· web vieweco mark product category no.118 “plastic products version2” attached certificate...

Eco Mark Application No.118 Attached CertificatesEco Mark Product Category No.1 18 “ Plastic Products Version 2 ” Attached Certifica te

This attached certificate shall be submitted accompanied with “Application for Eco Mark product

certificate and utilization” when applying for the product category No. 118 “Plastic Products

Version2”.

Date:

Brand name

Applicant(company)

(company seal)

<How to Prepare 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 the certificates specified in “Documents to be submitted”. Submit these

certificates with this document when applying for Eco Mark Product certification or use.

3. Shaded areas in “Documents to be submitted” do not require submission.

*Prepare certificates referring to the examples provided.

4. The issuer(s) in the “Issued by” column must prepare “Documents to be submitted”

Note1) In case using materials (sheets, etc.) that have been certified under this product

category, certificates for proving the certification of the materials are not required.

ItemFill in this Column

(check all items that apply)

Documents to beSubmitted

Issued by

Developer of product Own company －－

Other companiesApproval of Eco Mark Application (Form 118-N)

Approver of application

If a product with Eco Mark certification under No.118 “Plastic products made with recycle materials” is applied.

Certification Number( )

* Fill in the column within thick frame line in case the company developed the product is different from the applicant.

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Eco Mark Application No.118 Attached Certificates

If a product with Eco Mark certification under this product category is to be applied as another brand name.

The product has been already certified under other company’s brand name *This item is for the same product (not the similar product). This is not applied if any product specifications such as materials, the manufacturing plant or the size have been changed or processed. In addition, this item is not applies to Self-recycling products and products that used halogenated compounds。

A copy of notice of Eco Mark certification examination resultsProduct category corresponding table between the existing eco mark product and one under applicationDrawing of planned Eco Mark indication

Applicant

4-1(4)(12)(14)(17)(18)documents to indicate a type of synthetic resin, MSDS, packaging materials, environmental conservation activities, design drawing to describe the appropriate disposal/treatment method

Documents certifying changes under the applicable criteria (if any)e.g. packaging

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Eco Mark Application No.118 Attached CertificatesRequired certification documents to meet “4. Certification Criteria and Certification Procedure”

4-1-1. Material criteria and certification procedure

Applicable criteriaFill in this column

*Please check the appropriate items.Documents to be

submittedIssued by

4-1-1.(1)Percentage of recycled material in the product.

Recycled material supply

Manufacturing process

[The weight percentage of recycled plastic materials in the total weight of the product]

50％or more less than 50% (NOT applicable)

［Product classification］

(1) Food/cosmetic containers, medical related products

(2) Accessories/personal adornments (3) Toys/play set/sporting goods (4) Recording media, etc. (5) Packaging, etc. (6) Indoor facilities/equipment (7) Products for agriculture, fisheries and

forestry (8) Outdoor facilities/equipment (9) Self-recycling products (10) Other products

Form 118‐A Applicant

Form 118‐Brecycled material collector note 1)

Form 118‐C Applicant

4-1-1.(2)4-1-4.(18)Self-recycling products (option)

［Self-recycling products］

Yes / No

* If “Yes”, documents provided in the right column

shall be submitted. If “No”, such documents are

nor required.

Form 118‐D

Copy of the instruction manual, product labeling or catalogue indicating collection method (contact information). (Draft is acceptable.)

Applicant

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Eco Mark Application No.118 Attached Certificates4-1-1.(3)Collection and recycling of the product which uses halogenated compounds at disposal, etc.

［ the products that use halogenated compounds］

Yes / No



nor required

Form 118‐E

Copy of the instruction manual, product labeling or catalogue indicating collection method (contact information). (Draft is acceptable.)

or documents ensuring that the product is to be used continuously for 20 years or more

Applicant

(for the products that use halogenated compounds)[industrial waste under special management specified by the “Waste Disposal and Public Cleansing Law”, and radioactive waste provided by the “Law for Control of Nuclear Materials”, “Nuclear Fuel Materials and Atomic Reactors” or the “Law for Prevention of Damage from Radioactive Isotopes”.] （*1）

Yes / No

* If “Yes”, Form118-E does not require. If “No”,

documents provided in the right column shall be

submitted.

