Environment
Canada
Ozone-depleting Substances Regulations, 1998
Subsection 2.2(1)
Form 5.13
Environnement
Canada
Notice of Shipment in Transit
(One notice for each group of controlled substances)
The notice is for the year:
Section 1 – Information respecting the person submitting the notice
Name of person submitting this notice (e.g. corporation):
Telephone no.:
Address:
Fax no. (if applicable):
City:
Province:
Postal Code:
Name of the person authorized to act on behalf of
person submitting this notice in Canada:
Telephone no.
in Canada:
For Environment Canada Use
Address in Canada:
Fax no. in Canada (if applicable):
City:
Province:
Postal Code:
Section 2 - Information respecting the controlled substance
1) Group of controlled substances (check only one):
1
Tetrachloromethane
7
Hydrobromofluorocarbons
2
1,1,1-trichloroethane
8
Methyl Bromide
Hydrochlorofluorocarbons
3
,4
Chlorofluorocarbons
9
5
,6
Bromofluorocarbons
10
Bromochloromethane (Halon 1011)
2) Condition of the controlled substances (check only one):
Recovered
Reclaimed
Recycled
Used
New
3) For each controlled substance, list the information concerning quantity, commercial name, formulation and classification:
Trade Name / Name of
substance
Canada Customs
classification no.*
Total quantity of substance
(kilogram)
Controlled substance and
% in mixture
Total quantity of controlled
substance (kilogram)
__________________
_____________________
______________________
______________________
_________________________
__________________
_____________________
______________________
______________________
_________________________
*Classification number under the Harmonized Commodity Description and Coding System as set out in the Customs Tariff (10 digits)
ODS 5.13 (0803)
www.ec.gc.ca/ozone/index.htm
Page 1 of 3
Environment
Canada
Ozone-depleting Substances Regulations, 1998
Subsection 2.2(1)
Form 5.13
Environnement
Canada
Section 3 – Information respecting each carrier of the controlled substance (attach supplementary sheets if necessary)
Name of the first carrier:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Name of the second carrier:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Name of the third carrier:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Name of the fourth carrier:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Section 4 – Information respecting the Custom broker in Canada
Name of the Custom broker in Canada:
Telephone no.:
Fax no.: (if applicable):
Address in Canada
Section 5 – Information respecting the origin of the controlled substance
Name of sender:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Country of origin of the controlled substance:
Countries through which the controlled substance has transited:
Port of entry into Canada:
Estimated date of entry into Canada (yyyy/mm/dd):
ODS 5.13 (0803)
www.ec.gc.ca/ozone/index.htm
Page 2 of 3
Environment
Canada
Ozone-depleting Substances Regulations, 1998
Subsection 2.2(1)
Form 5.13
Environnement
Canada
Section 6 – Information respecting the destination of the controlled substance
Name of foreign recipient:
Telephone no.:
Fax no.: (if applicable):
Address (including country)
Country of destination:
Port of exit from Canada:
Estimated date of exit from Canada (yyyy/mm/dd):
Section 7 – Information respecting the storage in Canada (if known at the time the notice is submitted)
Name of the person responsible
for the storage in Canada
Telephone no.:
Fax no.: (if applicable):
Address in Canada
Location of storage in Canada
(if different from the address of the
person responsible for the storage)
Expected duration of storage in Canada:
Section 8 – Declaration and signature
I declare that this notice does not contain false or misleading information.
Date, place
ODS 5.13 (0803)
Signature of person submitting this notice or person authorized
to act on behalf of person submitting this notice
www.ec.gc.ca/ozone/index.htm
Page 3 of 3