Vol. 145, No. 3 — January 15, 2011

ARCHIVED — Supplement

DEPARTMENT OF THE ENVIRONMENT

CANADIAN ENVIRONMENTAL PROTECTION ACT, 1999

Proposed notice requiring the preparation and implementation of pollution prevention plans in respect of Cyclotetrasiloxane, octamethyl- (siloxane D4) in industrial effluents

Pursuant to section 91 of the Canadian Environmental Protection Act, 1999, the Minister of the Environment proposes to publish the annexed Notice under section 56 of the Canadian Environmental Protection Act, 1999 (hereinafter referred to as the “Act”). This proposed Notice will initiate a 60-day comment period. Following the comment period and after review of the comments received, the Minister intends to publish a Final Notice requiring the preparation and implementation of pollution prevention plans in the Canada Gazette, Part I.

The Final Notice will require the preparation and implementation of a pollution prevention plan in respect of Cyclotetrasiloxane, octamethyl- in effluents from industrial facilities. Cyclotetrasiloxane, octamethyl- is a substance specified on the List of Toxic Substances in Schedule 1 of the Act.

More information on pollution prevention planning can be found in the Guidelines for the Implementation of the Pollution Prevention Planning Provisions of Part 4 of the Act. These guidelines and other information related to pollution prevention and pollution prevention planning can be found at the Pollution Prevention Planning section of Environment Canada’s Web site at www.ec.gc.ca/planp2-p2plan.

MARGARET KENNY
Director General
Chemicals Sector Directorate
On behalf of the Minister of the Environment

PROPOSED NOTICE REQUIRING THE PREPARATION AND IMPLEMENTATION OF POLLUTION PREVENTION PLANS IN RESPECT OF CYCLOTETRASILOXANE, OCTAMETHYL- (SILOXANE D4) IN INDUSTRIAL EFFLUENTS

Notice is hereby given that, pursuant to the provisions of Part 4 of the Canadian Environmental Protection Act, 1999, the Minister of the Environment requires any person or class of persons described in section 2 of the Notice, to prepare and implement a pollution prevention plan in respect of Cyclotetrasiloxane, octamethyl- which is specified on the List of Toxic Substances in Schedule 1 of the Canadian Environmental Protection Act, 1999.

1. Definitions

The definitions in this section apply to this Notice.

“Act” means the Canadian Environmental Protection Act, 1999 (CEPA 1999).

“Calendar Year” refers to a complete year beginning January 1 and ending December 31.

“D4” means Cyclotetrasiloxane, octamethyl-, Chemical Abstracts Service (CAS) (see footnote 1) Registry Number 556-67-2.

“Effluent” means wastewater from an industrial facility released into a wastewater system or to surface water.

“Final discharge point” is an identifiable discharge point beyond which the industrial facility owner or operator no longer exercises control over quality of the effluent.

“Minister” means the Minister of the Environment.

“Notice” means the Proposed notice requiring the preparation and implementation of pollution prevention plans in respect of of Cyclotetrasiloxane, octamethyl- (siloxane D4) in industrial effluents.

“Plan” means a pollution prevention plan.

“Treatment” in respect of wastewater, means to subject the wastewater to physical, chemical or biological processes, other than dilution, to remove contaminants.

“Wastewater system” means any work or site used for the collection and deposit of wastewater, whether or not the wastewater is treated.

2. Person or class of persons required to prepare and implement a plan

(1) This Notice applies to any person or class of persons who owns or operates an industrial facility that, in 2011 or any time thereafter, meets all the following criteria:

(a) Manufactures or uses D4 or a mixture containing D4 where the total quantity of D4 manufactured or used is equal or greater than 100 kg per calendar year; and
(b) As a result of manufacturing or use of D4 or a mixture containing D4, releases an effluent containing D4 at the final discharge point of the facility.

(2) The Notice applies to any person or class of persons who is the successor or assign of the persons identified in subsection 2(1).

(3) Despite subsection 2(1), the Notice does not apply to any person or class of persons who owns or operates an industrial facility that

(a) uses a mixture that contains D4 in a concentration of less than 1%; or
(b) uses D4 strictly as contained in any solid material including, but not limited to, rubber, wiring insulation and seals for automobiles, and that does not release an effluent containing D4 at the final discharge point of the facility.

3. Activities in relation to which the plan is to be prepared

The Minister requires all persons or class of persons identified in section 2 of the Notice to prepare and implement a plan in relation to the release of D4 in effluents through

(a) the manufacture of D4 or a mixture containing D4; or
(b) the use of D4 or a mixture containing D4.

4. Factors to consider in preparing the plan

The Minister requires all persons or class of persons identified in section 2 of the Notice to consider the following factors when preparing their plan:

(1) D4 was declared toxic under paragraph 64(a) of the Act and the proposed order to add this substance to Schedule 1 of the Act was published in the Canada Gazette, Part I, on May 16, 2009. According to the final Screening Assessment Report, D4 is entering or may be entering the environment in a quantity or concentration or under conditions that have or may have an immediate or long-term harmful effect on the environment or its biological diversity. The final Screening Assessment Report also concluded that D4 meets the criterion for persistence as set out in the Persistence and Bioaccumulation Regulations.

(2) In order to prevent or minimize release of D4 to the aquatic environment, the overall risk management objective is to achieve the lowest level of release of D4 to water that is technically and economically feasible. Therefore, continual improvement towards achieving this objective is encouraged.

(3) The specific risk management objective for this Notice is to achieve and maintain a total D4 concentration in effluent at final discharge point of the facility, through methods other than dilution, that is less than or equal to

(a) 2.3 μg/L for effluent released directly in surface water or in a wastewater system that does not have treatment; or
(b) 17.3 μg/L for effluent released into a wastewater system that does have treatment.

For a person or class of persons subject to the Notice on the date of publication in the Canada Gazette, Part I, these concentrations should be met no later than 48 months from the date of publication of the Notice.

For a person or class of persons becoming subject to the Notice after the date of publication in the Canada Gazette, Part I, these concentrations should be met no later than 12 months from becoming subject to the Notice.

(4) Sampling and analysis should be completed as described below:

(a) The sampling should be representative of normal operating conditions related to the manufacturing or use of D4;
(b) Samples should be representative of the effluent at final discharge point(s) of the facility;
(c) Samples should be collected and analyzed at the minimum frequency indicated below:
- (i) For continuous processes: four grab samples per calendar year with a minimum interval of 60 days between each sample,
- (ii) For batch processes: one grab sample for each batch produced within a calendar year. If more than four batches are produced within a calendar year, four grab samples should be collected. Sample should be collected when there is a potential for release;
(d) Analysis of samples should be performed in accordance with generally accepted standards of good scientific practice at the time of the analysis and by a laboratory that is accredited by a Canadian accrediting body under the International Organization for Standardization standard ISO/IEC 17025: 2005 titled General Requirements for the Competence of Testing and Calibration Laboratories, as amended from time to time.

(5) In preparing a plan, a person or class of persons subject to the Notice is to give priority to pollution prevention activities. “Pollution prevention” (P2), as defined in section 3 of the Act, means “the use of processes, practices, materials, products, substances or energy that avoid or minimize the creation of pollutants and waste and reduce the overall risk to the environment or human health.”