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Eco Mark Application No.118 Attached Certificates4-1-2. Recycling criteria and certification procedure



submittedIssued by

4-1-2.(4)Indication of a type of polymers

Photographs or design drawings to show the contents and the labeled portion of indication (Draft is acceptable.)

Applicant

4-1-2.(5)Method to separate by individual material

[Mixing with materials other than plastic］

Yes / No* If “Yes”, certificates in the right column shall be

submitted. If “No”, such documents are nor

required.

Documents to explain the method to sort and separate each material (drawings, etc.)

Applicant

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Eco Mark Application No.118 Attached Certificates4-1-3. Harmful substances criteria



submittedIssued by

4-1-3.(6)Use of ozone-destroying substances such as CFSs substitutes (HCFSs)

Form 118‐F Applicant

4-1-3.(7)Plastic additives used for products

Form 118‐G

* For virgin materials, a positive list of resin is acceptable

Manufacturer of each

manufacturing process

N ote 1)

4-1-3.(8)prescription constituents of the product (Cd, Pb, Cr6+, Hg and their compounds)

Form 118-H Applicant

4-1-3.(9)prescription constituents of the product (carcinogenic substances by IARC)

［ Whether the product is classified into the following 1, 2 or 3］

Yes1.Food/cosmetic containers, medical

related productsToys covered by the Enforcement Regulation of Food Sanitation Law

2. Accessories/personal adornments(above 1 is not included)

3. Toys/play set/sporting goods (above 1 is not included)

No.



nor required.

Form 118‐H Applicant

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Eco Mark Application No.118 Attached Certificates4-1-3.(10)Harmful substances by Food Sanitation Act and 88/378/EEC EN-71 Part 3)

* If “Yes” for (1) in 4-1-3.(9), test results provided

in the right column shall be submitted.

Test results showing the compliance with “Standards or criteria regarding Apparatus and Containers and Packaging” in Food Sanitation Act

Third party testing body, applicant or manufacturer　N ote 1)

* If “Yes” for (2) and (3) in 4-1-3.(9), test results

provided in the right column shall be submitted.

Test results of 88/378/EEC EN-71 Part ３ (Cd, Pb, Cr6+, Hg arsenic, total mercury and selenium, barium and antimony)

4-1-3.(11)Harmful substances by the enforcement regulations of the environmental standard concerning soil contamination.

* If test result by 88/378/EEC EN-71 Part ３ for 4-1-

3.(10), test results on Cd, Pb, Cr6+, arsenic, total

mercury and selenium provided in the right

column are not required

Results of elusion test for the product (plastic parts) by the enforcement regulations of the environmental standard concerning soil contamination.(Cd, Pb, Cr6+, arsenic, total mercury, selenium, PCB and benzene)

4-1-3.(12)MSDS, PRTR law a. submit the MSDS of the product

MSDS(refer

Form 118‐I)

Applicant

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Eco Mark Application No.118 Attached Certificatesb. Use or elution of the Class 1 specified

chemical substances in PRTR Law at the manufacturing of the product.

(Whether PRTR law is applied or not is not considered)

Yes / No

* If “Yes”, required items provided in the right

column shall be filled in. If “No”, such

documents are nor required.

Form 118‐J

Finished product

manufacturing plant

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Eco Mark Application No.118 Attached Certificates4-1-4. Other Criteria

Applicable criteria

Fill in this column*Please check the appropriate items.

Documents to be submitted

Issued by

4-1-4.(13)Throwaway product

［Throwaway product］ Yes / No * If “Yes”, required items provided in the right

column shall be filled in. If “No”, such documents

are nor required.

Form 118-E Applicant

4-1-4.(14)the packaging condition, packaging materials and their raw material

Raw material of packaging ( )Packaging condition

［ The packaging material that contains halogen compound］

Used / Not used

* If “Used”, required items provided in the right

column shall be filled in. If “Not used”, such

documents are nor required.

Form 118‐E Applicant

4-1-4.(15)(17)Consideration and to reduce the amount of plastic usedConsideration to reduce the environmental burden in the manufacturing plant.

