Application Form and Information Submission Application for an Enco Certification Mark for a Textile Floor-covering Cleaning & Maintenance Formulation according the EGTS 1503 Standard, Issue 1-2014 (Dry Compound type Products only.) CONTACT DETAILS Applicant’s full name…………………………………………………………………. Company represented…………………………………………………………………. Applicants position…………………………………………………………………… Applicant’s correspondence address………………………………………………….. Applicant’s telephone no……………………………………………………………… Applicant’s email address…………………………………………………………….. Company Website……………………………………………………………………. Company Registration No…………………………………………………………… Company VAT No…………………………………………………………………… © EGTS:1503 Issue 1:Revision 2:December 2014 1 PRODUCT Product name…………………………………………………………………………. Product purpose……………………………………………………………………….. Product Dilution Applied for…………………………………………………………. Product manufacturing site……………………………………………………………. ………………………………………………………………………………………… ………………………………………………………………………………………… As the Responsible Person for the submission of this application I confirm that all information supplied is correct Signature of Responsible Person…………………………………………………….. Date…………………………………………………………………………………… © EGTS:1503 Issue 1:Revision 2:December 2014 2 PRODUCT FORMULATION (Ref: Section 5.4.1 of the Standard) Water Content………………………………………. (% Wt/Wt) Ingredient & Chemical Name Function in product CAS Number (if applicable) Continue on a separate sheet if necessary © EGTS:1503 Issue 1:Revision 2:December 2014 3 DID Number (if applicable) Concentration in product (% & W/W) Safety Data Sheet Attached? % Activity of Ingredient TOXICITY REQUIREMENT – CDV METHOD (Ref: Section 5.5.1 of the Standard & DID List Parts A & B) Ingredient Chemical name Critical Dilution Volume Degradation Factor Chronic Toxicity Factor TOTAL CDV % Solid Content of product Adjusted TOTAL CDV Where a CDV, DF or TF value has been estimated indicate with a capital “E” (via method in DID List Part B) CDV = (% concentration in product x Degradation Factor / Chronic Toxicity Factor) x 1000 i.e. for ingredient Sodium Lauryl Sulphate DID part A list number is 2005 Degradation Factor = 0.05 Chronic Toxicity Factor = 0.0028 % concentration in the product (or, g/100g of product) = 0.5 © EGTS:1503 Issue 1:Revision 2:December 2014 4 CDV = (0.5 x 0.05 / 0.0028) x 1000 = 8928.6 The total of all CDVs must be =/< 180,000 (after accounting for % solid content) Total CDV for …………………………….. = © EGTS:1503 Issue 1:Revision 2:December 2014 5 BIODEGRADABILITY (Ref: Section 5.6.1 of the Standard) Surfactant Chemical Name © EGTS:1503 Issue 1:Revision 2:December 2014 Aerobically Biodegradable? Yes/No Determined By: DID Published Data (state publication below) Detergent Regulation test 6 For Anaerobic Biodegradation is the Non-biodegradable portion at 0.4g or less per litre of product as supplied? EXCLUDED SUBSTANCES (Ref: Sections 5.7.1 to 5.7.6 of the Standard) Criteria Does the undiluted product have an Oral Lethal Dose <5,000mg/kg? Does the undiluted product have an Inhalation Lethal Concentration <20mg/litre at 1 hour? The 100% dry product shall not contain substances present at >0.1% with the following EU Risk phrases: R23, R24, R25, R26, R27, R28, R39, R48, R65, and R68 (H330, H311, H301, H300, H310, H370, H372, H304, H371) The 100% dry product shall not contain substances present at >0.1% with the following EU Risk phrases R34 or R35 (H314). The 100% dry product shall not contain substances present at >0.1% with the following EU Risk phrases: R40, R45, R46, R49, R60, R61, R62, R63, R64, and R68 (H351, H350, H340, H350i, H360FD, H351f, H361d, H362). The 100% dry product shall not contain substances present