(6) The use of alternatives to D4 should be considered to reduce or minimize environmental risks. The chosen alternatives should not have, through their degradation, the potential to produce D4, nor should such alternatives cause similar environmental effects.

(7) Additional documents that should be kept with the plan:

(a) a description and the location (maps) of all final discharge points; and
(b) a description of the factors (e.g. type of technology, human factor, accidental releases, type of manufacturing, daily use) that could increase the quantity or concentration of the substance in the facility’s effluent.

(8) The plan should include one year of monitoring which involves sampling and analysis at the final discharge point(s) after meeting the specific risk management objective for this Notice set in subsection 4(3). Sampling and analysis should be conducted as specified in subsection 4(4).

(9) The Minister will evaluate the effectiveness of this Notice with respect to the risk management objective set out in subsection 4(2) and effluent concentrations set out in subsection 4(3) of the Notice in order to determine whether other measures, including regulations, are needed to further prevent or reduce negative impacts of D4 on the environment.

5. Period within which the plan is to be prepared

(1) For a person or class of persons subject to the Notice on the date of publication in the Canada Gazette, Part I, the Minister requires that the plan be prepared and implementation initiated no later than 12 months from the date of publication of the Notice.

(2) For a person or class of persons becoming subject to the Notice after the date of publication in the Canada Gazette, Part I, the Minister requires that the plan be prepared and implementation initiated no later than six months from becoming subject to the Notice.

6. Period within which the plan is to be implemented

(1) For a person or class of persons subject to the Notice on the date of publication in the Canada Gazette, Part I, the Minister requires that the plan be implemented no later than 60 months from the date of publication of the Notice.

(2) For a person or class of persons becoming subject to the Notice after the date of publication in the Canada Gazette, Part I, the Minister requires that the plan be implemented no later than 24 months from becoming subject to the Notice.

7. Content of plan

A person or class of persons identified in section 2 of the Notice is to determine the appropriate content of that person’s plan; however, the plan must meet all the requirements of the Notice. The plan must also contain the information required to file the Declaration of Preparation referred to in section 9 of the Notice and have the capacity to generate the information required to file the Declaration of Implementation referred to in section 10 and the Interim Progress Reports referred to in section 12 of the Notice.

8. Requirement to keep plan and record keeping

Under section 59 of the Act, any person or class of persons identified in section 2 of the Notice must keep a copy of the plan at the place in Canada in relation to which the plan is prepared. Where a single plan is prepared for more than one facility, a copy of that plan must be kept at each location.

Any person or class of persons identified in section 2 of the Notice must keep the plan and any records pertaining to the plan for a minimum of five years following the date set out in section 6 of the Notice.

9. Declaration of Preparation

Under subsection 58(1) of the Act, any person or class of persons identified in section 2 of the Notice must file, within 30 days after the end of the period within which the plan is to be prepared as specified in section 5 or extended under section 14, a written “Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(1) of CEPA 1999)” to the Minister, using the form that the Minister provides and that contains the information set out in Schedule 1 of the Notice. Where a person has prepared a single plan for several facilities, a separate Declaration of Preparation must be filed for each facility.

10. Declaration of Implementation

Under subsection 58(2) of the Act, any person or class of persons identified in section 2 of the Notice must file, within 30 days after the end of the period within which the plan is to be implemented as specified in section 6 or extended under section 14, a written “Declaration That a Pollution Prevention Plan Has Been Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(2) of CEPA 1999)” to the Minister, using the form that the Minister provides and that contains the information set out in Schedule 5 of the Notice. Where a person has prepared a single plan for several facilities, a separate Declaration of Implementation must be filed for each facility.

11. Filing of amended declarations

Under subsection 58(3) of the Act, where a person or class of persons specified in section 2 of the Notice has filed a Declaration of Preparation or a Declaration of Implementation, referred to in sections 9 and 10 of the Notice, and the Declaration contains information that, at any time after the filing, has become false or misleading, that person or class of persons must file an amended Declaration to the Minister within 30 days after the time that the information became false or misleading, using the appropriate form referred to in section 9 or 10 of the Notice.

12. Interim Progress Reports

A person or class of persons identified in section 2 of the Notice must file to the Minister, on or before each of the dates below, a written “Interim Progress Report — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents,” using the form that the Minister provides and that contains the information set out in Schedule 4 of the Notice. If a Declaration of Implementation is submitted before an Interim Progress Report is due, the requirement to submit such an Interim Progress Report is nullified.

(1) For a person or class of persons subject to the Notice on the date of publication in the Canada Gazette, Part I,

Interim Progress Report No. 1 — 24 months from the date of publication of the Notice;
Interim Progress Report No. 2 — 36 months from the date of publication of the Notice; and
Interim Progress Report No. 3 — 48 months from the date of publication of the Notice.

(2) For a person or class of persons becoming subject to the Notice after the date of publication in the Canada Gazette, Part I, no interim progress report is required.

13. Use of a plan prepared or implemented for another purpose

Under subsection 57(1) of the Act, a person or class of persons may use a pollution prevention plan prepared or implemented for another purpose to satisfy the requirements of sections 2 to 8 of the Notice. Under subsection 57(2) of the Act, where a person or class of persons uses a plan that does not meet all the requirements of the Notice, the person or class of persons must either amend the plan so that it meets all of those requirements or prepare an additional plan that meets the remainder of those requirements. Persons or classes of persons using existing plans must still file the Declaration of Preparation referred to in section 9 of the Notice, the Declaration of Implementation referred to in section 10 of the Notice, and any amended declarations under section 11 of the Notice, where applicable, and any Interim Progress Reports required under section 12 of the Notice.

14. Extension of time

Under subsection 56(3) of the Act, where the Minister is of the opinion that further time beyond the period referred to in section 5 is needed to prepare the plan, or that further time beyond the period referred to in section 6 is needed to implement the plan, the Minister may extend the period for a person or class of persons who submits a written “Request for Time Extension for Preparation or Implementation of a Pollution Prevention Plan in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 56(3) of CEPA 1999).” The written request must be submitted using the form that the Minister provides, contain the information set out in Schedule 3 of the Notice, and be made before the expiry of the date referred to in the applicable section 5 or section 6 of the Notice or before the expiry of any extended period.

15. Application for waiver of factors to consider

Under subsection 56(5) of the Act, the Minister may waive the requirement for a person or class of persons to consider a factor specified in section 4 where the Minister is of the opinion that it is neither reasonable nor practicable to consider that factor on the basis of reasons provided by that person or class of persons when submitting a written “Request for Waiver of the Requirement to Consider a Factor or Factors — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 56(5) of CEPA 1999).” The written request must be submitted using the form that the Minister provides and contain the information set out in Schedule 2 of the Notice. Such a request must be made before the expiry of the period within which the plan is to be prepared as referred to in section 5 of the Notice or before the expiry of any extended period.

16. More information on pollution prevention planning

Additional information and guidance on preparing plans may be obtained from

the Pollution Prevention section of Environment Canada’s Web site (www.ec.gc.ca/p2/Default.asp?lang=En&n=88D8B369-1);
the Pollution Prevention Planning section of Environment Canada’s Web site (www.ec.gc.ca/planp2-p2plan/Default.asp?lang=En&n=F7B45BF5-1);
the CEPA Environmental Registry (www.ec.gc.ca/CEPARegistry/plans/P2/); and
the Canadian Pollution Prevention Information Clearinghouse (www.ec.gc.ca/cppic).

