Process name
(in any unit)
Packaging material:
4-1.(12) Packaging
Packaging method:
material
4-1.(12) Use of
halogens in
packaging material
(plastic
material
only)
< >Used /< >Not Used
(Select where appropriate)
Manual mentioning
criteria4-1.(13) 1)/2) Applicant
4-1.(13) Information
Test result
conforming
JISA5905 or
JISA5908
4-2.(1) Product
quality
111 (Certificates) -
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Third party
testing body or
Applicant
Example 1-111
Date
Director
Eco Mark Office
Japan Environment Association
Date of issue of this certificate
XXXXX XXXXX
Company name
Seal
Address to send
this certificate
Issuer of
certificate
*Issuer: Applicant
Approval of Eco Mark Use Application
This is to consent to the application for Eco Mark certification and use of
XXX (your company name) (Eco Mark certified) brand name XXXX
(certification no. XX) by XXX (applicant) as brand name XXXX.
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Entry Table A-111
Product Weight Certificate
Date
(Company name)
Product type (
)
Seal
Submit the form for each product type. If the weight percentage of materials is identical among several
product types, notes should be added.
<Wooden part>
The percentage of reused/unused wood as materials for wooden parts shall be 100%.
< > Conformed / < > Not conformed
Material distribution of wooden part
Parts
Raw material
(Thinned wood, waste
wood, etc.)
Name of raw material
supplier
Weight percentage
Wooden part
Total weight percentage of wooden part in the entire product:
(%)
<Decorative work, Adhesive, and Additives>
Parts
Decorative work
Adhesive
Name of prescription constituents
Weight percentage
e.g. PE
e.g. Melamine resin
Function:
Additive
e.g.Formaldehyde catcher
Total weight percentage of decorative work, adhesive, and additives in the
entire product:
(%)
Check an applicable item and describe.
Method for Controlling Weight < >The mixture rate is controlled by written prescription/mixture daily report, etc.
Name of Record Document: (
) e.g. Written prescription
Percentage
of
Above
Form Controller: (
)
e.g Molding Manager
Reused/Unused
Wood
and
< > Controlling by other method
Other Materials
(
)
* If 10 or more material suppliers are involved, a list of suppliers (Entry Table B) should be submitted.
* The combination of the total of weight percentage for wooden part and the total for decorative work,
adhesive, additives, etc. should be 100.
111 (Certificates) -
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Entry Table B-111
To: Japan Environment Association, Eco Mark Office
Raw Material Certificate List
Date of issue:
(issued by: Company name)
(company seal）
*Issuer: Applicant
The following list includes reused/unused wood and waste plant fibers.
No.
e.g.
Reused/unused wooden material
Thinned wood
111 (Certificates) -
Name of raw material supplier
XX Forest Association, XX Prefecture
6
Example 2 (Thinned wood) -111
To: Japan Environment Association, Eco Mark Office
Raw Material Certificate
【発行担当者】
Address
Date of issue:
(issued by: Company name)
Dept.
Title:
Name:
company seal
TEL：
E-mail;:
*Issuer: Raw material supplier
FAX:
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
e.g.: 20%
of thinned
300 trees/1500 trees (per 1 ha)
trees
e.g.: First thinning in 1980
Which time
Percentage of thinned trees: 30%
of thinning?
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 thinned trees per hectare)/
(Number of tress planted trees per hectare) x 100
Place of production: Place where woods were harvested.
111 (Certificates) -
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Example 2 (Construction waste wood / Waste wood) -111
To: Japan Environment Association, Eco Mark Office
Raw Material Certificate
【発行担当者】
Address
Date of issue:
(issued by: Company name)
Dept.
Title:
Name:
company seal
TEL：
E-mail;:
*Issuer: Raw material supplier
FAX:
This is to certify that the following waste wood / construction waste wood are supplied to (Eco
Mark product manufacturer) as reused/unused wood or plant fibers.
Details of waste wood material
< > Used wood
Recycled material: (
e.g. packaging material
Waste
Wood
Content
)
%
< > 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 (
%
%
)
< > Wood from dismantled buildings(Wood and wooden materials disposed as
waste in construction work as dismantling of buildings)
* The following 2 certificates shall be attached.
