Product Name: (please fill in product name)
Date:
Mr. Akio Owatari
General Manager
Imaging Products Environmental CS＆PL Management
Imaging Products Operation Division
Seiko Epson Corporation
(Signature)
Name of responsible person
Posision
Company name
Company address
Phone number
Fax number
Certificate of Regulation Conformation
As described below, we hereby guarantee the regulation state of
(please fill in product name) as the following.
In case of changes in this Certificate, we will promptly contact your company.
In case the information provided below is inaccurate, and a fine or other penalty is applied to
your company or your subsidiary companies as a result of such inaccuracy, your company is free
of any liability and we shall resolve the problem at our expense.
Contact person
Division name
E-mail address
Phone number
Fax number
1/5
Form-CC07-07-048-AE（Rev.A.4）
Product Name: (please fill in product name)
1. Regulatory Status
0) Product:
Single component ( solid content
%)
Mixture
1) New Chemical/Existing Chemical:
Name of the substance/CAS# if it is possible
Country
Regulation
Japan
LERMCS
Status
The substance(s) or all ingredient(s) are listed on the inventory
of Existing and New Chemicals (ENCS).
Notified
New chemical substance(s) in this product
USA
TSCA
The substance(s) or all ingredients are listed in TSCA Inventory
(or notified PMN & NOC).
New chemical substance(s) in this product
Notified the substance(s), but NOC has not been submitted.
Under a Polymer Exemption
Europe
Dangerous Substance Directive
92/32/EEC
7th
Amendment of 67/548/EEC
The substance(s) or all ingredients are listed in EINECS.
=>Please fill in attached format1(Questionnaire)
Notified, then need to nominate importer(s)
New chemical substance(s) in this product
Australia
Industrial Chemicals (Notification and
The substance(s) or all ingredients are listed in AICS.
Assessment) Act.
Notified already STD, Certificate #:
New chemical substance(s) in this product
Notified LVC by other importer(s)
Korea
Toxic Chemical Substance Control Law
The substance(s) or all ingredients are listed in Korean Existing
Chemicals.
New chemical substance(s) in this product
Philippine
Republic Act No. 6969
The substance(s) or all ingredients are listed in PICCS.
New chemical substances in this product
China
Provisions on the Environmental
The substance(s) or all ingredients are already listed in the
Administration of New Chemical
Inventory of the Existing Chemical Substances in China
substances
The substance(s) or all ingredients have imported in China
before October 14, 2003.
Not yet imported in China
Canada
CEPA
The substance(s) or all ingredients are listed in DSL.
New chemical substance(s) in this product
2/5
Form-CC07-07-048-AE（Rev.A.4）
Product Name: (please fill in product name)
2) Regulated Substances
Country
Regulation
Status
Japan
LERMCS
1)
Class1 Specified Chemical Substance or Class2 Specified
Chemical Substance
Contain(s) (chemical name)
2)
Export Control Order
Not Contain
Designated Chemical Substance
Contain(s) (chemical name)
Not Contain
Regulated (chemical name)
Not regulated
(List No.1 §1~15, List No.2)
PRTR Law
TypeI,II,III Monitoring Chemical Substance
Contain(s) or over 1% (chemical name)
Contain(s) less than 1% (chemical name)
Not contain
Industrial Safety and Health Law
1) Article 55 and 56 Substances
Contain(s) (chemical name content:
%)
Not Contain
2) Article 57-1 Substances that should label
Contain(s) restricted substance(s) over the limit
(chemical name content:
%)
Contain(s) restricted substance(s) less than limit
(chemical name content:
%)
Not Contain
3)
Article 57-2 Substances that should inform
Contain(s) restricted substance(s) over the limit
(chemical name content:
%)
Contain(s) restricted substance(s) less than limit
(chemical name content:
%)
Not Contain
Fire Service Law
Regulated (Class:
Water Pollution Control Law
Contain(s) (chemical name)
Enforcement Orders：substances on Aeticle2
Not contain
Regulation of Waste and Public
Contain(s) substance(s) required specific control
Cleansing Law
)
Not regulated
(chemical name)
Not contain
Offensive Odor Control Law
Contain(s) specific odor substances (chemical name)
Not contain
Poisons and Deleterious Substances
Control Law
Contain(s)
substances
classified
“poisons
and
deleterious
substances” (chemical name)
Not contain
Ordinance on Prevention of Hazards
Due
to
Specified
Chemical
Substances
Ordinance
Contain(s) Class 2 and 3 substances
(chemical name)
Not contain
on
the
Prevention
Organic Solvent Poisoning
of
Contain(s) Class1, 2, 3 substances (chemical name)
Not contain
3/5
Form-CC07-07-048-AE（Rev.A.4）
Product Name: (please fill in product name)
USA
TSCA—SNUR
Contain(s) regulated substances
(chemical name, section of TSCA)
EPA intends to regulate the substance(s)
(chemical name, information of proposal)
Not regulated
Proposition 65
Europe
Regulated (chemical name)
Not regulated
Dangerous Substance Directive
Contain(s) any substances which are to be marked with the R-phrases
67/548/EEC
according to Annex III.