17. Notice Reference Code: P2D4

For administrative purposes, all communication with Environment Canada concerning the Notice should refer to reference code P2D4.

18. Public disclosure of information and forms

The Minister of the Environment intends to publish the information submitted in response to this Notice in Schedules 1, 4 and 5 on the Pollution Prevention Planning section of Environment Canada’s Web site.

Under section 313 of the Act, all persons submitting information to the Minister are entitled to submit a written request that specific information be treated as confidential. Persons submitting such a request should include the reasons for that request.

The Notice includes the following forms:

Schedule 1: Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(1) of CEPA 1999);

Schedule 2: Request for Waiver of the Requirement to Consider a Factor or Factors — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 56(5) of CEPA 1999);

Schedule 3: Request for Time Extension for Preparation or Implementation of a Pollution Prevention Plan in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 56(3) of CEPA 1999);

Schedule 4: Interim Progress Report — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents; and

Schedule 5: Declaration That a Pollution Prevention Plan Has Been Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(2) of CEPA 1999).

Forms referred to in the Notice (Schedules 1 to 5) are published as part of the Notice and are to be filled out electronically using the Pollution Prevention Planning Online Reporting Tool found on Environment Canada’s Web site at www.ec.gc.ca/planp2-p2plan.

19. Environment Canada contact information

For technical questions or comments about this proposed Notice, please contact or send queries to

Bernard Madé
Director
Chemical Production Division
Environment Canada
351 Saint-Joseph Boulevard
Gatineau, Quebec
K1A 0H3
Telephone: 819-994-4404
Fax: 819-994-5030
Email: pgpc-cmp.dppc-cpd@ec.gc.ca

For more information about pollution prevention planning, please contact

Regulatory Innovation and Management Systems
c/o Innovative Measures Section
Environment Canada
351 Saint-Joseph Boulevard
Gatineau, Quebec
K1A 0H3
Telephone: 819-994-0186
Fax: 819-953-7970
Email: LCPEPlansP2-CEPAP2Plans@ec.gc.ca

EXPLANATORY NOTE

(This note is not part of the Notice.)

Compliance with the Act is mandatory under subsection 272(1) of the Act. Subsection 272(2) of the Act defines the penalties for persons who commit offences under the Act. Subsections 273(1) and 273(2) further outline the terms and penalties of those persons providing false or misleading information. Penalties under both subsections 272(2) and 273(2) include fines of not more than $1 million, imprisonment for a term of not more than three years, or both.

For additional information on the Act, the Compliance and Enforcement Policy for the Canadian Environmental Protection Act, 1999 and on applicable penalties, please contact the Enforcement Branch by email at environmental.enforcement@ec.gc.ca. The Policy is available at www.ec.gc.ca/lcpe-cepa/default.asp?lang=En&n=5082BFBE-1.

NOTE: Do not fill out this form. Please contact Environment Canada for more information about electronic reporting, as provided in sections 18 and 19 of the Notice.

Notice Reference Code: P2D4

Is this an amendment to a Declaration previously submitted? Yes No

If yes, please specify the amended parts and reasons below. In addition, please complete Parts 1.0 and 9.0 and any other parts of this Declaration for which previously reported information has become false or misleading. Previously reported information that is unchanged need not be resubmitted.

If no, please proceed to Part 1.0.

Amendment Part(s)

Please specify the parts of the Declaration that you would like to amend.

Amendment Reason(s)

Please specify the reason for each of the amendments that you would like to make.

1.0 Information on the Person or Class of Persons Subject to the Notice

Name of the Person or Class of
Persons Subject to the Notice: ______________________________

Facility Name: ______________________________

Street Address of Facility: ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

Telephone Number: ______________________________
(with area code)

Email: ______________________________

Mailing Address of Facility
(if different from Street Address): ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

National Pollutant Release Inventory ID
(if no ID, leave blank): ______________________________

Six-digit North American Industry Classification
System (NAICS) Code (if no code, leave blank): ______________________________

Facility Technical Contact: ______________________________

Email: ______________________________

Telephone Number: ______________________________
(with area code)

Fax Number (if available): ______________________________
(with area code)

Please enter the name of a General Contact for the facility. This contact information will be used by Environment Canada to correspond with your facility on items related to your submission, including your facility registration and password required for login and reporting online.

General Contact Information

First Name: ______________________________

Last Name: ______________________________

Email: ______________________________

Position / Job Title: ______________________________

Telephone Number (with area code): ______________________________

Fax Number (if available) [with area code]: ______________________________

2.0 Use of Plans Prepared or Implemented for Another Purpose

Is the Pollution Prevention Plan used to fulfill the obligations of this Notice:

a pollution prevention plan that was previously prepared on a voluntary basis?
Yes No
a pollution prevention plan that was previously prepared for another government or under another Act of Parliament?
Yes No

If yes, identify the other government requirement(s) or Act of Parliament.

Parts 3.0 through 7.0 must be completed separately for each combination of Substance and Activity selected in Part 3.0 below.

3.0 Substance and Activity

Substance and Activity for which information is required (choose all those that apply):

Manufacture of D4 (see footnote 2) or a mixture containing D4

Use of D4 or a mixture containing D4

4.0 Baseline Information Prior to Implementation of the Pollution Prevention (P2) Plan

Notes:

a) Wherever possible, the data collected in Parts 4.1, 4.2, 4.3 and 4.4 of this Declaration are consistent with the reporting requirements of the National Pollutant Release Inventory.

b) In this Part, where indicated, use the following Basis of Estimate Codes to describe how each quantity reported was determined:

M1 Continuous Emission Monitoring Systems

M2 Predictive Emission Monitoring

M3 Source Testing

C Mass Balance

E1 Site-specific Emission Factor

E2 Published Emission Factor

O Engineering Estimates

X Other (specify): ___________________

c) This Declaration requires reporting of data from the 2012 Preparation Year (January 1 to December 31).

If you are reporting data for a year other than the above specified years, check the situation that applies.

Person or class of persons subject to the Notice at the date of publication that have been granted a time extension to prepare a plan that result in a Preparation Year other than 2012

Person or class of persons becomes subject to the Notice after the date of publication that result in a Preparation Year other than 2012

Indicate the new Preparation Year for which you are reporting: ___________________

The year indicated above will represent the new Preparation Year for which the person or class of persons are required to report data (i.e. all references to the Preparation Year 2012 throughout this Declaration will be replaced by this new Preparation Year).

4.1 Nature of Activity

For the activity identified in Part 3.0 of this Declaration, indicate whether the substance was manufactured, processed or otherwise used, and the nature of such activity at the facility for the Preparation Year 2012. More than one nature of activity may be identified.

Manufacture:

For on-site use/processing

For sale/distribution

As a by-product

As an impurity

Description: ____________________

Use/process:

As a reactant

As a formulation component

As an article component

Repackaging only

As a by-product

Description: ____________________

Other use:

As a physical or chemical processing aid

As a manufacturing aid

Ancillary or other use

As a by-product

Description: ___________________

4.2 On-site Uses/Manufacture

For the activity identified in Part 3.0 of this Declaration, did this facility use/manufacture the substance on-site in the Preparation Year? Yes No

If yes, report the total quantity of all on-site uses/manufacture of the substance, in kilograms (kg), for that year, in the appropriate field below.

