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Selenium-containing Substances Reporting Form

Published in the Canada Gazette on May 25, 2013

(Excel Format - Part 1 – Questions - 137 KB)
(PDF Format - Part 2 – Declaration Signature Page - 22 KB)

Table of Contents

Part 1 – Questions

Introduction

You may respond to the Selenium-containing substances section 71 Notice using the Selenium-containing Substances Reporting Form. Please note that there are 2 parts to the Selenium Reporting Form that must be filled out and submitted in order for the response to be considered complete:

  1. Selenium-containing Substances Reporting Form Part 1 – Questions (Submit the Excel format):
    Please complete the applicable sections, as outlined in Schedule 2 to the Notice. The sections of the Notice can be accessed using the tabs below.

    Note that respondents are encouraged to complete and submit the Selenium-containing Substances Reporting Form- Part 1 in Excel format, either by email or electronically (via CD, DVD or USB memory stick).

  2. Selenium-containing Substances Reporting Form Part 2 – Declaration Signature Page (Submit the PDF format):
    In addition to completing Part 1 of the Selenium-containing Substances Reporting Form, you must also complete and sign the Selenium- containing Substances Reporting Form Part 2- Declaration Signature Page to declare that the information being submitted is accurate and complete.

    Note that the signed Selenium-containing Substances Reporting Form- Part 2 may be submitted via email, mail or fax.

Please refer to the Selenium-containing Substances Guidance Document for assistance in completing the section 71 Notice.

Provide the information no later than October 1, 2013, 5 p.m. Eastern Daylight Saving Time to:

Minister of the Environment, to the attention of the Substances Management Coordinator, Chemicals Management Plan
200 Sacré-Cœur Boulevard, Gatineau QC K1A 0H3
Email: Substances@ec.gc.ca
Telephone: 1-800-567-1999 (toll free in Canada) or 819-953-7156 (outside of Canada)
Fax: 1-819-953-7155
Website: Chemical Substances

Schedule 1

Substance
CAS RN[1]Name of the substance 
1306-24-7Cadmium selenide (CdSe)
3425-46-5Selenocyanic acid, potassium salt
5819-01-2Dodecane, 1,1'-selenobis-
7446-08-4Selenium oxide (SeO2)
7446-34-6Selenium sulfide
7488-56-4Selenium sulfide (SeS2)
7782-49-2Selenium
7783-00-8Selenious acid
7783-07-5Hydrogen selenide (H2Se)
7791-23-3Seleninyl chloride
10102-18-8Selenious acid, disodium salt
10214-40-1Selenious acid, copper(2++) salt (1:1)
12002-86-7Silver selenide (AgSe)
12069-00-0Lead selenide (PbSe)
12137-76-7Palladium selenide (PdSe)
12214-12-9Cadmium selenide sulfide (Cd2SeS)
12626-36-7Cadmium selenide sulfide (Cd(Se,S))
12656-57-4Cadmium sulfoselenide orange (Pigment Orange 20)
13410-01-0Selenic acid, disodium salt
20405-64-5Copper selenide (Cu2Se)
21559-14-8Selenium, bis(diethylcarbamodithioato-S)bis(diethylcarbamodithioato-S,S')-
56093-45-9Selenium sulfide
58339-34-7Cadmium sulfoselenide red (Pigment Red 108)

Schedule 2

Persons Required to Provide Information

  1. This notice applies to any person who, during the 2012 calendar year, imported a total quantity greater than 100 kg of a substance listed in Schedule 1 to this notice, at a concentration equal to or above 0.001 percent by weight (w/w %), whether in:
    • (a) a mixture or in a product, intended to be used in a residence, that is:
      • (i) a polish, paint, coating, ink, adhesive or sealant;
      • (ii) for cleaning or for fabric care;
    • (b) a mixture or product intended to clean floors or food preparation surfaces; or
    • (c) a toy intended to be used by children under the age of six years.
  2. This notice applies to any person who, during the 2012 calendar year, used a total quantity greater than 100 kg of a substance listed in Schedule 1 to this notice, whether alone; or at a concentration equal to or above 0.001 percent by weight (w/w %) in a mixture or in a product:
    • (a) in the manufacture of  a mixture or a product, intended to be used in a residence, that is:
      • (i) a polish, paint, coating, ink, adhesive or sealant;
      • (ii) for cleaning or for fabric care;
    • (b) in the manufacture of a mixture or product intended to clean floors or food preparation surfaces; or
    • (c) in the manufacture of a toy intended to be used by children under the age of six years.
  3. This notice does not apply to the substance set out in Schedule 1, whether alone, in a mixture or in a product that:
    • (a) is in transit through Canada; or
    • (b) is, or is contained in, a pest control product within the meaning of subsection 2(1) of the Pest Control Products Act where that pest control product is registered under the Pest Control Products Act.
  4. Respondents to this notice who:
    • (a) imported a substance listed in Schedule 1 shall complete sections 4, 5, and 7 in Schedule 3; or
    • (b) used a substance listed in of Schedule 1 shall complete sections 4, 5, 6, and 7 in Schedule 3.