Form 118‐K

Finished product

manufacturing plant

4-1-4.(16)Compliance with the environmental law

Form 118-L

Plant manager of

Finished product

manufacturing plant

4-1-4.(17)voluntary environmental conservation activities

Form 118-O Applicant

4-1-4.(18) ［Mixing with materials other than plastic］ A copy of the Applicant

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Eco Mark Application No.118 Attached CertificatesInformation on method to separate/sort by individual material

Yes / No

* If “Yes”, attached certificates provided in the right

column shall be submitted. If “No”, such documents

are nor required.

instruction manual, product label or a catalog which indicated a proper handling of separating/sorting of materials (Draft acceptable)

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4-2. Quality Criteria and Certification Procedure

Applicable criteria



Issued by

4-2.(19)Product quality

［applicable quality standard］

(1)Laws and regulations such as Food Sanitation Act and JIS.

(2)Industry's own quality standard.(3) company’s own quality standard

For (1) or (2)Name of applicable standards;( )

In case the product has been certified under No.118 “Plastic products recycled material used”;

There is no change in quality control and manufacturing plant from the previous application.

There are changes from the previous application.

* If there is no change, a certificate provided in the

right column (test results, etc. certifying the compliance with the applicable quality standards) and Form 118-M are not required.

Products fall into (1)(2): Test results, etc. certifying the compliance with the applicable quality standards

Third party testing body,

applicant or manufactur

er

Form 118‐M Applicant

Products fall into (3):Test results, etc. certifying the compliance with the company’s own standards (contents of standards, etc.) Applicant

Form 118‐M

Required certification documents to meet “6. Other”

Applicable criteria



Issued by

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Eco Mark Application No.118 Attached Certificates6.(2)-(6)Planned Display of Eco Mark

　 Yes / No

If an Eco Mark is displayed, fill in the following items

and submit the design drawing

Intended location of Eco Mark displayed Product Packaging Catalogue/leaflet Instruction manual Other ( )

Indication with Eco Mark logo Eco Mark license holder (applying

company) Eco Mark certification number

Design drawing of Eco Mark display (draft)

Applicant

［Container or Packaging Material］ Yes / No

* If “Yes”, attached documents provided in the right

column shall be submitted. If “No”, such documents

are nor required.

Design drawing to clarify that the Eco Mark is not related to the contents of the container or packaging. (draft)

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Eco Mark Application No.118 Attached CertificatesForm 118-A　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　To: Japan Environment Association, Eco Mark Office

Ratio of material to the entire productDate of issue:

XXXXX XXXXXCompany name （ company

seal） *Issuer: Applicant

　　Product type(　　　　　　　　)

* Submit the form for each product type. If the weight percentage of materials is identical among several product types, notes should be added. If this form provides insufficient space, similar tables should be submitted separately.

4-1. (1) Ratio of material to the entire product

Part or product name

W(g)

Plastic material Other materialRecycled material Polymer

name for virgin

material*1

W(g)Additives

*2W(g)

Name of

material

W(g)Polymer name for

post consumer material

W(g)

Polymer name for

pre consumer material

W(g)

Part 1Part 2Part 3Part 4Part 5Total

weight A B C D Ｅ

Weight percentage of recycled plastic in total plastic weight.(B+C) / (B+C+D+E) x 100 = (g) / (g) x100 = %

* Omit the figures below the 1st place of decimals

Weight percentage of plastic in total product weight(B+C+D+E) / A x 100 = (g) / (g) x 100 = %

* Omit the figures below the 1st place of decimals

*1 Please list as PE, PP, etc. for plastic polymers, and PA6 or PA66 for nylon. List polymers for glass fibers.

*2 Please list plasticizers, color materials, stabilizer, etc. for additives to plastic materials

[Method for Controlling Mixture Rate]

Method for applicant to instruct fabricator on mixture rate

Check an appropriate item and describe.

The mixture rate is specified in product instructions to be given to a plastic fabricator.

The mixture rate is specified in a contract with a plastic fabricator. Instructing by other method. *Describe specific content below.

( )

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Method for controlling Mixture rate by fabricator

Check an appropriate item and describe.