If no, proceed to Part 4.3 of this Declaration.

For the activity identified in Part 3.0 of this Declaration, report the total quantity of all on-site uses/manufacture of the substance with the Basis of Estimate Code (see Part 4.0, Note b), indicating how the substance is used/manufactured.

Total Quantity of On-site Uses/Manufacture of D4 for the Preparation Year (kg)	Basis of Estimate Code	Type of On-site Use

4.3 On-site Releases of D4 Through Industrial Effluents

For the activity identified in Part 3.0 of this Declaration, did this facility release an effluent containing D4 at any final discharge point in the Preparation Year? Yes No

If yes, report below the quantity of all releases of the substance in kg for that year in the appropriate field.

If no, proceed to Part 4.4 of this Declaration.

4.3.1 Releases to Air — No data required for Part 4.3.1 of this Declaration

4.3.2 Underground Injection — No data required for Part 4.3.2 of this Declaration

4.3.3 Releases to Surface Waters

For the activity identified in Part 3.0 of this Declaration, report the quantity of all releases of the substance to surface waters and/or discharged to a wastewater system that does not have a treatment during the Preparation Year. Please also indicate the Basis of Estimate Code (see Part 4.0, Note b).

Type of Releases	Quantity Released for the Preparation Year (kg)	Basis of Estimate Code
a) Surface water
b) Wastewater system that does not have a treatment
TOTAL

4.3.4 Releases to Land — No data required for part 4.3.2 of this Declaration

4.4 Off-site Transfers

4.4.1 Product Distribution — No data required for part 4.4.1 of this Declaration

4.4.2 Off-Site Transfers for Disposal into a Wastewater System that Does Have a Treatment

For the activity identified in Part 3.0 of this Declaration, did this facility transfer the substance off-site (off-site transfer includes the release of an effluent to a wastewater system that does have a treatment) for disposal in the Preparation Year? Yes No

If yes, report the total quantity of off-site transfers of the substance for disposal into a wastewater system that does have a treatment, in kg, for that year in the appropriate field below. Report only the net mass of the substance that was sent off-site, not the total mass of the mixture containing the substance.

If no, proceed to Part 4.4.3 of this Declaration.

Total Quantity Transferred into a Wastewater System that Does Have a Treatment for the Preparation Year (kg)	Basis of Estimate Code

4.4.3 Off-Site Transfers for Recycling — No data required for Part 4.4.3 of this Declaration

4.5 Additional Baseline Information

4.5.1 Sampling and Analysis

For the activity identified in Part 3.0 of this Declaration, indicate whether a continuous process or a batch process was used in the Preparation Year:

Continuous process Batch process

If a batch process is used, indicate how many batches were produced during the Preparation Year 2012:

1
2
3
4 or more

For the activity identified in Part 3.0 of this Declaration, indicate the dates, test results and laboratory accreditations for sampling and analysis of industrial effluent containing D4 at all final discharge points as described in subsection 4(4) of the Notice for the Preparation Year.

Sample	Concentration of D4 in Effluent (µg/L)	Date of Sampling	Date of Laboratory Analysis	Laboratory Name, City and Phone Number	Laboratory Accreditation Number
No. 1
No. 2
No. 3
No. 4
Average Concentration

4.5.2 Wastewater Treatment Plant Name and Address

For the activity identified in Part 3.0 of this Declaration and effluent discharged to a wastewater system that does have a treatment as identified in Part 4.4.2 of this Declaration, identify the name and address of the wastewater treatment plant in which the effluent is treated.

Name of the Wastewater Treatment Plant	Type of Treatment (if known)	Address

5.0 Anticipated Actions and Results

5.1 Anticipated Action

Parts 5.1.1 through 5.1.6 must be completed separately for each anticipated action in the P2 plan, i.e. Part 5.1 will be completed as many times as there are anticipated actions to report.

Describe for the activity identified in Part 3.0 of this Declaration, the status of the anticipated action to be taken in implementing the Pollution Prevention Plan.

What is the current status of this Action?

Planned/to be initiated

In progress

Completed

In Part 5.1.1, describe for the activity identified in Part 3.0 of this Declaration, the anticipated action to be taken in implementing the Pollution Prevention Plan.

5.1.1 Anticipated Action: __________________________________________

In Parts 5.1.2 and 5.1.3, identify whether the anticipated action represents a pollution prevention method(s) or other environmental protection method(s), by selecting from the list of options provided below.

5.1.2 Types of Pollution Prevention Methods:

For a detailed description of pollution prevention methods, please refer to the Pollution Prevention Planning Handbook (www.ec.gc.ca/ planp2-p2plan/default.asp?lang=En&n=56875F44-1#howto).

Material or feedstock substitution

Product design or reformulation

Equipment or process modifications

Spill and leak prevention

On-site reuse, recycling or recovery

Inventory management or purchasing techniques

Good operating practices or training

Other: _________________________________________

5.1.3 Other Types of Environmental Protection Methods:

Energy recovery

Off-site recycling

Incineration with energy recovery

Waste treatment

Pollution control

Disposal

Other: _________________________________________

In Part 5.1.4, report, where possible, the corresponding change to annual uses, releases and/or transfers of the substance anticipated to be achieved by implementing that action in kg and μg/L. Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity. Note that predicting a quantitative change for some anticipated actions, such as training, may not be possible.

5.1.4 Anticipated Changes: ___________________________________________

In Part 5.1.5, relate these changes to a specific element of the baseline information as described in Part 4 of this Declaration.

5.1.5 Baseline Elements Affected: _______________________________________

Finally, in Part 5.1.6, identify the planned completion date for the anticipated action.

5.1.6 Planned Completion Date (year/month/day): _______________________

This ends Parts 5.1.1 through 5.1.6 that must be completed separately for each anticipated action in the P2 plan.

5.2 Total Anticipated Results

The table below summarizes, for the activity identified in Part 3.0 of this Declaration, the total anticipated change to annual releases of the substance in kg and μg/L relative to the Preparation Year 2012.

In the two columns, relative to the Preparation Year, report the total anticipated change to be achieved by implementing only the anticipated actions described in Part 5.1 of this Declaration.

Important: Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity.

Type of Release	Total Anticipated Change Relative to the Preparation Year (kg)	Total Anticipated Change Relative to the Preparation Year (μg/L)
Surface water
Wastewater system that does not have a treatment
Wastewater system that does have a treatment

6.0 Monitoring and Reporting

Describe the anticipated monitoring and reporting that will be used to track progress in implementing the Pollution Prevention Plan.

7.0 Risk Management Objective

Describe how the Pollution Prevention Plan will meet the risk management objectives for D4 identified in subsection 4(2) and 4(3) of the Notice. If this plan will not meet the risk management objectives, explain why.

This ends Parts 3.0 through 7.0 of this Declaration to be completed separately for each combination of Substance and Activity specified in Part 3.0 above.

8.0 Factors to Consider

Describe what was done by the person or class of persons subject to the Notice to take into account the “Factors to Consider in Preparing the Plan” in subsections 4(4), 4(5) and 4(6) of the Notice, except those factors for which a waiver has been granted by the Minister of Environment.