- Explanatory documents to demonstrate that materials subject to preservatives,
termicides, and pesticides are differentiated and eliminated during recycling. (e.g.
differentiation and elimination manual, work flow)
Const- intermediate processor license (or a certificate showing a registration number)
ruction < > Wood and wooden materials produced by construction of new buildings and
waste
building extensions
wood
< > 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.)]
* Check appropriate items and fill in blanks.
* For construction waste wood, an issuer of this certificate shall be an intermediate processor.
111 (Certificates) -
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Example 2 (Less useful wood-1/3) -111
To: Japan Environment Association, Eco Mark Office
Raw Material Certificate
【発行担当者】
Address
Date of issue:
(issued by: Company name)
Dept.
Title:
Name:
company seal
TEL：
E-mail;:
*Issuer: Raw material supplier
FAX:
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. If bamboos
collected after felling in bamboo groves for the purpose of maintenance and
preservation are used, photographs or map of the surroundings of bamboo groves
should be submitted.
Raw material types of less useful wood
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
111 (Certificates) -
9
%
%
100%
Example 2 (Less useful wood-2/3) -111
[Details] (Other than bamboo)
Type of forest
Sustainably
managed forests*1)
Place of production
< > Natural regenerated forests
< > Plantation forests
Acquisition of third party certificate (a copy of certificate
should be applied)
< >Yes (name
) < >No
Attachment 1
< > Conformed < > Not conformed
Example: city, prefecture, country
Type of tree
Amount
Year of planting*2)
Tip end diameter*3)
cm
*1) Fill in the blank if small diameter logs in accordance with conditions “a” or “b” in “3.
Terminology” are used as raw materials. Environmental policy on the forest should be
submitted (one to several pages in A4 size).
*2) Fill in the blank if the forest is a plantation.
*3) Fill in the blank if small diameter logs are used as raw materials.
Place of production: Place where woods were harvested.
Generation process, tree type, and other details should be given. (Separate
forms are allowable.)
Details of logging or cutting should be given. (e.g. clear cutting, patch logging,
and strip logging etc.)
* Check appropriate items and fill in blanks.
111 (Certificates) -
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Example 2 (Less useful wood-3/3) –111
[Details] (Bamboo)
Bamboo type
(Place of production/Example)
- City, Prefecture, Country
Place of production
and Surrounding
conditions
Explanation that
felling is performed
for the purpose of
maintenance and
preservation
(Surrounding conditions)
- Forest or agricultural lands. Bamboo groves invade those
lands and suppress appropriate growing. (Describe
specifically)
To solve the problem stated above, explain what actions are
taken.
State annual number of times felling is performed, as well as
the owner and manager of bamboo forest.
Management plan
Amounts
Place of production: Place where bamboos were harvested.
111 (Certificates) -
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Example 2 (Waste plant fiber) -111
To: Japan Environment Association, Eco Mark Office
Raw Material Certificate
【発行担当者】
Address
Date of issue:
(issued by: Company name)
Dept.
company seal
*Issuer: Raw material supplier
Title:
Name:
TEL：
E-mail;:
FAX:
This is to certify that the following waste plant fiber materials are
supplied to (Eco Mark product manufacturer) as reused/unused wood.
Details of waste plant fiber
< > Agricultural residues generated during harvest
and processing of agricultural products
Waste
plant < > Used packaging material
fiber
< > Other (
Content
%
%
)
%
Total
100%
Generation process, type of plant fiber, and other details should be given. (Separate
forms are allowable.)
* Check appropriate items and fill in blanks.
111 (Certificates) -
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Example 3-111
Date
Director
Eco Mark Office
Japan Environment Association
Date of issue of this certificate
XXXXX XXXXX
Company name
Seal
Issuer of
certificate
*Issuer: Paint manufacturer
Certificate of Chemical Substance
This is to certify that paints supplied for (product under application for
Eco Mark certification) meet Criterion 4-1.(8) in terms of chemicals listed
below. Details are given in the following table.
Substance
Amount used
Total content of Cadmium, mercury,
%
hexavalent chromium, lead
%
Lead
Arsenic
< > Not Used/< >Used
Antimony
< > Not Used/< >Used
TBT
< > Not Used/< >Used
TPT
< > Not Used/< >Used
End of the document
* Check appropriate items and fill in blanks.