Contain(s) =>Please show the substances in attached Format2
Not contain
Dangerous Preparation Directive
Contain(s) at least one sensitizing substance or over 0.1wt%
1999/45/EC
Not contain at least one sensitizing substance/ Contain less than 0.1wt%
Restrictions on the marketing and use
Contain(s) restricted substance(s)
of chemicals Directive 76/769/EEC
(chemical name, Content:
Not contain
%)
=>will replace to REACH Annex XVII
REACH: Substances meets criteria on
Contain(s) =>Please show the substances in attached Format2
Annex XIII
Not contain
Swiss
ChemG
Please fill in “5. Appendix”, if it requires different label in EU.
China
Regulations for Environmental
Banned or Severely Restricted Toxic Chemicals
Korea
Management (Chemical Law is not
Contain(s) (chemical name)
effective)*1
Not contain
Toxic Chemical Substance Control
Contain(s) Prohibited Chemical(s) (chemical name)
Law
Contain(s) Toxic Chemical(s) (chemical name)
Contain(s) Restricted Toxic Chemical(s) (chemical name)
Contain(s) Observational Chemical(s) (chemical name)
Not contain
*1： Substances that classified as “Exportation banned”： http://www.crc-sepa.org.cn/zhengqiu/jzckl.htm
Substances that classified as “Importation Banned”： http://www.crc-sepa.org.cn/zhengqiu/jzjkl.htm
Substances with restriction ： http://www.crc-sepa.org.cn/zhengqiu/xzjkl.htm
4/5
Form-CC07-07-048-AE（Rev.A.4）
Product Name: (please fill in product name)
2. Others (Specific Substances)
Substance
Status
Endocrine disrupters*2
Contain(s) (chemical name)
Carcinogenic Substance*3
Contain(s)
→
Not contain
Carbon Black
Others (chemical name)
Not contain
Azo dyes*4
Contains (chemical name)
Not contain
Nonylphenol, Octylphenol and their ethoxylates
Contains (chemical name)
Not contain
*2: Endocrine disrupters that was listed as” substances are suspected of having endocrine disruptive” , which announced by the
Environmental Agency in 1998 → http://www.env.go.jp/chemi/end/
*3: Carcinogenic substance which are classified as carcinogenic, suspected of having a carcinogenic potential according to the
following:
①IARC: Group1, 2A, 2B ②Japan Society for Occupational Health: Category 1, Category 2 ③ACGIH: A1, A2 ④EPA: Category A, B, C
⑤NTP: substances that is known to be human carcinogens, substances that is reasonably anticipated to be human carcinogens
⑥EU: Category1, 2, 3 ⑦MAK list: MAK 1, 2, 3A, 3B ⑧TRGS 905: substances classified as carcinogenic, mutagenic and reproduction
*4: Azo dyes that may release, by reductive cleavage of one or more azo groups, one or more of the aromatic amines listed in
Appendix on 19th Amendment Council Directive (2002/61/EC), 12 th adapting to technical progress of Commission Directive
(2003/3/EC) and the following Council Directive 76/769/EEC.
CAS RN: 92-67-1, 92-87-5, 95-69-2, 91-59-8, 97-56-3, 99-55-8, 106-47-8, 615-05-4, 101-77-9, 91-94-1, 119-90-4, 119-93-7, 838-88-0,
120-71-8, 101-14-4, 101-80-4, 139-65-1, 95-53-4, 95-80-７, 137-17-7, 90-04-0, 60-09-3, EC number 405-665-4 + substances that
are added on new Directive of 76/769/EEC.
3. Toxicology Information
Study
Acute oral toxicity
Methods
Others (
Acute dermal toxicity
LD50 [
mg/kg]
animals [
]
mg/kg]
animals [
]
No data
)
LD50 [
No data
OECD Test Guideline No. 403
Others (
Acute eye irritation
)
OECD Test Guideline No. 402
Others (
Acute inhalation toxicity
Results
OECD Test Guideline No. 423
)
LC50 [
mg/L/4hr]
animals [
]
] animals[
]
No data
OECD Test Guideline No. 405
Primary Irritation Index [
Others (
Classification of irritancy [
)
]
No data
Acute dermal irritation
OECD Test Guideline No. 404
Maximum Group Mean Score [
Others (
Classification of irritancy [
)
]
animals [
]
]
No data
Skin sensitization
OECD Test Guideline No. 429
Sensitizer rate [
OECD Test Guideline No. 406
Classification [Negative]
Others (
Ames test
)
Already submitted
Stimulation Index [
]
No data
OECD Test Guideline No. 471
Others (
4. MSDS
)
%]
[Negative]
No data
attached to this form
due to submit [Date:
]
5. Appendix
If you have any additional information, please fill this space or attach next page.
5/5
Form-CC07-07-048-AE（Rev.A.4）