at >0.1% with the following EU Risk phrases: R42 and R43 (H334, H317) The 100% dry product shall not contain substances present at >0.1% with the following EU Risk phrases: R50, R51, R52, R53, and R59 (H400, H411, H412, H413, EUH059) The undiluted product shall not contain the following substances: Alkyl phenol ethoxylates Formaldehyde Nitromusks or polycyclic musks of any sort Sodium hydroxyl methyl glycinate Diazolidinylurea 5-bromo-5-nitro-1,3-dioxane 2-Bromo-2-nitropropane-1,3-diol Heavy metals including lead hexavalent chromium or selenium © EGTS:1503 Issue 1:Revision 2:December 2014 7 Reason Toxicity Toxicity Toxicity Toxic by eye contact Carcinogen, mutagen, reproductive toxin Sensitisers Environmentally hazardous Yes No SUBSTITUTION (Ref: Section 5.7.7 of the Standard) EDTA and/or its salts have been substituted by? EDTA and/or its salts have not been able to be substituted? EDTA and /or its salts were not used in this product at all? REACH (Ref: Sections 5.7.8 of the Standard) Substances of Very High Concern under REACH regulations (to current date) are present? Yes / No BIOCIDES (Ref: Section 5.8.1 of the Standard) Name of Biocide For preservation of product only – Yes/No? Classified under R50-R53 (toxic to aquatic life) Yes/No? 2-octyl-2H-isothiazol-3-on 5-Chlor-2-Methyl-4isothiazolin-3-on / 2Methyl-2H-isothiazol-3-on © EGTS:1503 Issue 1:Revision 2:December 2014 8 If Yes to previous question – is Log Pw of biocide less than 3.0? Or, is BCF for biocide less than 100? FRAGRANCES (Ref: Section 5.9 of the Standard) Fragrance Name Fragrance name © EGTS:1503 Issue 1:Revision 2:December 2014 Percentage content in the product as supplied Manufactured according to COP of International Fragrance Association – Yes/No? Contains Nitromusks/Polycyclic musks – Yes/No? 9 Substance in the fragrance with risk phrases R43 and/or R42 (H334, H317)? If so: Name Percent content DAMAGE TO THE ATMOSPHERE (Ref: Section 5.10 of the Standard) Criteria The 100% dry product contains 1% or less of substances that could cause smog, tropospheric ozone or poor indoor air quality? The 100% dry product contains substances that cause ozone depletion? Yes No Yes No PHOSPHORUS (Ref: Section 5.11 of the Standard) Criteria The product as used contains 0.5g (Wt/Wt) or less of total phosphorus? © EGTS:1503 Issue 1:Revision 2:December 2014 10 PACKAGING (Ref: Sections 6.1 – 6.7 of the Standard) Criteria Yes No Not Applicable Yes No Not Applicable For plastic packaging – is either recyclable, refillable, mass reduced, or, contains at least 25% recycled/postconsumer materials For plastic packaging – clearly marked to show type of packaging for recycling (DIN6120 Parts 1 & 2, and DIN7728 Part 1) Is the package Child Resistant to European Standard EN 862 (2006) or has the packaging passed the alternative requirements detailed in section 6.3 of EGTS:1503? Heavy metals (including lead, mercury, cadmium and hexavalent chromium) are present at levels less than 100ppm? Phthalates and chlorinated substances (PVC and phthalate softened PVC) have been deliberately used in the packaging materials? (an exception is made if the post-consumer portion of the package contains these substances.) LABELLING (Ref: Section 7.1 of the Standard) Criteria Package marked – Dry powder not to be diluted in water before use? Package marked – used produced is to be swept or vacuumed from surface and not disposed of to drain? Package marked - with appropriate environmental information for disposal of unused product, used product and empty packaging? Package marked – with Enco Certification Mark and with description as described in the Standard? © EGTS:1503 Issue 1:Revision 2:December 2014 11