Identification

Note: The Selenium Reporting Form Part 2 - Declaration Signature Page must also be submitted in order for the response to be considered complete.

Name of the person (e.g. company):                                                                                    
Federal business number: 
Canadian head office street address: 
City: 
Province / State (in North America): 
Postal Code / ZIP: 
Country: 
Mailing address (if different from the street address):  
City: 
Province / State (in North America): 
Postal Code / ZIP: 
Country: 
Contact name for the Canadian Environmental Protection Act, 1999 (CEPA 1999) section 71 notices:  
Title of the contact:  
Contact’s mailing addresses (if different from above):  
City: 
Province / State (in North America): 
Postal Code / ZIP: 
Country: 
Telephone number:  
Fax number (if any):  
Email (if any):  
Pursuant to section 313 of the Canadian Environmental Protection Act, 1999, I request that the sections specified in this form be treated as confidential. (Y/N):  

Schedule 3, Section 5

5. (1) For each substance listed in Schedule 1 that a person imported or used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information: 

  • (a) the CAS RN of the substance; 
  • (b) the applicable Consumer and Commercial Code(s), set out in section 8;
  • (c) for each applicable Consumer and Commercial Code, the total quantity of the substance reported in kilograms (rounded to 2 significant digits);  
  • (d) for each applicable Consumer and Commercial Code, the description and the common or generic name of the known or anticipated final mixture, product or manufactured item containing the substance;
  • (e) for each applicable Consumer and Commercial Code, the concentration, or range of concentrations, of the substance by weight (w/w%) in the known or anticipated final mixture, product or manufactured item containing the substance.

5. (2) Where code C999 is applicable for paragraph (1)(b), a written description of the mixture, product or manufactured item must be provided.

(a)
CAS RN
Is your involvement with the CAS RN confidential?  (Y/N)(b)
Consumer and Commercial Code(s)
(set out in section 8)
Is the code confidential? (Y/N)If C999 is applicable, provide a written description Is the description of C999 confidential? (Y/N)(c)
Total quantity of the substance reported in kg (rounded to 2 significant digits)
Is the quantity confidential? (Y/N)
        
        
        
        

Continuation

(a)
CAS RN
(d)
Description and the common or generic name of the known or anticipated final mixture, product or manufactured item containing the substance
Is the description and the common or generic name confidential? (Y/N)(e)
Concentration, or range of concentrations, of the substance by weight (w/w%) in the known or anticipated final mixture, product, or manufactured item containing the substance
Is the concentration confidential? (Y/N)Additional NotesNotes confidential? (Y/N)
       
       
       
       

Schedule 3, Section 6

6. (1) For each substance listed in Schedule 1 that a person used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information:

  • (a) the CAS RN of the substance;
  • (b) the applicable Substance Function Code(s) set out in section 9 that apply to the substance; and
  • (c) for each applicable Substance Function Code, the total quantity of the substance used reported in kilograms (rounded to 2 significant digits).

6. (2) Where code U999 is applicable for paragraph (1)(b), a written description of the substance function must be provided.

(a)
CAS RN
(b)
Applicable Substance Function Code(s)
(set out in section 9)
Is the code confidential? (Y/N)If U999 is applicable, provide a written description Is the description of U999 confidential? (Y/N)(c)
Total quantity of the substance used, reported in kg (rounded to 2 significant digits)
Is the quantity confidential? (Y/N)Additional NotesNotes confidential? (Y/N)
         
         
         
         

Schedule 3, Section 7

7. For each substance listed in Schedule 1 that a person imported or used during the 2012 calendar year, for which the criteria set out in Schedule 2 have been met, the person shall provide the following information from any calendar year:

  • (a) the CAS RN of the substance;
  • (b) any unpublished data or studies, with a dosing duration of less than two weeks, with regards to the human health endpoint acute mammalian toxicity;[2] and
  • (c) the study title(s) for the data or studies submitted in paragraph (b).
(a)
CAS RN
(b)
Unpublished data or studies with regards to acute
(< 2 weeks) mammalian toxicity studies
Is the full data or study submitted confidential? (Y/N)(c)
Study title(s) for the data or studies submitted in paragraph (b)
Is the title of the data or study submitted confidential? (Y/N)Additional NotesNotes confidential? (Y/N)
       