The mixture rate is controlled by written prescription/mixture daily report, etc.Name of Record Document: ( ) e.g. Written prescriptionForm Controller: ( ) e.g Fabrication Manager

For each raw material, a raw material supplier (pellet material supplier) confirms the mixture rate in writing.

Controlling by other method( )

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Eco Mark Application No.118 Attached CertificatesForm 118-B

To : XXXX company,

Raw Material Certificate

Date of issue: (Issuer : Company Name) （ company

seal）

[Issuing person]Address : Department : Position : Name: TEL: FAX:E-mail:

* Issuer: Recycled Material Collector

This is to certify that recycled materials are supplied to (name of manufacturer of the Eco Mark product).

[ ] Pre-consumer materials1. Location of production e.g. film factory

2. Content of generation

e.g. inferior goods, strip materials

3. Name of material e.g. polyethylene

4. Description of recycling process

Specific recycling method for material generated in 2

[ ] Post- consumer materials1. Materials and products disposed after use

e.g. PET bottle

2. Name of material e.g. PET

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Eco Mark Application No.118 Attached Certificates* Materials produced during the manufacturing process of the product under application are

excluded.* Check appropriate items and fill in blanks.

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Eco Mark Application No.118 Attached CertificatesForm118‐C

To: Japan Environment Association, Eco Mark Office

Manufacturing Process Certificate

Date of issue:


seal）*Issuer: Applicant

* “Recycled plastic supply” means the production of pellets or flakes. * Trading firms and other entities that are not involved in manufacturing do not have to be

filled in. * The manufacturing process of plastic parts including fiber should be indicated.* If the following chart is not enough due to a large number of parts, similar chart(s)

should be submitted separately.

Part name

Recycled plastic collector →

Recycled plastic supplier (pellet manufacturer)

→Fabricator

Part name



→Fabricator

Part name



→Fabricator →

Assembler

Part name

Virgin plastic resin supplier (manufacturer) →

Fabricator ↓Finished product manufacturerPart

nameVirgin plastic resin supplier (manufacturer) →

Fabricator

Part name

Virgin plastic resin supplier (manufacturer) →

Fabricator

Note1) In case using materials (sheets, etc.) that have been certified under this product category, only

names of manufacturers after the certified material are acceptable.

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Eco Mark Application No.118 Attached CertificatesForm 118‐D


Certificate of Self- Recycling Product

Date of issue:



This is to certify the following;

1. Explanation of collection route of the applied product and process to produce the equal-quality product made from collected recycled plastic

(1) Name of collector of the applying product : (2) Name of vender separating and regenerating plastic parts from the product (3) Name of remanufacturer :(4) Recycling plan of the applying product other than a self-recycling product

2. Volume of collected plastic parts and Volume of the materials recycled

Period

Volume of collected plastic

parts (kg)［A］

Volume of the materials

recycled (kg)［B］

Percentage of material recycling

(%) ［B/A］

performed

From: Year MonthTo: Year MonthFrom: Year MonthTo: Year MonthFrom: Year MonthTo: Year MonthFrom: Year MonthTo: Year Month

Note）Eco Mark office may ask the applicant to report the collection rate (or Eco Mark office may conduct audit) after conclusion of Eco Mark use contract.

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Eco Mark Application No.118 Attached CertificatesForm 118‐E

To : Japan Environment Association, Eco Mark Office

Certificate for Collection and Recycling

Date of issue:



This is the certificate for the followings:　 (Check where appropriate and fill in 1-3 below)　　　 Product using halogenated compounds 　　　□ Packaging material using halogenated compounds　　　□ Throwaway product　

1. List of collection/recycling operators (including intermediate processors), Bases for intake system, Intermediate place for intake, etc.

Company nameRole in collection/recycling, license for

processing business, etc.

* If the above space is not enough, extra lines or tables can be added separately.

