No. 126 ver 2 J
Attached Certificates
J.Automotive RefinishPaints
Date：Brand name
Applicant / (Company name) / Company seal
<Preparing Attached Certificates>
1.Indicate details of the product under application for certification in “Fill in this Column.”
Shaded areas in “Fill in this Column” do not require entry.
2.Prepare yourself or have other interests prepare the certificates specified in “Documents to be Submitted.” Submit these certificates with this document when applying for Eco Mark Product certification or use.
3.Prepare certificates referring to the examples provided.
4.The issuer(s) in the “Issued by” column must prepare “Documents to be Submitted.”
Item / Description / Submitted Document / Certified ByClassification of Product Applied / □Putty
□Auto-body filler
□Surfacer
□Primer
□Filler
□Wash primer
□Base coat
□Clear coat
(Please check applicable brackets.) / Product brochures andother materials / Applicant
Company Developed / Other In-house
(Please check applicable brackets.) / If product is developed by a third party, the form “Approval of Eco Mark Use Application” (Example 1) / Paint manufacturer
In the event that a product already eco mark certified by a third party is submitted for certification under a different brand name / There are changes other than the brand name □ Yes ／□No
(Please check applicable brackets.)
（No certification of the following items is required if the change is only in the brand name） / Copy of notice of examination result for eco mark product certification
A compassion tableof already certified product model and the applied model
Certificate on conformance to certification criteria applicable to the changes made (when there are changes)
Evaluation of purchased materials / Copy of ISO9001:2000, etc. or (Example 2) / Paint manufacturer
4-1 Common environmental criteria
Item / Description / Submitted Document / Certified By4－1.(1)(2)
Dilution at coating site or not / Of the type “dilution at site”
Not of the type “dilution at site” / For the type “dilution at site”, documents showing recommended solvents and dilution ratio (use manuals, product label, brochure, etc.) / Applicant or Paint manufacturer
4－1.(1)
The amount of aromatic hydrocarbon solvent in the paint / The amount of aromatic hydrocarbon solvent
in the paint( g/l)
For the type “dilution at site”, the value when using recommended solvent ______at the dilution ratio of _____%
Paint type
Multiple-component type
Not multiple-component type
(Please check applicable brackets.) / Paint contents table (Example “A”) or analysis results (For multiple component-type paints and paints diluted at site, the contents computed from the mixing ratio of components and dilution agent) / Paint manufacturer or Manufacturer’s or Third party testing body
4－1.(2)
The VOC fraction of the paint / The VOC fraction of the paint
( g/l)
For the type “dilution at site”, the value when using recommended solvent ______at the dilution ratio of _____%
(Please check applicable brackets.) / Paint contents table (Example “A”) or analysis results (For multiple component-type paints, the contents computed from the mixing ratio of components / Paint manufacturer or Manufacturer’s or Third party testing body
4－1.(3)
Use of antiseptic /anti-fungal agent / Use of antiseptic or anti-fungal agent
< >Used / < >None
(Content %)
(Please check applicable brackets.) / If “Used,” submit MSDS (chemical name, CAS No. etc.) of substances contained. / Chemical supplier or Paint Manufacturer
4－1.(4)
Use of chemical substances listed in Table 2 / Submit a list of substances contained.
(Example 3) / Paint manufacturer
4－1.(5)
hydrocarbon halides / Certificate
(Example 4) / Director of final production factory
4－1.(6)
Used or unused Class 1 chemical substances of PRTR / < > Used / < > None
(Please check applicable brackets.) / If “Used,” submit a list of substances contained.
(Example 5) / Paint manufacturer
4－1.(7)
Environmental regulations / Certificate
(Example 6) / Director of final production factory
4－1.(8)
“Poisonous and Deleterious Substances Control Law” and “Law Concerning Examination and Regulation of Manufacture etc. of Chemical Substances” / Certificate
(Example 7) / Director of final production factory or applicant
4－1.(9)
Information about proper handling of the paint / MSDS / Mandatory / Applicant
Instruction Manual / Either
Product Label
Brochure
4－1.(10)
Container / < > Returnable container
< > Unleaded metal can
Collection and recycling
(Please check applicable brackets.) / For “a” or “c”, description of recycling system, material, etc. / Applicant
4-2 Quality criteria
Item / Description / Submitted Document / Certified subject4－2.(11)
Product quality / a) Copy of Certificate of Quality Control certifying conformance to applicable quality standards and;
b) “Example 8” or copy of JIS plant certification document
If no applicable JIS standards exist, performance certificate and “Example 8” / Director of final production factory