8.1 Other Information to Provide

Provide a description of the factors (e.g. type of technology, human factor, accidental releases, type of manufacturing, daily use) that could increase the quantity or concentration of the substance in the facility’s effluent (as required in paragraph 4(7)(b) of the Notice).

9.0 Certification

I hereby certify that a Pollution Prevention Plan has been prepared and is being implemented in respect of Cyclotetrasiloxane, octamethyl- (siloxane D4) in industrial effluents and that the information provided in this Declaration is true, accurate and complete.

_______________________________________

Signature of the Person Subject to the Notice or
Duly Authorized Representative

_______________________________________

Date

Name: ________________________________________________________________

Please Print

Title/Position: __________________________________________________________

Please Print

NOTE: Do not fill out this form. Please contact Environment Canada for more information about electronic reporting, as provided in sections 18 and 19 of the Notice.

Notice Reference Code: P2D4

Is this an amendment to a Schedule previously submitted? Yes No

If yes, please specify the amended parts and reasons below. In addition, please complete Parts 1.0 and 4.0 and any other parts of this Schedule for which previously reported information has become false or misleading. Previously reported information that is unchanged need not be resubmitted.

If no, please proceed to Part 1.0.

Amendment Part(s)

Please specify the parts of the Schedule that you would like to amend.

Amendment Reason(s)

Please specify the reason for each of the amendments that you would like to make.

1.0 Information on the Person or Class of Persons Subject to the Notice

Name of the Person or Class of
Persons Subject to the Notice: ______________________________

Facility Name: ______________________________

Street Address of Facility: ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

Telephone Number: ______________________________
(with area code)

Email: ______________________________

Mailing Address of Facility
(if different from Street Address): ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

National Pollutant Release Inventory ID
(if no ID, leave blank): ______________________________

Six-digit North American Industry Classification
System (NAICS) Code (if no Code, leave blank): ______________________________

Facility Technical Contact: ______________________________

Email: ______________________________

Telephone Number: ______________________________
(with area code)

Fax Number (if available): ______________________________
(with area code)

General Contact Information

First Name: ______________________________

Last Name: ______________________________

Email: ______________________________

Position / Job Title: ______________________________

Telephone Number (with area code): ______________________________

Fax Number (if available) [with area code]: ______________________________

2.0 Factor(s) for Which a Waiver Is Being Requested

Identify for which factor(s) listed in the Notice a waiver is being requested.

3.0 Rationale for Request

Explain why it would not be reasonable or practicable to consider each factor for which a waiver is being requested.

Explain how the outcome of the pollution prevention plan will be affected if this or these factor(s) to consider are not taken into account.

Identify which, if any, additional factor(s) you propose to consider in preparing the pollution prevention plan (optional).

4.0 Certification

I hereby certify that the information provided in this Request is true, accurate and complete.

________________________________________

Signature of the Person Subject to the Notice or
Duly Authorized Representative

________________________________________

Date

Name: ___________________________________________________________

Please Print

Title/Position: ______________________________________________________

Please Print

NOTE: Do not fill out this form. Please contact Environment Canada for more information about electronic reporting, as provided in sections 18 and 19 of the Notice.

Notice Reference Code: P2D4

Is this an amendment to a Schedule previously submitted? Yes No

If no, please proceed to Part 1.0.

Amendment Part(s)

Please specify the parts of the Schedule that you would like to amend.

Amendment Reason(s)

Please specify the reason for each of the amendments that you would like to make.

1.0 Information on the Person or Class of Persons Subject to the Notice

Name of Person or Class of Persons
Subject to the Notice: ______________________________

Facility Name: ______________________________

Street Address of Facility: ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

Telephone Number: ______________________________
(with area code)

Email: ______________________________

Mailing Address of Facility
(If different from Street Address): ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

National Pollutant Release Inventory ID
(if no ID, leave blank): ______________________________

Six-digit North American Industry Classification
System (NAICS) Code (if no code, leave blank): ______________________________

Facility Technical Contact: ______________________________

Email: ______________________________

Telephone Number: ______________________________
(with area code)

Fax Number (if available): ______________________________
(with area code)

General Contact Information

First Name: ______________________________

Last Name: ______________________________

Email: ______________________________

Position / Job Title: ______________________________

Telephone Number (with area code): ______________________________

Fax Number (if available) [with area code]: ______________________________

2.0 Request for Time Extension

Identify for which of the following a time extension is requested (choose one):

to prepare a pollution prevention plan

to implement a pollution prevention plan

For the person or class of persons identified in Part 1.0, it is requested that the date be extended to: _____________________ (specify exact date — month/day/year)

3.0 Rationale for Request

Explain why additional time is needed to prepare or implement a pollution prevention plan.

4.0 Certification

I hereby certify that the information provided in this Request is true, accurate and complete.

________________________________________

Signature of the Person Subject to the Notice or
Duly Authorized Representative

________________________________________

Date

Name: ___________________________________________________________

Please Print

Title/Position: ______________________________________________________

Please Print

NOTE: Do not fill out this form. Please contact Environment Canada for more information about electronic reporting, as provided in sections 18 and 19 of the Notice.

Schedule 4: Interim Progress Report — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents

Notice Reference Code: P2D4

Is this an amendment to a Report previously submitted? Yes No

If yes, please specify the amended parts and reasons below. In addition, please complete Parts 1.0 and 9.0 and any other parts of this Schedule for which previously reported information has become false or misleading. Previously reported information that is unchanged need not be resubmitted.

If no, please proceed to Part 1.0.

Amendment Part(s)

Please specify the parts of the Report that you would like to amend.

Amendment Reason(s)

Please specify the reason for each of the amendments that you would like to make.

1.0 Information on the Person or Class of Persons Subject to the Notice

Name of Person or Class of Persons
Subject to the Notice: ______________________________

Facility Name: ______________________________

Street Address of Facility: ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

Telephone Number: ______________________________
(with area code)

Email: ______________________________

Mailing Address of Facility
(if different from Street Address): ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

National Pollutant Release Inventory ID
(if no ID, leave blank): ______________________________

Six-digit North American Industry Classification
System (NAICS) Code (if no code, leave blank): ______________________________

Facility Technical Contact: ______________________________

Email: ______________________________

Telephone Number: ______________________________
(with area code)

Fax Number (if available): ______________________________
(with area code)

General Contact Information

First Name: ______________________________

Last Name: ______________________________

Email: ______________________________

Position / Job Title: ______________________________

Telephone Number (with area code): ______________________________

Fax Number (if available) [with area code]: ______________________________

2.0 Use of Plans Prepared or Implemented for Another Purpose — No data is required for Part 2.0 of this Report

Parts 3.0 through 7.0 must be completed separately for each combination of Substance and Activity selected in Part 3.0 below.

3.0 Substance and Activity

Substance and Activity for which information is required (choose all those that apply):

Manufacture of D4 (see footnote 3) or a mixture containing D4

Use of D4 or a mixture containing D4

4.0 Progress Information During Implementation of the Pollution Prevention (P2) Plan

The Preparation Year refers to the year identified in your Schedule 1 — Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents.