       
       
       

Schedule 3, Section 8

8. For the purpose of section 5, the following table sets out the Consumer and Commercial Codes and their corresponding descriptions:

Consumer and Commercial CodesTitleDescription
C102Foam Seating and Bedding Substances that are, or are contained in, foam mattresses, pillows, cushions, and any seating, furniture and furnishings containing foam.
C104Fabric, Textile and Leather articles not otherwise covered in this tableSubstances that are, or are contained in, fabric, textile and leather products to impart color and other desirable properties such as water, soil, stain repellence, wrinkle resistance, or flame resistance.
C105Cleaning and Furnishing CareSubstances that are, or are contained in products or mixtures that are, used to remove dirt, grease, stains, and foreign matter from furniture and furnishings, or to cleanse, sanitize, bleach, scour, polish, protect, or improve the appearance of surfaces.
C106Laundry and Dishwashing Substances that are, or are contained in, laundry and dishwashing products or mixtures.
C108Personal Care Substances that are, or are contained in, personal care products or mixtures that are used for cleansing, grooming, improving or altering skin, hair, or teeth. 
C110Apparel and Footwear Care Substances that are, or are contained in, apparel and footwear care products or mixtures that are applied post-market.
C201Adhesives and SealantsSubstances that are, or are contained in, adhesive or sealant products or mixtures used to fasten other materials together or prevent the passage of liquid or gas.
C202Paints and CoatingsSubsatnces that are, or are contained in, paints or coatings.
C303Plastic and Rubber materials not otherwise covered in this tableSubstances that are, or are contained in, rubber and plastic products, mixtures or manufactured items not otherwise covered in this table.
C304Toys, Playground and Sporting EquipmentSubstances that are, or are contained in, toys, playground, and sporting equipment made of wood, metal, plastic or fabric.
C305Arts, Crafts and Hobby MaterialsSubstances that are, or are contained in, arts, crafts, and hobby materials.
C306Ink, Toner and ColourantsSubstances that are, or are contained in, ink, toners and colourants used for writing, printing, creating an image on paper, and substances contained in other substrates, or applied to substrates to change their colour or hide images.
C402Lubricants and GreasesSubstances that are, or are contained in, products or mixtures to reduce friction, heat generation and wear between solid surfaces.
C999Other (specify)Substances that are, or are contained in, products, mixtures or manufactured items that are not described within any other Consumer and Commercial Code.  A written description of the substance, product, mixture or manufactured item must be provided when using this code.