5. Product Category, etc.
Item / Submitted Document / Certified ByEco Mark labeling or not (plan) / Yes Product Packaging
Catalog, leaflet
Manuals others （ ）
No（If yes, sample indication drawing must be submitted.）
（Please check the applicable brackets. If yes, please submit a sample indication drawing as below.） / Applicant
Article 3 of “Eco Mark Usage
Regulations”
Spot planned for Eco Mark
indication, Mark
Environmental information indicated below Eco Mark / Submission of sample indication drawing (no fixed format, manuscript)
Article 7 of “Eco Mark Usage
Regulations”
Indication of the name of Eco MarkUser and Eco Mark
certification number
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No. 126 ver 2 J
Attached Certificates
Example 1
, 200X
Secretariat
Eco Mark Office
Japan Environment Association
XXXXX XXXXX
Company name
Seal
*Issuer: Applicant
Approval of Eco Mark Use Application
We hereby approve that (the applicant company) file an application for Eco Mark product certification and usage under the brand name “______”with respect to the product which has been Eco Mark certified under our brand name“______” with certification number (only if already certified).
, 200x
To: Eco Mark Office
The Japan Environment Association
Company Name
Certificate for Evaluation of Procured Material
(The manufacturer of the subject product) certifies that the items indicated below are being conducted regarding Certification Criteria 4-1.(1), (2),(3), (4), (5) and (6).
Items
aTo ensure that the procured materials conform to the matters stipulated in Certification Criteria 4-1.(1), (2), (3), (4), (5) and (6).
bTo evaluate and select suppliers for procuring the material on the basis of their capability to supply products following our company’s requirements.
cTo establish a standard for selection, evaluation and reevaluation.
End
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No. 126 ver 2 J
Attached Certificates
Substance Name / Boiling point / Content in one liter(to one-hundredth of a gram) / Aromatic or not / VOC or not
1 / (e.g.) Xylene / 144.4 / 0.88 / Yes / Yes
2 / (e.g.) 1,3,5 trimethyl benzene / 169 / 0.07 / Yes / Yes
3 / (e.g.) Cyclohexane / 156 / 1.35 / Yes
4
5
6
7
8
9
10
11
12
13
14
※VOC＝boiling point 23～260℃
(1)Aromatics total
(2)VOCs total
, 200x
To: Mr. XXXX
X X Department
XX Company
Company Name
Contents of Aromatic Hydrocarbon-based Solvents and VOCs in Paint
We hereby certify that the following aromatic hydrocarbon-based solvents and VOCs have been added to (the applied product) at the maximum as formulation ingredients:
, 200x
To: Mr. XXXX
X X Department
XX Company
Company Name
Certificate on Chemical Substances
We hereby certify that the (name of the subject product) meets the values prescribed in 4‐1.(3) of the Certification Criteria for chemical substances listed in Table 2 as shown below.
Substance Name / Usedor notCadmium / □Notused ／ □Used
Mercury / □Notused ／ □Used
Hexavalent Chromium / □Notused ／ □Used
Lead / □Notused ／ □Used
Arsenic / □Notused ／ □Used
Antimony / □Notused ／ □Used
Tributyltin / □Notused ／ □Used
Triphenyltin / □Notused ／ □Used
Alkylphenol / □Notused ／ □Used
Nonyl phenol / □Notused ／ □Used
4-octyl phenol / □Notused ／ □Used
Formaldehyde / □Notused ／ □Used
Tetradecane / □Notused ／ □Used
, 200x
To: Mr. XXXX
X X Department
XX Company
Factory director Name
Company Name
Certificate of Conformance
We hereby certify that the (name of the subject product) doesn’t contain hydrocarbon halides including Class 5 CFCs, other CFCs, carbon tetrachloride, trichloroethane and HCFCs, as listed below.