Notes:

a) Whenever possible, the data collected in Parts 4.1, 4.2, 4.3 and 4.4 of this Report are consistent with the reporting requirements of the National Pollutant Release Inventory.

b) In this Part, where indicated, use the following Basis of Estimate Codes to describe how each quantity reported was determined:

M1 Continuous Emission Monitoring Systems

M2 Predictive Emission Monitoring

M3 Source Testing

C Mass Balance

E1 Site-specific Emission Factor

E2 Published Emission Factor

O Engineering Estimates

X Other (specify): ______________________________

c) The Notice (Reference Code P2D4) requires reporting of data in an Interim Progress Report for the following calendar years (January 1 to December 31):

Interim Progress Report	Reporting Year
Interim Progress Report No. 1	2013
Interim Progress Report No. 2	2014
Interim Progress Report No. 3	2015

Indicate the number of the Interim Progress Report for which the person or class of persons is reporting: ___________. (Note that the Reporting Year associated with this Interim Progress Report Number is referred to as the Reporting Year throughout this Report.)

If applicable, indicate the new Reporting Year for which you are reporting: ___________. (Note that this is referred to as the Reporting Year throughout this Report.)

4.1 Nature of Activity

For the activity identified in Part 3.0 of this Report, indicate whether the substance was manufactured, processed, or otherwise used, and the nature of such activity at the facility in the Reporting Year. More than one nature of activity may be identified.

Manufacture:

For on-site use/processing

For sale/distribution

As a by-product

As an impurity

Description: ______________________________

Use/Process:

As a reactant

As formulation component

As an article component

Repackaging only

As a by-product

Description: ______________________________

Other Use:

As a physical or chemical processing aid

As a manufacturing aid

Ancillary or other use

As a by-product

Description: ______________________________

4.2 On-site Uses/Manufacture

For the activity identified in Part 3.0 of this Report, did this facility use/manufacture the substance on-site in the Reporting Year? Yes No

If yes, report the total quantity of all on-site uses/manufacture of the substance, in kilograms (kg), for that year, in the appropriate field below.

If no, proceed to Part 4.3 of this Report.

For the activity identified in Part 3.0 of this Report, report the total quantity of all on-site uses/manufacture of the substance with the Basis of Estimate Code (see Part 4.0, Note b), indicating how the substance is used/manufactured.

Total Quantity of all On-site Uses/Manufacture of D4 for the Reporting Year (kg)	Basis of Estimate Code	Type of On-site Use

4.3 On-site Releases of D4 in Industrial Effluents

For the activity identified in Part 3.0 of this Report, did this facility release an effluent containing D4 at any final discharge point in the Reporting Year? Yes No

If yes, report below the quantity of all on-site releases of the substance, in kg for that year, in the appropriate field.

If no, proceed to Part 4.4 of this Report.

4.3.1 Releases to Air — No data required for Part 4.3.1 of this Report

4.3.2 Underground Injection — No data required for Part 4.3.2 of this Report

4.3.3 Releases to Surface Waters

For the activity identified in Part 3.0 of this Report, report the quantity of all releases of the substance to surface waters and/or in a wastewater system that does not have a treatment during the Reporting Year. Please also indicate the Basis of Estimate Code (see Part 4.0, Note b).

Type of Releases	Quantity of D4 Released for the Reporting Year (kg)	Basis of Estimate Code
a) Surface water
b) Wastewater system that does not have a treatment
TOTAL

4.3.4 Releases to Land — No data required for Part 4.3.4 of this Report

4.4 Off-site Transfers

4.4.1 Product Distribution — No data required for Part 4.4.1 of this Report

4.4.2 Off-Site Transfers for Disposal into a Wastewater System that Does Have a Treatment

For the activity identified in Part 3.0 of this Report, did this facility transfer the substance off-site (Off-site transfers include the release of an effluent to a wastewater system that does have a treatment) for disposal in the Reporting Year? Yes No

If yes, report the total quantity of off-site transfers of the substance for disposal into a wastewater system that does have a treatment, in kg for that year, in the appropriate field below. Report only the net mass of the substance that was sent off-site, not the total mass of the mixture containing the substance.

If no, proceed to Part 4.4.3 of this Report.

Total Quantity of D4 Transferred into a Wastewater System that Does Have a Treatment for the Reporting Year (kg)	Basis of Estimate Code

4.4.3 Off-Site Transfers for Recycling — No data required for Part 4.4.3 of this Report

4.5 Additional Progress Information

4.5.1 Sampling and Analysis

For the activity identified in Part 3.0 of this Report, indicate whether a continuous process or a batch process was used in the Reporting Year:

Continuous process Batch process

If a batch process is used, indicate how many batches were produced during the Reporting Year:

1
2
3
4 or more

For the activity identified in Part 3.0 of this Report, indicate the dates, test results and laboratory accreditations for sampling and analysis of industrial effluent containing D4 at all final discharge points as described in subsection 4(4) of the Notice for the Reporting Year.

Sample	Concentration of D4 in Effluent (µg/L)	Date of Sampling	Date of Laboratory Analysis	Laboratory Name, City and Phone Number	Laboratory Accreditation Number
No. 1
No. 2
No. 3
No. 4
Average Concentration

4.5.2 Wastewater Treatment Plant Name and Address

For the activity identified in Part 3.0 of this Report and effluent discharged to a wastewater system that does have a treatment as identified in Part 4.4.2 of this Report, identify the name and address of the wastewater treatment plant in which the effluent is treated.

Name of the Wastewater Treatment Plant	Type of Treatment (if known)	Address

5.0 Action(s) Taken and Results Achieved to Date

5.1 Action Taken to Date

Parts 5.1.1 through 5.1.6 must be completed separately for each action taken to date in the P2 plan, i.e. Part 5.1 will be completed as many times as there are actions taken to date to report.

Describe for the activity identified in Part 3.0 of this Report, the current status of the actions taken to date in implementing the Pollution Prevention Plan. Please complete for each action that was reported in your last submitted schedule.

What is the current status of this action?

Planned/to be initiated

In progress

Completed

Discontinued

If the action is “Discontinued,” please provide the reason why you will no longer be carrying out this action for the activity.

In Part 5.1.1, describe, for the activity identified in Part 3.0 of this Report, the action taken to date in implementing the Pollution Prevention Plan. For the purpose of this Report, “to date” refers to December 31 of the Reporting Year specified in Section 4.0 of this Report. For the first Interim Progress Report, report actions taken since initiating the implementation of the Pollution Prevention Plan. For all subsequent Interim Progress Reports, report actions taken since filing of the previous Interim Progress Report.

5.1.1 Action taken to date: ______________________________________________

In Parts 5.1.2 and 5.1.3, identify whether the action taken to date represents a pollution prevention method(s) or other environmental protection method(s), by selecting from the list of options provided below.

5.1.2 Types of Pollution Prevention Methods:

For a detailed description of pollution prevention methods, please refer to the Pollution Prevention Planning Handbook (www.ec.gc.ca/ planp2-p2plan/default.asp?lang=En&n=56875F44-1#howto).

Material or feedstock substitution

Product design or reformulation

Equipment or process modifications

Spill and leak prevention

On-site reuse, recycling or recovery

Inventory management or purchasing techniques

Good operating practices or training

Other: ______________________________

5.1.3 Other Types of Environmental Protection Methods:

Energy recovery

Off-site recycling

Incineration with energy recovery

Waste treatment

Pollution control

Disposal

Other: ______________________________

In Part 5.1.4, report, where possible, the corresponding change to annual uses, releases and/or transfers of the substance achieved to date by implementing this action in kg and in μg/L. Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity. Note that predicting a quantitative change for some actions taken, such as training, may not be possible.

