BIOMASS VERIFICATION PROCEDURE

PELLET SUPPLIER DECLARATION FORM

PSDF

Version 2009.1

Protected by  copyright

Pelletsupplier declaration form 

Scope

In the framework of the use of biomass pellets as a sustainable and a renewable source of energy for generating green energy in Europe, a verification procedure has been set up.

As part of this procedure, the manufacturer of biomass pellets is kindly requested to fill in this formcarefully. Please keep in mind that this is an official declaration, which shall be verified by an independent body.

The whole delivered information is guaranteed to bekept confidential.Restricted access to this document shall be granted to and only to:

  • GDF-SUEZ/Electrabel as end-user;
  • Laborelec as process owner for this procedure;
  • SGS Belgium as accredited body;
  • The authority in charge of green energy regulation in the country where pellets are being fired.

This declaration consists in 5 functional parts:

-PART 1 – Administrative information

-PART 2 – Raw material sourcing and certificates

-PART 3 – Pellet production chain and energy balance

-PART 4 – Transportation of the delivered pellets

-PART 5 – Signature of the declaration

Please fill it in electronically or if not possible in CAPITAL LETTERS, print it out, sign it and stamp it, scan it and send it under electronic form to SGS BELGIUM.

CAUTION

Any significant modification affecting the delivered information within this document
must be compulsorily communicated to SGS BELGIUM within two weeks under writtenform,
possibly by filling a new Declaration or by Fax or by letter.

The authorities request a yearly revision of all data gathered in this document according to the date when the biomass has been fired for the first time.

Follow-up certification suppliers to GDF-SUEZ/Electrabel TPM/Fuel Procurement

Regentlaan, 8, B-1000 Brussels, BELGIUM

Toon Bosmans

Tel.: +32 (0)2 519 36 92 Mob. +32 474 45 67 27
e-mail :

Technical specifications and verification process: Laborelec

Rodestraat 125, B-1630 Linkebeek, BELGIUM

Dr.Ir. Yves Ryckmans

Tel.:+32 (0)2 382 03 03 Fax: +32 (0)2 382 02 41 Mob.: +32 (0)478 65 24 48

e-mail :

Inspection and independent reporting: SGS Belgium

Parc Créalys, rue Phocas Lejeune 4, B-5032 Gembloux, BELGIUM

Ir. François Ducarme

Tel.:+32 (0)81 71.51.94 Fax.:+32 (0)81 71.51.61 Mob.:+32 (0) 479-89.07.99

e-mail:

PART 1 – Administrative information

Company :…………………………………………………………………………....………

Name of contact person : …………………...…………………………………………..……

Address :………………………………...…………………………………………………...

City :………………………………………………………Postcode :……………………....

Country : ………………………Tel :..……………………Fax :….……………..………….

e-mail address : ………………………………………………………………………..…….

Please indicate site of production if different from company location

Name of contact person : …………………...…………………………………………..……

Address :………………………………...…………………………………………………...

City :………………………………………………………Postcode :……………………....

Country : ………………………Tel :..……………………Fax :….……………..………….

e-mail address : ………………………………………………………………………..…….

PART2 – Raw biomass sourcing and certification

This part has been designed for essentially woody biomass as far as certification is concerned.

Nevertheless, please mention any other type of biomass that is used as raw material if applicable.

On the next pages, it is necessary to listall main sources of raw material suppliers per country / region of origin and per generic type of materials.

A different table has to be to be filled in for each type of generic raw material and for each country/region of origin. Use as many copies of the table as needed to describe each kind of raw material and each country/region of origin.

If several suppliers are similar (i.e. they deliver the same kind of raw product and are located in the same country / region of origin), it is permitted to regroup them in the same table. All suppliers involved have to be listed in each table.

In each table, one must mention any applicable forest certification systemfor the raw woody material:

- FSC (Forest Stewardship Council)

- PEFC (PanEuropeanForest Certification)

- CSA-SFM (Canadian Standards Association’s Sustainable Forest Management)

- SFI (Sustainable Forest Initiative)

- FFCS (FinnishForest Certification System)

- APSC Approved pre-scope certificate of one of the endorsed forest management certification systems, with the intention of full certification

RAW MATERIAL 1
country / region of origin : ……………………………..
list of the supplier(s) names:……………………………..
massratio in the total on year base: ………………. %
 raw material is not at all wood(less than 5% in mass on year base)
then specify: ………………………………………………………………………….
 raw material is only partially wood(between 5% and 95% in mass on year base)
 raw material is essentially wood(more than 95% in mass on year base)
 raw material is guaranteed more than 99% pure wood
Type, origin and form of the raw woody material as received / Forest certification system (if any) / Transport data
1) TYPE(Check only one box)
 timber wood
 short rotation coppices[1]
 clean wood residues
 recycled wood (with traces of paint, varnish, reservatives, MDF, woodboards, etc.)
2) ORIGIN (Check only one box)
 saw mills
 forest harvesting
 forest thinning
 sanitary cuttings (dead,ill)
 wind throw trees
 wood industry (furniture, carpentry, fibreboards, plywood, etc.)
 garden & park cleaning
 domestic or industrial waste
3) FORM(Check one or several box(es))
 saw dust
 shavings
 wood offcuts
 wood chips
 wood bark
 round wood
 wood logs
 inhomogeneous form / none
 FSC
 PEFC
 CSA-SFM
 SFI
 FFCS
 APSC / Distance to the pellet plant
………………..km
type of vehicle :
conveyor belt
 truck
 train
 river boat
 other (specify)
………………..
Average load per vehicle in ton:
………metric ton

