Canada Gazette, Part I, Volume 146, Number 23: SUPPLEMENT

June 9, 2012

DEPARTMENT OF THE ENVIRONMENT

CANADIAN ENVIRONMENTAL PROTECTION ACT, 1999

Notice requiring the preparation and implementation of pollution prevention plans in respect of specified substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, related to the synthetic rubber manufacturing sector

Pursuant to section 91 of the Canadian Environmental Protection Act, 1999 (hereinafter referred to as the “Act”), the Minister of the Environment published in the Canada Gazette, Part Ⅰ, on January 1, 2011, a Proposed notice requiring the preparation and implementation of pollution prevention plans in respect of specified substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, related to the resin and synthetic rubber manufacturing sector.

Whereas persons were given the opportunity to file comments with respect to the proposed Notice for a comment period of 60 days; and

Whereas the Minister of the Environment has considered all comments received,

Notice is hereby given that, under subsection 56(1) of the Act, 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 the substances listed in this Notice which are specified on Schedule 1 of the Act.

The Government of Canada is taking action on chemical substances through the Chemicals Management Plan. Therefore, the Minister of the Environment may amend the Notice from time to time. Amendments may include adding additional substances which are listed on Schedule 1 of the Act or other amendments to the Notice or the Schedules, as required.

The Minister of the Environment will measure the performance of the Notice, throughout the preparation and implementation periods, in order to determine its effectiveness in meeting the risk management objectives set out in sections 3 and 4 of the Notice. This evaluation will determine whether additional measures, including regulations, may be required.

More information on pollution prevention planning can be found in the Pollution Prevention Planning Provisions of Part 4 of the Canadian Environmental Protection Act, 1999: Guidelines for Implementation. These guidelines and other information related to pollution prevention and pollution prevention planning can be found in the “Pollution Prevention Planning” section of Environment Canada’s Web site at www.ec.gc.ca/planp2-p2plan.

PETER KENT
Minister of the Environment

NOTICE REQUIRING THE PREPARATION AND IMPLEMENTATION OF POLLUTION PREVENTION PLANS IN RESPECT OF SPECIFIED SUBSTANCES ON SCHEDULE 1 OF THE CANADIAN ENVIRONMENTAL PROTECTION ACT, 1999 , RELATED TO THE SYNTHETIC RUBBER MANUFACTURING SECTOR

Notice is hereby given that, pursuant to the provisions of Part 4 of the Act, 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 the substances listed in the Table provided in section 3 of the Notice (hereinafter referred to as the “Table”) which are also specified on Schedule 1 of the Act.

1. Definitions

The definitions in this section apply to the Notice.

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

“Base Year” means the year for which there is existing data available, against which the results from this Notice will be compared.

“Minister” means the Minister of the Environment.

“Normal operating conditions” means the range of operating conditions under which the facility expects to operate that result in the highest level of emissions. Operations during periods of startup, shutdown and malfunction do not constitute normal operating conditions.

“Notice” means the Notice requiring the preparation and implementation of pollution prevention plans in respect of specified substances on Schedule 1 of the Act, related to the synthetic rubber manufacturing sector.

“Plan” means a pollution prevention plan.

“Preparation Year” means the year in which the plan will be prepared and the first year of reporting.

“Synthetic rubber manufacturing sector” includes facilities primarily engaged in manufacturing synthetic rubber from basic organic chemicals through a polymerization reaction. Excluded are facilities engaged in manufacturing rubber processing chemicals, facilities processing rubber into intermediate or final products, compounders and plastic processors.

In “Best available techniques economically achievable (BATEA),” the word “techniques” includes both the facility equipment used in the process and how the process is operated. It includes, but is not limited to, matters such as the number of employees, their qualifications and experience, working methods, training, supervision and the manner in which the process is operated. It also includes, but is not limited to, material or feedstock substitution, the design, construction, lay-out and maintenance of the facility and buildings.

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

(1) The Notice applies to any person or class of persons who, on the date of publication of the Notice or anytime thereafter,

(a) owns or operates a facility within the synthetic rubber manufacturing sector which, at any time, purchases, imports or uses one or more of the substances listed in column 2 of the Table, in quantities that equal or exceed the purchase, import or use threshold listed in column 4 of the Table (if applicable); and
(b) is involved in any or all of the substance-specific activities listed in column 5 of the Table.