Specified CFCs（5 ＣＦＣs） / Trichlorofluoromethane / CFCs substitute
（ＨＣＦＣ） / Chlorotrifluoroethane
Dichlorodifluoromethane / Dichlorofluoroethane
Trichlorotrifluoroethane / Chlorodifluoroethane
Dichlorotetrafluoroethane / Chlorofluoroethane
Chloropentafluoroethane / Hexachlorofluoropropane
Other
ＣＦＣs / Chlorotrifluoromethane / Pentachlorodifiluoropropane
Pentachlorofluoroethane / Tetrachlorotrifluoropropane
Tetrachlorodifluoroethane / Trichlorotrifluoropropane
Heptachlorofluoropropane
Hexachlorodifluoropropane / Dichloropentafluoropropane
Chlorohexafluoropropane
Pentachlorotrifluoropropane
Tetrachlorotetrafluoropropane / Pentachlorofluoropropane
Tetrachlorodifluoropropane
Trichloropentafluoropropane
Dichlorohexafluoropropane / Trichlorotrifluoropropane
Dichlorotetrafluoropropane
Chloroheptafluoropropane / Chloropentafluoropropane
Carbontetrachloride / Tetrachlorofluoropropane
1,1,1-trichloroethane / Trichlorodifluoropropane
CFCs substitute
（ＨＣＦＣ） / Dichlorofluoromethane / Dichlorotrifluoropropane
Chlorodifluoromethane
Chlorofluoromethane / Chlorotetrafluoropropane
Trichlorofluoropropane
Tetrachlororfluoroethane / Dichlorodifluoropropane
Trichlorodifluoroethane / Chlorotrifluoropropane
Dichlorotrifluoroethane / Dichlorofluoropropane
Chlorotetrafluoroethane / Chlorodifluoropropane
Trichlorofluoroethane / Chlorofluoropropane
Dichlorodifluoroethane
Please indicate clearly that the issuer holds the post of factory director or its equivalent, or concurrently holds it with other posts.
, 200x
To: Mr. XXXX
X X Department
XX Company
Company Name
Report on the Use of Class 1 Designated Chemical Substances in PRTR Law
We hereby report that the (name of the subject product) uses the substances listed below as a component(s), which belong(s) to the Class 1 chemical substance(s) prescribed in the “Law Concerning Reporting, etc. of Releases to the Environment of Specific Chemical Substances and Promoting Improvements in Their Management (PRTR Law).”
Substance Name, 200x
To: Mr. XXXX
X X Department
XX Company
Factory director Name
Company Name
Certificate of Conformance
We hereby certify that (the company undertaking final manufacturing process of the subject product) is producing the (name of the subject product) in conformance with the requirements indicated below.
Requirements
That the applicable environmental laws and pollution prevention agreements have been duly observed for the period of _____ years* preceding the date of application with respect to air pollution, water contamination, noise, vibration, odor, emission of hazardous substances, etc. from the manufacturing process.
Relevant regulations: Examples Air Pollution Control Law
Water Pollution Control Law
Noise Regulation Law
Vibration Regulation Law
Offensive Odor Control Law
XX Prefecture XX Environment Protection
Ordinance
XX City Pollution Control Agreement
End
(*) Might declare that there has been no violation since the establishment of a business.
Please indicate clearly that the issuer holds the post of factory director or its equivalent, or concurrently holds it with other posts.
, 200x
To: Mr. XXXX
X X Department
XX Company
Company Name
Certificate of Conformance
We hereby certify that (the company undertaking final manufacturing process of the subject product) is producing the (name of the subject product) in conformance with the requirements indicated below.
Requirements
The laws concerning the handling of chemical substances such as the “Poisonous and Deleterious Substances Control Law” and the “Law concerning the Examination and Regulation of Manufacture etc. of Chemical Substances” shall have been observed.
End
, 200x
To: Mr. XXXX
X X Department
XX Company
Factory director Name
Company Name
Certificate of Quality Control
We, the manufacturer responsible for the final process step of (name of the product for which application is filed), hereby certify that we manage the product in accordance with the quality control items listed in the separate paper (quality test results pursuant to applicable JIS standards, performance certificate based on in-house standards, etc.), and ship only those product lots that conformto the quality control standards.
End
Please indicate clearly that the issuer holds the post of factory director or its equivalent, or concurrently holds it with other posts.
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