Declaration of Non-Engagement
Selected Substances - 2005
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| If your company was not engaged,
during the 2005 calendar year, in the activities described in the
attached Notice with respect to Selected Substances identified as
Priority for Action, please complete only this form and return the
signed document to the address listed below. By completing this
declaration, you will not receive reminder letters or additional
information requests associated with this notice.
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| Identification |
| Company name: |
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| Canadian head office mailing address: |
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Contact name (for CEPA 1999 s.71 notices):
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Title of contact:
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Contact’s mailing address (if different from above):
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Telephone number:
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Fax number:
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Electronic mail:
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Non-Engagement Declaration
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This company
was not engaged during the 2005 calendar year, in the activities
described in the Notice with respect to Selected Substances identified
as Priority for Action, that was published in the Canada Gazette,
Part I, on March 4, 2006.
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Name (print)
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Title
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Signature
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Date of signature
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Stakeholder Identification
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Although this
company was not engaged during the 2005 calendar year, in the activities
described in the Notice with respect to Selected Substances identified
as Priority for Action, please retain our name on a list of stakeholders
for the following substances (If space is insufficient, please attach
a typed list):
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| CAS Number(s) and Substance Name(s): |
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Please return this form no
later than June 22, 2006 to:
Minister of the Environment, to the
attention of the DSL Surveys Coordinator
Environment Canada
Place Vincent Massey, 20th Floor
351 St. Joseph Boulevard
Gatineau,
Quebec K1A 0H3
Telephone: 1-888-228-0530 / (819) 956-9313 -- Fax: (819) 953-4936
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