5.1.4 Changes Achieved to Date: __________________________________________

In Part 5.1.5, relate these changes to a specific element of the baseline information described in Part 4 of this Report.

5.1.5 Baseline Elements Affected: _________________________________________

Finally, in Part 5.1.6, identify the completion date for the action taken.

5.1.6 Completion Date (year/month/day): __________________________________

This ends Parts 5.1.1 through 5.1.6 that must be completed separately for each action taken to date in the P2 plan.

5.2 Total Results Achieved to Date

The table below summarizes, for the activity identified in Part 3.0 of this Report, the total change achieved to date to annual releases of the substance in kg and μg/L relative to the Preparation Year as reported in Schedule 1 “Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(1) of CEPA 1999)” (Declaration of Preparation). For the purpose of this Report, “to date” refers to December 31 of the Reporting Year specified in Section 4.0 of this Report.

In the two columns, relative to Preparation Year, report those changes achieved from ALL actions taken to date in implementing a Pollution Prevention Plan.

Important: Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity.

Type of Release	Total Achieved Change Relative to the Preparation Year (kg)	Total Achieved Change to Date Relative to the Preparation Year (μg/L)
Surface water
Wastewater system that does not have a treatment
Wastewater system that does have a treatment

6.0 Monitoring and Reporting

Describe the monitoring and reporting used to track progress in implementing the Pollution Prevention Plan.

7.0 Risk Management Objective

Describe the progress or additional details on how the Pollution Prevention Plan will meet the risk management objectives for D4 identified in subsections 4(2) and 4(3) of the Notice.

This ends Parts 3.0 through 7.0 of this Report to be completed separately for each combination of Substance and Activity specified in Part 3.0 above.

8.0 Factors to Consider

Describe any progress made in this Reporting Year towards taking into account the “Factors to Consider in Preparing the Plan” in subsections 4(4), 4(5) and 4(6) of the Notice, except those factors for which a waiver has been granted by the Minister of the Environment.

8.1 Other Information to Provide

9.0 Certification

I hereby certify that the information provided in this Report is true, accurate and complete.

________________________________________

Signature of the Person Subject to the Notice or
Duly Authorized Representative

________________________________________

Date

Name: ____________________________________________________________

Please Print

Title/Position: _______________________________________________________

Please Print

NOTE: Do not fill out this form. Please contact Environment Canada for more information about electronic reporting, as provided in sections 18 and 19 of the Notice.

Notice Reference Code: P2D4

Is this an amendment to a Declaration previously submitted? Yes No

If no, please proceed to Part 1.0.

Amendment Part(s)

Please specify the parts of the Declaration that you would like to amend.

Amendment Reason(s)

Please specify the reason for each of the amendments that you would like to make.

1.0 Information on the Person or Class of Persons Subject to the Notice

Name of Person or Class of Persons
Subject to the Notice: ______________________________

Facility Name: ______________________________

Street Address of Facility: ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

Telephone Number: ______________________________
(with area code)

Email: ______________________________

Mailing Address of Facility
(if different from Street Address): ______________________________

City: ______________________________

Province/Territory: ______________________________

Postal Code: ______________________________

National Pollutant Release Inventory ID
(if no ID, leave blank): ______________________________

Six-digit North American Industry Classification
System (NAICS) Code (if no code, leave blank): ______________________________

Facility Technical Contact: ______________________________

Email: ______________________________

Telephone Number: ______________________________
(with area code)

Fax Number (if available): ______________________________
(with area code)

General Contact Information

First Name: ______________________________

Last Name: ______________________________

Email: ______________________________

Position / Job Title: ______________________________

Telephone Number (with area code): ______________________________

Fax Number (if available) [with area code]: ______________________________

2.0 Use of Plans Prepared or Implemented for Another Purpose — No data is required for Part 2.0 of this Declaration

Parts 3.0 through 7.0 must be completed separately for each combination of Substance and Activity selected in Part 3.0 below.

3.0 Substance and Activity

Substance and Activity for which information is required (choose all those that apply):

Manufacture of D4 (see footnote 4) and/or a mixture containing D4

Use of D4 and/or a mixture containing D4

4.0 Information after Implementation of the Pollution Prevention (P2) Plan

The Preparation Year refers to the year identified in your Schedule 1 — Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents.

Notes:

a) Whenever possible, the data collected in Parts 4.1, 4.2, 4.3 and 4.4 of this Declaration are consistent with the reporting requirements of the National Pollutant Release Inventory.

b) In this Part, where indicated, use the following Basis of Estimate Codes to describe how each quantity reported was determined:

M1 Continuous Emission Monitoring Systems

M2 Predictive Emission Monitoring

M3 Source Testing

C Mass Balance

E1 Site-specific Emission Factor

E2 Published Emission Factor

O Engineering Estimates

X Other (specify): ______________________________

c) This Declaration requires reporting of data for the year of Implementation (January 1 to December 31) of the Pollution Prevention Plan (as specified in the Notice or any other year specified to a person or class of persons who has been granted an extension of time to implement a plan).

Indicate the year of implementation for which you are reporting: _______________________. (Note that this will be referred to as the Implementation Year throughout this Declaration.)

4.1 Nature of Activity

For the activity identified in Part 3.0 of this Declaration, indicate whether the Substance was manufactured, processed or otherwise used, and the nature of such activity at the facility in the Implementation Year. More than one nature of activity may be identified.

Manufacture:

For on-site use/processing

For sale/distribution

As a by-product

As an impurity

Description: ______________________________

Use/process:

As a reactant

As a formulation component

As an article component

Repackaging only

As a by-product

Description: ______________________________

Other use:

As a physical or chemical processing aid

As a manufacturing aid

Ancillary or other use

As a by-product

Description: ______________________________

4.2 On-site Uses/Manufacture

For the activity identified in Part 3.0 of this Declaration, did this facility use/manufacture the substance on-site in the Implementation Year? Yes No

If yes, report the total quantity of all on-site uses/manufacture of the substance, in kilograms (kg), for that year, in the appropriate field below.

If no, proceed to Part 4.3 of this Declaration.

Total Quantity of all On-site Uses/Manufacture of D4 for the Implementation Year (kg)	Basis of Estimate Code	Type of On-site Use

4.3 On-site Releases of D4 Through Industrial Effluents

For the activity identified in Part 3.0 of this Declaration, did this facility release an effluent containing D4 at any final discharge point in the Implementation Year?
Yes No

If yes, report the quantity of all on-site releases of the substance, in kg, for that year, in the appropriate field below.

If no, proceed to Part 4.4 of this Declaration.

4.3.1 Releases to Air — No data required for Part 4.3.1 of this Declaration

4.3.2 Underground Injection — No data required for Part 4.3.2 of this Declaration

4.3.3 Releases to Surface Waters

For the activity identified in Part 3.0 of this Declaration, report the quantity of all releases of the substance to surface waters and/or discharged to a wastewater system that does not have a treatment during the Implementation Year. Please also indicate the Basis of Estimate Code (see Part 4.0, Note b).