PART3 –Pellet production chain

Capacity of the production plant / metric tons of pellet/year
………………………….
…………………………. / today
expected
Supplier of the processing (mills, densifiers) equipments if applicable /  Andritz (Sprout-Matador, ADR Geldrop)
California Pellet Mill
 Kemyx
 Other, specify ……………………………..
Date of commissioning of the biomass production plant / MM………………..YY…………..

PART 4 – Energy balance

ELECTRICITY
Give the origin of the electricityused in the pellet production process. /  from network
 own generation
 genset
fossil cogeneration plant
 biocogeneration plant
 wind or solar farm
 other (specify)
…………………………… / _ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
FOSSIL PRIMARY ENERGY
Give the specification of anyfossil primary energy used as energy source in thepellet production process.
If any fossil fuel is used, specify in what part of the process :
handling
chipping / crushing
drying
 other (specify)………………………. /  natural gas
 industrial gas
 diesel oil
 propane
 waste heat fossil boiler
other (specify)………………………. / _ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
_ _ _,_ %
NON FOSSIL PRIMARY ENERGY
Give the specification of any non fossil primary energy used as energy source in the pellet production process.
If any biomass is used, specify in what part of the process :
drying
 other (specify)………………………. / woodpellets
wood residues
 bark
 other biomass residues
waste heat biomass boiler
 other (specify) ………………………………… / Origin of the biomass used as energy source in the process
 locally available
 transported by
 Truck
 Train
on …………….. km

PART5 – Transportation of the delivered pellets

Please fill the information for each applicable step of the transport scheme.

3.1 Inland road transportation from the production plant

 NOT APPLICABLE
Please cross only one square
Estimated distance
mass/truck / Transfer to:
 train station
 sea harbour
 river harbour
 power plant
K=...………………………….
Q=...………………………… / To City/Town of ………………..……..…
Powered by:
 fossil diesel oil
 bio-diesel
 other ......
km
metric tons

3.2 Inland train transportation

 NOT APPLICABLE
Please cross only one square
Estimated distance
mass/train / Station of origin:
Transfer to:
 sea harbour
 river harbour
 power plant
K=...………………………….
Q=...………………………… / From City/Town of ………………………
To City/Town of ……………………….…
Powered by:
 electricity
 diesel oil
 bio-diesel
 other ......
km
metric tons

3.3 Inland river transportation (flatboats)

 NOT APPLICABLE
Estimated distance / Harbour of origin:
Transfer to (one square!):
 sea harbour
 power plant
K=...…………………………. / From City/Town of…………..……..……
To City/Town of ……………..………..…
Powered by:
 fossil diesel oil
 bio-diesel
 other ......
km

3.4 International sea or river transportation

 NOT APPLICABLE / SeaHarbour of origin:
Transfer to (one square!):
 sea harbour ARAG
 power plant…………….
Contract type / From City/Town of ………………………
To City/Town of …………………………
 Free-on-Board (FOB)
 Cost Insurance Freight (CIF)

PART6 – Contact details and declaration signature

Company :…………………………………………………………………………....………

Person in charge : …………………...…………………………………………..……

I certify herewith that I am an official representative of the company operating the biomass production.

I declare herewith that the product is made of vegetal material that originates from traceable origin and that the whole information delivered in the present document is to my knowledge as complete and as correct as possible. I shall do everything within my power to ensure that the product be compatible with the attached specifications, according to the type of biomass (see Annex I).

I also agree by making this claim that an independent inspection company named by the addressee or its customer get a yearly access to the biomass production site in order to verify this claim. I also state that I will do everything within my power to assist the inspection company in retrieving the information and documents necessary for the investigation for this claim.

Place and date / …………………………….……………… , DD/MM/YYYY
Name and signature of producer / ……………………………………………………………….
……………………………………………………………….

------

Name of inspection company / ……………………………………………………………….
I certify that the data gathered in this form has been checked and validated
Name and signature of inspector / ……………………………………………………………….

------Part to be filled in by SGS Belgium------

Supplier code / _ _ _-_ _
Date and place / DD/MM/YYYY, …………………………….………………..
Name of the reviewer / ………………………………………………………….……
I certify that the data gathered in this form has been checked and validated Signature and stampSGS Belgium

Annex I Biomass specifications

Table1 – Clean biomass pellets (wood based)

Date (dd/mm/yy): Inspector’s initials or SGS STAMPPage: 1 of 8

[1] Short rotation coppices are wood originating from quick growing vegetal species such that the grown biomass is harvested on a periodic base being maximal 8 years after the first planting of after the first harvest.