2. Shipped and collected amount of plastic part and material recycling of the applied product (actual result or plan)

* Check □ of “Actual result” or “Plan”

Period

Shipped

amount of

plastic

part（kg）

［A］

Collected

amount of

plastic part

（kg）

［B］

Collectio

n rate

（%）

［B］/

［A］

Amount of

material

recycling

（ｋｇ）

［C］

Percentage

of material

recycling

(%)

［C］/［B］

□ Actual result

□ Plan

From: Year Month

To： Year Month

In case reporting the plan, please indicate the following;　　　　　- Release (shipment) date of the product: Year Month　　　　　- Period from the shipment to the collection (average) : Months

Note）Eco Mark office may ask the applicant to report the collection rate (or Eco Mark office may

19/34

Eco Mark Application No.118 Attached Certificatesconduct audit) after conclusion of Eco Mark use.

20/34


3. Others (Management system, etc.)* Select where appropriate.1) Obtaining method

for materials to collect

Buy out as valuable resource／ Take in without charge Others （Concrete method：）

2) Bases for intake Yes （If “yes”, fill in the name of the bases, etc. in the table below）

No3) Intermediate place for intake

Yes （If “yes”, fill in the name of the intermediate place, etc. in the table below）

No4)Management

method of sell/purchase slips of collected materials

(Fill in freely. If the following space is not enough, attached document should be submitted separately. In that case, fill in the name of attached document in the space.)

5） Note This is to declare that the development of collection/recycling system shall obey the laws and regulations such as “Waste Disposal and Public Cleansing Law”.

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Eco Mark Application No.118 Attached CertificatesForm 118-F


Certificate on the use of ozone layer depleting substances including HCFC

Date of issue:



This is to certify that the product and the packaging materials shall not contain the specific CFCs (five types), other CFCs, carbon tetrachloride, trichloroethane, and HCFCs listed below as halogenated hydrocarbon.

CFC5s

Trichlorofluoromethane HCFCs ChlorotrifluoroethaneDichlorodifluoromethane DichlorofluoroethaneTrichlorotrifluoroethane ChlorodifluoroethaneDichlorotetrafluoroethane ChlorofluroethaneChloropentafluoroethane Hexachlorofluoropropane

Other CFCs

Chlorotrifluoromethane PentachlorodifluoropropanePentachlorofluoromethane TetrachlorotrifluoropropaneTetrachlorodifluoroethane TrichlorotetrafluoropropaneHeptachlorofluoropropane DichloropentafluoropropaneHexachlorodifluorpropane ChlorohexafluoropropanePentachlorotrifluoropropane PentachlorofluoropropaneTetrachlorotetrafluoropropane TetrachlorodifluoropropaneTrichloropentafluoropropane TrichlorotrifluoropropaneDichlorohexafluoropropane DichlorotetrafluoropropaneChloroheptafluoropropane ChloropentafluoropropaneCarbon Tetrachloride Tetrachlorofluoropropane1,1,1-Trichloroethane Trichlorodifluoropropane

HCFCs Dichlorofluoromethane DichlorotrifluoropropaneChlorodifluoromethane ChlorotetrafluoropropaneChlorofluoroethane TrichlorofluoropropaneTetrachlorofluoroethane DichlorodifluoropropaneTrichlorodifluoroethane ChlorotrifluoropropaneDichlorotrifluoroethane DichlorofluoropropaneChlorotetrafluoroethane Chlorodifluoropropane

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Eco Mark Application No.118 Attached CertificatesTrichlorofluoroethane ChlorofluoropropaneDichlorodifluoroethane

23/34

Eco Mark Application No.118 Attached CertificatesForm 118-G

To : XXXX company, Certificate of Plastic Additives

Date of issue:


seal）*Issuer is a manufacturer for each manufacturing process.

This is the certificate for the following plastic additives to be used for manufacturing。

Manufacturing process

□　virgin resin / recycled pellet manufacturing□　mold processing

Type of resin

Type of plastic additive

Select where appropriate

Fill in this column

Name of positive listClassification No. of positive list/name of substances, etc.

If listed in the positive list as the

following(1) - (4), or other resin

containing additives

(1) Plasticizer Used Not Used

(2) Coloring agent

Used Not Used

(3) Stabilizer Used Not Used

(4) Slip additives Used Not Used

additives other than (1)-(4)

Used Not Used

Please list all if used

Name of additives other than (1)-(4) Name of positive listClassification No. of positive list/name of substances, etc.

