The Swedish Society for Nature Conservation Good Environmental Choice (Bra Miljöval) Form for assessing a chemical substance that is an ingredient or forms part of an ingredient A INFORMATION ABOUT MANUFACTURER AND SUPPLIER A1 Manufacturer Name of company Corporate ID number Version 2006:2 Address Postcode City Country Telephone (switch board) Fax Website Person to contact Name Position E-mail Telephone A2 Supplier (if other than manufacturer) Name of company Corporate ID number Address Postcode City Country Telephone (switch board) Fax Website Person to contact Name Position E-mail Telephone 1
B INFORMATION ABOUT THE ingredient B1 Trade name B2 Prohibited substances The ingredient does not contain: Cadmium compounds Lead compounds Mercury compounds Organic halogen compounds Chromium compounds Phthalates Phosphorous compounds B3 Safety data sheets A safety data sheet must be submitted to the Swedish Society for Nature Conservation for the ingredient (see REACH regulations for structure). Safety data sheet sent to e-mail bmv-kem@naturskyddsforeningen.se Safety data sheet sent by post. C Information about chemical substances All chemical substances included in the ingredient must be reported in accordance with points C1 C12 below. Copy the points in section C if the ingredient consists of several chemical substances. The Swedish Society for Nature Conservation considers all chemical substances that occur in contents over 0.01% as part of the ingredient, regardless of whether or not the chemical substance was added intentionally. If the chemical substance is a surfactant, complexing agent, solvent or preservative, complete test reports must be submitted regarding degradability, bioaccumulability and ecotoxicology. C1 Chemical substance Name CAS-number Included in trade name 2
C2 Classification of health risk The chemical substance or its breakdown products are not classified with the risk phrases: R45, May cause cancer R49, May cause cancer by inhalation R40, Suspected of causing cancer R46, May cause heritable genetic damage R68, Possible risk of irreversible effects R60, May impair fertility R61, May cause harm to the unborn child R62, Risk of impaired fertility R63, Possible risk of harm to the unborn child R64, May cause harm to breastfed babies C3 Classification of health risks associated with surfactants, complexing agents, solvents, preservatives, thickening agents and dissolving agents, bleaching agents, acids and other additives The chemical substance or its breakdown products are not classified with the risk phrases: R48, Danger of serious damage to health by prolonged exposure R33, Danger of cumulative effects R42, May cause sensitisation by inhalation R43, May cause sensitisation by skin contact R26, Very toxic by inhalation R27, Very toxic in contact with skin R28, Very toxic if swallowed R23, Toxic by inhalation R24, Toxic in contact with skin R25, Toxic if swallowed R39, Danger of very serious irreversible effects C4 Biological substances The biological substance is not classified as R43, May cause sensitisation by skin contact, or listed in EU directive 2003/15/EC on amendment to annex III, part 1 of the cosmetics directive 76/768/EEC. The biological substance is classified as R43, May cause sensitisation by skin contact, or listed in EU directive 2003/15/EC on amendment to annex III, part 1 of the cosmetics directive 76/768/EEC. The extraction agents used must be supplied in a listed appended to the application. The list must contain all extraction agents and their CAS-numbers. C5 Aerobic degradability Aerobic degradability must be reported for organic chemical substances that are surfactants, complexing agents, solvents, preservatives, thickening agents and dissolving agents, bleaching agents, acids and other additives. Test method Test results 3
C6 Anaerobic degradability and potential for sediment accumulation Anaerobic degradability must be reported for surfactants and for organic other additives. For organic other additives for which there is no risk of accumulation in anaerobic environments and which have an adsorption coefficient below 25% and a desorption coefficient greater than 75%, anaerobic degradability does not need to be reported. Test method Test results There is no risk of the other additive accumulating in anaerobic environments. Adsorption coefficient Desorption coefficient C7 Bioaccumulation Bioaccumulability must be reported for organic chemical substances that are preservatives, solvents, thickening agents and dissolving agents, bleaching agents and other additives. Bioconcentration factor Test method If no bioconcentration factor is available, the octanol-water-coefficient should be reported. Log K ow C8 Toxicity to aquatic organisms Data for acute toxicity is reported for surfactants, complexing agents, solvents, preservatives, thickening agents and dissolving agents, bleaching agents, acids and other additives. Acute toxicity to fish (mg/l) Test method Acute toxicity to Daphnia (mg/l) Test method Acute toxicity to algae (mg/l) Test method C9 Raw materials for synthesis and organic halogen compound residues Raw materials for surfactant synthesis and any content of organic halogen compounds in the surfactant must be reported. Palm oil is not a raw material for surfactant synthesis. Palm oil is a raw material for surfactant synthesis. Documentation that the manufacturer or its supplier is RSPO-certified: Enclosed with application. Sent from manufacturer. The surfactant contains <100 ppm TOX organic halogen compounds. 4
C10 Information for colouring agents The colouring agent is approved under the Swedish National Food Administration Code (SLVFS) 1999:22. The colouring agent is not classified using risk phrase R43, May cause sensitisation by skin contact. The colouring agent is an azo colouring agent and could potentially be broken down into amines. If the colouring agent is an azo colouring agent and could potentially be broken down into amines, a list of these must be enclosed with the application. The list must contain all amines and their CAS-numbers. C11 Safety data sheets A safety data sheet must be submitted to the Swedish Society for Nature Conservation for the chemical substance (see REACH regulations for structure). Safety data sheet has been sent to e-mail bmv-kem@naturskyddsforeningen.se Safety data sheet has been sent by post. Please confirm by signing below that the information in this form is correct. Location and date Signature by person authorized to sign for the manufacturer Name in print The form should be sent to: The Swedish Society for Nature Conservation Box 7005 402 31 Göteborg Sweden 5