Type of Releases	Quantity of D4 Released for the Implementation Year (kg)	Basis of Estimate Code
a) Surface water
b) Wastewater system that does not have a treatment
TOTAL

4.3.4 Releases to Land — No data required for Part 4.3.4 of this Declaration

4.4 Off-site Transfers

4.4.1 Product Distribution — No data is required for Part 4.4.1 of this Declaration

4.4.2 Off-Site Transfers into a Wastewater System that Does Have a Treatment

For the activity identified in Part 3.0 of this Declaration, did this facility transfer the substance off-site (off-site transfer includes release of an effluent to a wastewater system that does have a treatment) for disposal in the implementation year?
Yes No

If yes, report the total quantity of off-site transfers of the substance for disposal into a wastewater system that does have a treatment, in kg, for that year, in the appropriate field below. Report only the net mass of the substance that was sent off-site, not the total mass of the mixture containing the substance.

If no, proceed to Part 4.4.3 of this Declaration.

Total Quantity of D4 Transferred into a Wastewater System that Does Have a Treatment for the Implementation Year (kg)	Basis of Estimate Code

4.4.3 Off-Site Transfers for Recycling — No data required for part 4.4.3 of the declaration

4.5 Additional Information after Implementation of the Pollution Prevention (P2) Plan

4.5.1 Sampling and Analysis

For the activity identified in Part 3.0 of this Declaration, indicate whether a continuous process or a batch process was used during the Implementation Year:

Continuous process Batch process

If a batch process is used, indicate how many batches were produced during the Implementation Year:

1
2
3
4 or more

Sample	Concentration of D4 in Industrial Effluent (µg/L)	Date of Sampling	Date of Laboratory Analysis	Laboratory Name, City and Phone Number	Laboratory Accreditation Number
No. 1
No. 2
No. 3
No. 4
Average Concentration

4.5.2 Wastewater Treatment Plant Name and Address

Name of the Wastewater Treatment Plant	Type of Treatment (if known)	Address

5.0 Action(s) Taken and Results Achieved

5.1 Action Taken

Parts 5.1.1 through 5.1.6 must be completed separately for each action taken in the P2 plan, i.e. Part 5.1 will be completed as many times as there are actions taken to report.

Describe for the activity identified in Part 3.0 of this Declaration, the current status of the action taken to date in implementing the Pollution Prevention Plan. Please complete for each action that was reported in your last submitted Interim Progress Report.

What is the current status of this action?

Planned/to be initiated

In progress

Completed

Discontinued

If the action is “Discontinued,” please provide the reason why you will no longer be carrying out this action for the activity.

In Part 5.1.1, describe, for the activity identified in Part 3.0 of this Declaration, the action taken in implementing the Pollution Prevention Plan. If you have previously filed an Interim Progress Report, report only those actions that have been taken since the last Interim Progress Report.

5.1.1 Action Taken: ___________________________________________________

In Parts 5.1.2 and 5.1.3, identify whether the action represents a pollution prevention method(s) or other environmental protection method(s), by selecting from the list of options provided below.

5.1.2 Types of Pollution Prevention Methods:

For a detailed description of pollution prevention methods, please refer to the Pollution Prevention Planning Handbook (www.ec.gc.ca/planp2-p2plan/default.asp?lang=En&n=56875F44-1#howto).

Material or feedstock substitution

Product design or reformulation

Equipment or process modifications

Spill and leak prevention

On-site reuse, recycling or recovery

Inventory management or purchasing techniques

Good operating practices or training

Other: ______________________________

5.1.3 Other Type of Environmental Protection Methods:

Energy recovery

Off-site recycling

Incineration with energy recovery

Waste treatment

Pollution control

Disposal

Other: ______________________________

In Part 5.1.4, report, where possible, the corresponding change to annual uses, releases and/or transfers of the substance achieved by implementing that action in kg and μg/L. Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity. Note that estimating a quantitative change for some actions taken, such as training, may not be possible.

5.1.4 Changes Achieved: __________________________________________________

In Part 5.1.5, relate these changes to a specific elements of the baseline information described in Part 4 of this Declaration.

5.1.5 Baseline Elements Affected: __________________________________________

Finally, in Part 5.1.6, identify the completion date for the action taken.

5.1.6 Completion Date (year/month/day): ____________________________________

This ends the section (Parts 5.1.1 through 5.1.6) that must be completed separately for each action taken in the P2 plan.

5.2 Total Results Achieved

The table below summarizes, for the activity identified in Part 3.0 of this Declaration, the total achieved change to annual releases of the substance in kg and μg/L relative to the Preparation Year as reported in the “Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Cyclotetrasiloxane, octamethyl- (Siloxane D4) in Industrial Effluents (Subsection 58(1) of CEPA 1999)” (Declaration of Preparation).

In the two columns, relative to Preparation Year, report the changes achieved from ALL actions taken as a result of implementing the Pollution Prevention Plan.

Important: Indicate a decrease with a negative sign (“–”) and an increase with a positive sign (“+”) in front of the reported quantity.

Type of Release	Total Change Achieved Relative to the Preparation Year (kg)	Total Change Achieved Relative to the Preparation Year (μg/L)
Surface water
Wastewater system that does not have a treatment
Wastewater system that does have a treatment

6.0 Monitoring and Reporting

Describe the monitoring and reporting used to track progress in implementing the Pollution Prevention Plan.

7.0 Risk Management Objective

Describe how the Pollution Prevention Plan met the risk management objective(s) for D4 identified in subsections 4(2) and 4(3) of this Notice. If this plan did not meet the risk management objectives, explain why.

This ends Parts 3.0 through 7.0 of this Declaration to be completed separately for each combination of Substance and Activity specified in Part 3.0 above.

8.0 Factors to Consider

Describe any progress made towards taking into account the “Factors to Consider in Preparing the Plan” found in subsections 4(4), 4(5) and 4(6) of the Notice, or describe any additional details or changes in how these factors were taken into account, except those factors for which a waiver has been granted by the Minister of the Environment.

9.0 Certification

I hereby certify that a Pollution Prevention Plan has been implemented in respect of Cyclotetrasiloxane, octamethyl- (siloxane D4) in industrial effluents and that the information provided in this Declaration is true, accurate and complete.

______________________________

Signature of the Person Subject to the
Notice or Duly Authorized Representative

______________________________

Date

Name: ____________________________________________________________

Please Print

Title/Position: _______________________________________________________

Please Print

Footnote 1
The Chemical Abstracts Service (CAS) Registry Number is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society.

Footnote 2
D4 refers to Cyclotetrasiloxane, octamethyl- (CAS Registry Number 556-67-2).
The Chemical Abstracts Service (CAS) Registry Number is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society.

Footnote 3
D4 refers to Cyclotetrasiloxane, octamethyl- (CAS Registry Number 556-67-2).
The Chemical Abstracts Service (CAS) Registry Number is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society.

Footnote 4
D4 refers to Cyclotetrasiloxane, octamethyl- (CAS Registry Number 556-67-2).
The Chemical Abstracts Service (CAS) Registry Number is the property of the American Chemical Society and any use or redistribution, except as required in supporting regulatory requirements and/or for reports to the Government when the information and the reports are required by law or administrative policy, is not permitted without the prior, written permission of the American Chemical Society.

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ARCHIVED — Supplement

DEPARTMENT OF THE ENVIRONMENT

CANADIAN ENVIRONMENTAL PROTECTION ACT, 1999