(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. Substance-specific activities and risk management objectives in relation to which the plan is to be prepared

The Minister requires any person or class of persons identified in section 2 of the Notice to prepare and implement a plan in relation to the substance-specific activities and risk management objectives listed below, as well as to the factors to consider listed in section 4 of the Notice involving the substances and their corresponding thresholds (if applicable).

The Table provided in this section lists the substances addressed within the Notice, along with

their item number and substance-specific notice reference code;
their Chemical Abstracts Service (CAS) Registry Number;
their purchase/import/use threshold (if applicable);
substance-specific activities for which the plan is to be prepared;
substance-specific risk management objectives;
the Base Year (if applicable); and
deadlines.

1 Item Number and Substance- Specific Notice Reference Code	2 Substance Name	3 CAS Registry Number (see footnote 1)	4 Substance Purchase/ Import/Use Threshold (if Applicable)
(1) P2SRM-Isoprene	Isoprene (1,3-Butadiene, 2-Methyl-)	78-79-5	100 kg/year

5 Activities for Which the Plan Is to Be Prepared	6 Substance-specific Risk Management Objective	7 Base Year (if Applicable) (see footnote 2)	8 Deadlines (see footnote 3)
— Manufacturing of butyl rubber (including isoprene storage in tanks) — Manufacturing of halobutyl rubber (including isoprene storage in tanks) — Manufacturing of styrene-isoprene-styrene block copolymers (including isoprene storage in tanks) — Manufacturing of polyisoprene (cis-1,4-polyisoprene) rubber (including isoprene storage in tanks) — Manufacturing of styrene-isoprene rubber (including isoprene storage in tanks) — Manufacturing of any other type of synthetic rubber (including isoprene storage in tanks) — Any other manufacturing activity within the synthetic rubber manufacturing sector that involves the use of isoprene	To reduce human exposure to isoprene through the reduction of industrial emissions of isoprene to the environment by 80% relative to the base year, using BATEA.	2009	— Deadline for preparing the plan: June 9, 2013 — Deadline for implementing the plan: June 9, 2016 — Interim Progress Reports are not required

