Companies that do not meet the requirements of the Notice
with respect to certain high priority petroleum substances, but
who have a business interest in a substance in the notice are encouraged
to identify themselves as stakeholders by completing this form.
IDENTIFICATION
Name of the company :
Canadian head office address:
Contact name:
[ ] Mr.
[ ] Ms. [ ]
Dr.
Title of contact:
Contact's address (if different from above):
Telephone number:
Fax number:
Email address:
STAKEHOLDER INTEREST
Please retain our name on a list of stakeholders for the
following substances (If space is insufficient, please attach a typed
list):
CAS Registry Number(s) and Substance Name(s):
Type of interest:
[ ]
Import
[ ]
Manufacture of the substance
[ ]
Use/Application of the substance
[ ]
Use of the substance to make a mixture, product or manufactured item
[ ]
Past or Potential Future involvement with the substance
CAS Registry Number(s) and Substance Name(s):
Type of interest:
[ ]
Import
[ ]
Manufacture of the substance
[ ]
Use/Application of the substance
[ ]
Use of the substance to make a mixture, product or manufactured
item
[ ]
Past or Potential Future involvement with the substance
CAS Registry Number(s) and Substance Name(s):
Type of interest:
[ ]
Import
[ ]
Manufacture of the substance
[ ]
Use/Application of the substance
[ ]
Use of the substance to make a mixture, product or manufactured
item
[ ]
Past or Potential Future involvement with the substance
[ ]
Pursuant to section 313 of the Canadian Environmental
Protection Act, 1999, I request that the information that I am submitting
be treated as confidential.
Name (print)
Title
Signature
Date of Signature
Please return this form to: Minister of the Environment, to the attention of the DSL Surveys Coordinator, Existing Substances Program Place Vincent Massey, 20th Floor, 351 Saint-Joseph Boulevard, Gatineau, Quebec K1A 0H3 Telephone: 1 888 228 0530/819-956 9313 Fax : 1-800-410-4314/819-953 4936 Email : DSL.SurveyCo@ec.gc.ca
(note on envelope or subject line of email: CMP Petroleum Stream Declaration)
Existing Substances Evaluation: Declaration of Stakeholder Interest For Petroleum Substances
Disclaimer: Although care has been taken to ensure that the information found on this website accurately reflects the requirements prescribed in the Canadian Environmental Protection Act (1999), you are advised that, should any inconsistencies be found, the legal documents, printed in the Canada Gazette, will prevail.