Schedule 3, Section 9

9. For the purposes of section 6, the following are the Substance Function Codes and their corresponding descriptions:

Substance Function codesTitleDescription
U001AbrasivesSubstances used to wear down or polish surfaces by rubbing against the surface.
U002Adhesives and sealant substancesSubstances used to promote bonding between other substances, promote adhesion of surfaces, or prevent seepage of moisture or air.
U003Adsorbents and absorbentsSubstances used to retain other substances by accumulation on their surface or by assimilation.
U004Agricultural substancesSubstances used to increase the productivity and quality of farm crops.
(non-pesticidal)
U005Anti-adhesive agentsSubstances used to prevent bonding between other substances by discouraging surface attachment.
U006Bleaching agentsSubstances used to lighten or whiten a substrate through chemical reaction, usually an oxidative process which degrades the colour system.
U007Corrosion inhibitors and antiscaling agentsSubstances used to prevent or retard corrosion or the formation of scale.
U008DyesSubstances used to impart colour to other materials or mixtures by penetrating into the surface of the substrate.
U009FillersSubstances used to provide bulk, increase strength, increase hardness, or improve resistance to impact.
U010Finishing agentsSubstances used to impart such functions as softening, static-proofing, wrinkle resistance, and water repellence.
U011Flame retardantsSubstances used on the surface of or incorporated into combustible materials to reduce or eliminate their tendency to ignite when exposed to heat or a flame.
U012Fuels and fuel additivesSubstances used to create mechanical or thermal energy through chemical reactions, or which are added to a fuel for the purpose of controlling the rate of reaction or limiting the production of undesirable combustion products, or which provide other benefits such as corrosion inhibition, lubrication, or detergency.
U013Functional fluidsLiquid or gaseous substances used for one or more operational properties in a closed system. This code does not include fluids used as lubricants.
(closed systems)
U014Functional fluidsLiquid or gaseous substances used for one or more operational properties in an open system.
(open systems)
U015IntermediatesSubstances consumed in a reaction to produce other substances for commercial advantage.
U016Ion exchange agentsSubstances that are used to selectively remove targeted ions from a solution. This code also includes aluminosilicate zeolites.
U017Lubricants and lubricant additivesSubstances used to reduce friction, heat, or wear between moving parts or adjacent solid surfaces, or that enhance the lubricity of other substances.
U018Odour agentsSubstances used to control odours, remove odours, mask odours, or impart odours.
U019Oxidizing or reducing agentsSubstances used to alter the valence state of another substance by donating or accepting electrons or by the addition or removal of hydrogen to a substance.
U020Photosensitive substancesSubstances used for their ability to alter their physical or chemical structure through absorption of light, resulting in the emission of light, dissociation, discoloration, or other chemical reaction.
U021PigmentsSubstances used to impart colour to other materials or mixtures by attaching themselves to the surface of the substrate through binding or adhesion.
U022PlasticizersSubstances used in plastics, cement, concrete, wallboard, clay bodies, or other materials to increase their plasticity or fluidity.
U023Plating agents and surface treating agentsSubstances applied to metal, plastic, or other surfaces to alter physical or chemical properties of the surface.
U024Process regulatorsSubstances used to change the rate of a reaction, start or stop the reaction, or otherwise influence the course of the reaction.
U025Processing aids, specific to petroleum productionSubstances added to water, oil, or synthetic drilling muds or other petroleum production fluids to control foaming, corrosion, alkalinity and pH, microbiological growth or hydrate formation, or to improve the operation of processing equipment during the production of oil, gas, and other products or mixtures from beneath the earth’s surface.
U026Processing aids, not otherwise covered in this tableSubstances used in applications other than the production of oil, gas, or geothermal energy to control foaming, corrosion, or alkalinity and pH, or to improve the operation of processing equipment.
U027Propellants and blowing agentsSubstances used to dissolve or suspend other substances and either to expel those substances from a container in the form of an aerosol or to impart a cellular structure to plastics, rubber, or thermo set resins.
U028Solids separation agentsSubstances used to promote the separation of suspended solids from a liquid.
U029Solvents (for cleaning or degreasing)Substances used to dissolve oils, greases and similar materials from textiles, glassware, metal surfaces, and other articles.
U030Solvents (which become part of formulation or mixture)Substances used to dissolve another substance to form a uniformly dispersed solution at the molecular level.
U031Surface active agentsSubstances used to modify surface tension when dissolved in water or water solutions, or reduce interfacial tension between two liquids or between a liquid and a solid or between liquid and air.
U032Viscosity adjustorsSubstances used to alter the viscosity of another substance.
U033Laboratory substancesSubstances used in a laboratory for chemical analysis, chemical synthesis, extracting and purifying other chemicals, dissolving other substances, and similar activities.
U034Paint additives and coating additives not otherwise covered in this tableSubstances used in a paint or coating formulation to enhance properties such as water repellence, increased gloss, improved fade resistance, ease of application or foam prevention.
U061Pest control substancesSubstances used as active ingredients or formulants in products or mixture used for directly or indirectly controlling, destroying, attracting or repelling a pest or for mitigating or preventing its injurious, noxious or troublesome effects.
U999Other (specify)Substances with a substance function not otherwise described in this table. A written description of the substance function must be provided when using this code.

Part 2 – Declaration Signature Page

To submit a section 71 Notice, complete and sign this form along with the Selenium-containing Substances Reporting Form Part 1 – Questions and send it to the Substances Management Coordinator by no later than 5 p.m. Eastern Standard Time, October 1, 2013

:

[3]:





I declare that the information that I am submitting in the Selenium-containing Substances Reporting Form Part 1 – Questions is accurate and complete.





________________________________________________



________________________________________________

Minister of the Environment, to the attention of the Substances Management Coordinator - Chemicals Management Plan
200 Sacré-Cœur Boulevard, 8th Floor, Gatineau, Quebec  K1A 0H3
Email : Substances@ec.gc.ca
Telephone: 1-800-567-1999 (toll free in Canada) or 1-819-953-7156 (outside of Canada)
Website: Chemical Substances


Footnote

[1] CAS RN: Chemical Abstracts Service Registry Number. The Chemical Abstracts Service information is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government of Canada when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society.
[2] Note: Full data or studies must be submitted as an attachment to your submission.  In column (b), indicate the name of the attachment(s) provided
[3] Federal business number is a nine-digit registration number issued by the Canada Revenue Agency (CRA) to Canadian businesses that register for one or more of the following: corporate income tax; importer/exporter account number; payroll (source) deductions (trust accounts); or goods and services tax. This number can be found on all forms issued to a business by the CRA. The first nine digits that appear on these forms is the Federal business number.