（　　　　　）

（　　　　　）

（　　　　　）

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Eco Mark Application No.118 Attached Certificates*1）For use of flame-retardant agents, follow the guideline for Eco Mark Implementation. *2）If the manufacturing plant varies form parts to parts, submit this certificate by each plant. *3）For the products among the grouping of 2-10 in Attachment 1, in case of using the plastic additives which are not listed in the positive lists, test results of 88/378/EEC EN-71- 3 shall be submitted. (test results of the parts or products including the respective substance are also acceptable)

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Eco Mark Application No.118 Attached CertificatesForm 118‐H


Certificate on harmful substances

Date of issue:



This is to certify the following;

1. Concerning Pb, Cd, Cr6+, Hg and their compounds [Certification Criteria 4-1-3(8) ]

as prescription constituents, Lead (pb)Cadmium (Cd)Hexavalent chromium(Cr)Mercury (Hg)and their compounds

Added

Not Added

2. Concerning addition of carcinogenic material by IARC [Certification Criteria 4-1-3(9) ]［Classification of the product; (1), (2) or (3) as below］

* Check if applicable Applicable

(1) Food/cosmetic containers, medical related products (2) Accessories/personal adornments (3) Toys/play set/sporting goods

Not Applicable

If “Applicable”; as prescription constituentsthe substances classified as Groups 1, 2A and 2B by IARC

Added

Not Added

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Eco Mark Application No.118 Attached CertificatesForm 118-I

Material Safety Data Sheet (example)

* This input table is a sample. Any format is acceptable if 16 items of JIS Z 7250 “MSDS” are covered. In addition, although MSDS is a safety data sheet for chemical substances, this table shall be input from the safety point of view of the product.

(Using other format or extending to multiple pages is acceptable)(1) PRODUCT AND COMPANY IDENTIFICATION(2) INFORMATION ON INGREDIENTS(3) HAZARDS IDENTIFICATION(4) FIRST AID MEASURES

(5) FIRE FIGHTING MEASURES(6) ACCIDENTAL RELEASE MEASURES(7) HANDLING AND STORAGE(8) EXPOSURE CONTROLS / PERSONAL PROTECTION(9) PHYSICAL AND CHEMICAL PROPERTIES(10) .STABILITY AND REACTIVITY(11) TOXICOLOGICAL INFORMATION(12) ECOLOGICAL INFORMATION(13) DISPOSAL CONSIDERATIONS(14) TRANSPORT INFORMATION(15) REGULATORY INFORMATION(16) OTHER INFORMATION

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Eco Mark Application No.118 Attached CertificatesForm 118-J

To : XXXX company, Report on the Amount of Release and Movement of Chemical

Substances Based on PRTR Law

Date of issue:


seal）* Issuer is a finished product manufacturer

For manufacturing ( the applying product ), this is to report that the materials listed below are used among the Class 1 specified chemical substances in “Law Concerning Reporting, etc. of Release to the Environment of Specific Chemical Substances and Promoting Improvements in Their Management (PRTR law)”.

Unit:t/year

Substance name

Ordinance No.

(Substance No.)

CAS No.

Place to release (Select where appropriate）

Total amount

of release 排

Total amount

of movementRelease

into air

Release

into public

water area

Release

into soil

* It is acceptable to use the format other than this Entry table or extra papers for items.

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Eco Mark Application No.118 Attached CertificatesForm 118-K

To : XXXX company, Report on Environmental Effort

Date of issue:


seal）* Issuer is a finished product manufacturer

1. Explanation for consideration and efforts to reduce used amount of plastic at manufacturing stage

[Certification Criteria 4-1-4(15) ] (Fill in the explanation by text or drawing)* Free format. If the following space is not enough, attached document should be submitted separately. In that case, fill in the name of attached document in the space.

2. Explanation for concrete efforts to save energy, to reduce emission amount of global warming gases and to reduce amount of waste [Certification Criteria 4-1-4(17) ]

(Fill in the explanation by text or drawing)* Free format. If the following space is not enough, attached document should be submitted separately. In that case, fill in the name of attached document in the space.* (Example) Efforts for environmental management system, such as ISO14001/Eco Action 21, etc., conducting green procurement, etc.