111 (Certificates) -
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Example 4-111
To: Japan Environment Association, Eco Mark Office
Environmental Laws and Agreements Compliance Certificate
Date of issue:
,
(Company name)
(Plant name)
(Name of the responsible person) title
Name
Plant address:
TEL
:
seal
(company seal)
* Enter the manager (or the corresponding responsible person) of the plant manufacturing
the finished goods in the Name of the responsible person column.
* Effective issuing date of this Certificate shall be within three months from the date of
application to Eco Mark.
We hereby certify that the following requirements are met:
1. We hereby certify that in manufacturing the applied product, we comply with related environmental
laws and regulations and pollution control agreement (hereinafter referred to as the “Environmental
Laws, etc.”) with respect to air pollution, water contamination, noise, offensive odor, and emission of
hazardous substances.
(Please check the relevant boxes as follows to submit the Certificate. It is also acceptable to submit
an attached list.)
Name of the Environmental Laws, etc. related to the plant
Remarks
 Air Pollution Control Law
 Water Pollution Control Law
 Noise Regulation Law
 Vibration Regulation Law
 Offensive Odor Control Law
 Other:
* In the “Other” column, enter the name of law applied to the plant, and if there are regulations or agreements of the area
where the plant is located, also enter the names of such regulations and agreements (e.g., xx Prefecture xx
Environmental Conservation Regulation, xx City Pollution Prevention Agreement).
2. We hereby certify that the state of compliance with the Environmental Laws, etc. prior to the date of
issue of this Certificate is as follows:
(Please check the relevant boxes to submit the Certificate. Violation refers to administrative
punishment or administrative guidance.)
 We have not violated any related Environmental Laws, etc. for the past five years.
 We have not violated any related Environmental Laws, etc. since foundation of the Company
(year).
 We violated related Environmental Laws, etc. in the past five years, have already taken proper
remedies and recurrence prevention measures, and thereafter comply with the related
Environmental Laws, etc. properly.
*If you committed any violation subject to administrative punishment or administrative guidance, you need
to submit the following documents in a and b:
a. For the fact of violation, the guidance document from the administrative agency (including a correction order
and warning) and copies of written answers to those documents (including reports on the cause and result of
correction)
b. For the management system for compliance with the Environmental Laws, etc., the following materials
(copies of recording documents, etc) in 1)-5):
1) List of the Environmental Laws, etc. related to the area where the plant is located;
2) Implementation system (organizational chart with entry of roles, etc.);
3) Document stipulating retention of recording documents;
4) Recurrence prevention measures (future preventive measures);
5) State of implementation based on recurrence prevention measures (result of checking of the state of
compliance, including the result of onsite inspection).
 We violated Environmental Laws, etc. in the past, and have not yet taken corrective measures.
111 (Certificates) -
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Example manual for Eco Mark Product Category No.111—Example 5—
(Product name)
Example of manual on use
(1) Material
Thinned wood is used for raw materials.
(2) Decorative work
Prescription constituents for decorative work are (
). Resin containing
halogens and organic halogenide are not added.
(3) Adhesive
Prescription constituents for adhesive are (
). Halogens are not used.
(4) Additives
Prescription constituents for additives are (
). Halogens are not used.
(5) Wood preserving agents
Wood termicides, wood preservatives, wood pesticides, and wood fungicides are not
used.
(6) Construction waste wood
<<Choice>> Wood from dismantled buildings are not used.
<<Choice>> Wood from dismantled buildings is used only after differentiating and
eliminating materials subject to preservatives, termicides, and pesticides.
Construction waste wood meet the requirements for hexavalent chromium
and arsenic provided by the detailed enforcement regulations of the Soil
Pollution Control Law.
(7) Formaldehyde emissions
F****grade of the JIS standard.
Or falling outside the scope of regulations by the Building Standards Act.
(8) Toluene and xylene
Not added.
(9) Coating
<<Choice>> Not used
<<Choice>> Meets the requirements for heavy metals and heavy metal compound in
Eco Mark certification criteria.
(10) Precaution
Users of the product should be warned that adequate draft and ventilation be
established during use, particularly used in the room with high temperature and
humidity.
(11) Disposal/Recycling
Recycling should be carried out based on the information provided by (1)-(9) above.
If disposal is the only option, ask an industrial waste management contractor to
perform the disposal.
For more details, please call:
Contact: Department of XX, XXX Corporation
111 (Certificates) -
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TEL: XX-XXXX-XXXX