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Eco Mark Application No.118 Attached CertificatesForm 118-L　To : XXXX company,

Environmental Laws and Agreements Compliance Certificate

Date of issue: ,

(Company name)(Plant name)(Name of the responsible person) title Name

seal (company seal or

representative

signature for overseas

companies)

Plant address: TEL　　:

* Enter the manager (or the corresponding responsible person) of the plant manufacturing the finished goods in the Name of the responsible person column. * Effective issuing date of this Certificate shall be within three months from the date of application to Eco Mark.

We hereby certify that the following requirements are met:1. We hereby certify that in manufacturing the applied product, we comply with related

environmental laws and regulations and pollution control agreement (hereinafter referred to as the “Environmental Laws, etc.”) with respect to air pollution, water contamination, noise, offensive odor, and emission of hazardous substances.(Please check the relevant boxes as follows to submit the Certificate. It is also acceptable to submit an attached list.)

Name of the Environmental Laws, etc. related to the plant Remarks □ Air Pollution Control Law□ Water Pollution Control Law□ Noise Regulation Law□ Vibration Regulation Law□ Offensive Odor Control Law□ Other: * In the “Other” column, enter the name of law applied to the plant, and if there are regulations or

agreements of the area where the plant is located, also enter the names of such regulations and

agreements (e.g., xx Prefecture xx Environmental Conservation Regulation, xx City Pollution Prevention

Agreement).

2. We hereby certify that the state of compliance with the Environmental Laws, etc. prior to the date of issue of this Certificate is as follows:(Please check the relevant boxes to submit the Certificate. V iolation refers to administrative punishment or administrative guidance.)□ We have not violated any related Environmental Laws, etc. for the past five years.□ We have not violated any related Environmental Laws, etc. since foundation of the

Company (year).□ We violated related Environmental Laws, etc. in the past five years, have already

taken proper remedies and recurrence prevention measures, and thereafter comply with the related Environmental Laws, etc. properly.

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Eco Mark Application No.118 Attached Certificates*If you committed any violation subject to administrative punishment or administrative guidance, you need to submit the following documents in a and b:

a. For the fact of violation, the guidance document from the administrative agency (including a

correction order and warning) and copies of written answers to those documents (including reports

on the cause and result of correction)

b. For the management system for compliance with the Environmental Laws, etc., the following

materials (copies of recording documents, etc) in 1)-5):

1) List of the Environmental Laws, etc. related to the area where the plant is located;

2) Implementation system (organizational chart with entry of roles, etc.);

3) Document stipulating retention of recording documents;

4) Recurrence prevention measures (future preventive measures);

5) State of implementation based on recurrence prevention measures (result of checking of the

state of compliance, including the result of onsite inspection).　□　We violated Environmental Laws, etc. in the past, and have not yet taken corrective

measures.

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Eco Mark Application No.118 Attached CertificatesForm 118-O

To : Japan Environment Association, Eco Mark OfficeReport on Environmental Conservation Activities

Date of issue:



1. Explanation of environmental conservation activities conducted by the whole company.

[Certification Criteria 4-1-4(15) ] (Fill in the explanation by text or drawing)* Free format. If the following space is not enough, attached document should be submitted separately. In that case, fill in the name of attached document in the space.* (example) efforts for environment management system such as ISO14001, or Eco Action 21, Green purchasing, etc.

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Eco Mark Application No.118 Attached CertificatesForm 118-M


Quality Control Certificate

Date of issue:



For (name of the brand product under application for Eco Mark certification); This is to certify that the products are controlled according to the quality management items in the separate sheet*1 (document describing actual quality control items) and only products that meet quality control criteria are shipped.

Separate sheet *1)(1) quality standard such as JIS, or quality standards stipulated in-house.(2) test results based on quality standards

* In case using materials (sheets, etc.) that have been certified under No.118 “plastic products using recycled materials” and there is no changes from the previous product examination in the submitted documents (plant, product quality, etc), this certificate are not required. materials are not required.

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Eco Mark Application No.118 Attached CertificatesForm 118‐N


Approval of Eco Mark Application

We hereby approve that (the applicant company) files an application for Eco Mark product certification.

Brand Name

Eco Mark Certification Number

*If already certified

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