4. Substance-specific factors to consider in preparing the plan

4(1) Isoprene

(a) Isoprene was concluded to meet the paragraph 64(c) criterion of the Act and was added to Schedule 1 of the Act on February 16, 2011. According to the final Screening Assessment Report, isoprene is entering or may enter the environment in a quantity or concentration or under conditions that constitute or may constitute a danger in Canada to human life or health. The final Screening Assessment Report is available on the CEPA Environmental Registry of Environment Canada’s Web site.
(b) The risk management objective for isoprene, as stated in the above Table, is to reduce human exposure to isoprene through the reduction of industrial emissions of isoprene to the environment by 80% relative to the Base Year, using BATEA.
(c) In order to ensure that environmental releases of isoprene and human health risks due to exposure to isoprene are adequately addressed using BATEA, the person or class of persons subject to the Notice will determine the industrial emissions of isoprene to air considering the factors stated in subparagraphs 4(1)(c)(i) through 4(1)(c)(iv), under normal operating conditions.
1. (i) Conducting sampling and analysis of isoprene from stack or point releases, including exhaust air volume rates and typical/current concentration of isoprene released to air, once before and once after putting into practice BATEA, but before the deadline to implement the plan. The “once before” sampling and analysis of isoprene from stack or point releases may be conducted anytime between the Base Year and the Preparation Year, as long as it is done under the facility’s normal operating conditions before putting into practice BATEA. The sampling and analysis of isoprene should be performed by a laboratory that is accredited under the International Organization for Standardization ISO/IEC 17025 standard titled General requirements for the competence of testing and calibration laboratories, as amended from time to time, and whose accreditation includes the analysis of isoprene within its scope of testing. The sampling and analysis of isoprene should be done using the latest available version of one of the following methods, as amended from time to time:
  - United States Environmental Protection Agency (U.S. EPA) Method 18 — Measurement of Gaseous Organic Compound Emissions by Gas Chromatography; or
  - U.S. EPA Method 0030 — Volatile Organic Sampling Train, and U.S. EPA Method 5041A — Analysis for Desorption of Sorbent Cartridges from Volatile Organic Sampling Train (VOST).
2. (ii) Measuring or estimating emissions of isoprene to air from storage tanks once before and once after putting into practice BATEA, but before the deadline to implement the plan. The “once before” measurement or estimate of emissions of isoprene to air from storage tanks may be conducted anytime between the Base Year and the Preparation Year, as long as it is done under the facility’s normal operating conditions before putting into practice BATEA. The measurement or estimation of emissions of isoprene to air from storage tanks should be done by taking into account the latest available version of one or more of the following sources, as amended from time to time:
  - U.S. EPA AP-42, Compilation of Air Pollutant Emission Factors, Volume I: Stationary Point and Area Sources, Chapter 7 — Liquid Storage Tanks;
  - U.S. EPA TANKS Emissions Estimation Software; and
  - Australian Government, Department of the Environment, Water, Heritage and the Arts, and National Pollutant Inventory (NPI) Emission Estimation Technique Manual for Fuel and Organic Liquid Storage.
3. (iii) Measuring or estimating fugitive emissions of isoprene to air once before and once after putting into practice BATEA, but before the deadline to implement the plan. The “once before” measurement or estimate of emissions of isoprene to air from fugitive emissions may be conducted anytime between the Base Year and the Preparation Year, as long as it is done under the facility’s normal operating conditions before putting into practice BATEA. The measurement or estimation of fugitive emissions of isoprene to air should be done by taking into account the latest available version of the following sources, as amended from time to time:
  - U.S. EPA Method 21 — Determination of Volatile Organic Compound Leaks, as specified in Title 40 of the Code of Federal Regulations (CFR), Part 60, Appendix A, with a leak definition and monitoring procedure and frequency as specified in U.S. EPA, Title 40 CFR Part 63, Subpart H — National Emission Standards for Organic Hazardous Air Pollutants for Equipment Leaks; or U.S. EPA Alternative Work Practice for Monitoring Equipment for Leaks, as specified in Title 40 CFR Part 63, Subpart A, paragraphs (c), (d) and (e) of section 63.11; and
  - U.S. EPA. Emission Inventory Improvement Program, Technical Report Series, Volume II: Point Sources, Chapter 16 — Methods for Estimating Air Emissions from Chemical Manufacturing Facilities.
4. (iv) Measuring or estimating emissions of isoprene to air from wastewater processes once before and once after putting into practice BATEA, but before the deadline to implement the plan. The “once before” measurement or estimate of emissions of isoprene to air from wastewater processes may be conducted anytime between the Base Year and the Preparation Year, as long as it is done under the facility’s normal operating conditions before putting into practice BATEA. The measurement or estimation of emissions of isoprene to air from wastewater processes should be done by taking into account the latest available version of the following source, as amended from time to time:
  - U.S. EPA Wastewater Treatment Model WATER9.
(d) In order to prevent or control environmental releases of isoprene, the person or class of persons subject to the Notice will consider the factors stated in subparagraphs 4(1)(d)(i) through 4(1)(d)(iii).
1. (i) Using BATEA to prevent or control the release of isoprene to air from the following emission sources: stack or point, storage or handling, fugitive, wastewater processes, and accidental or non-routine spills.
2. (ii) Establishing and implementing a leak detection and repair (LDAR) program which includes the use of the latest available version of one of the following sources, as amend ed from time to time:
  - U.S. EPA Leak Detection and Repair — A Best Practices Guide; or
  - U.S. EPA, Title 40 CFR Part 63, Subpart H — National Emission Standards for Organic Hazardous Air Pollutants for Equipment Leaks.
3. (iii) Adopting standards and operating practices for controlling air emissions as outlined in the latest available version of one of the following sources, as amended from time to time:
  - U.S. EPA, Title 40 CFR Part 63, Subpart F — National Emission Standards for Organic Hazardous Air Pollutants From the Synthetic Organic Chemical Manufacturing Industry; Subpart G — National Emission Standards for Organic Hazardous Air Pollutants From the Synthetic Organic Chemical Manufacturing Industry for Process Vents, Storage Vessels, Transfer Operations, and Wastewater; and Subpart U — National Emission Standards for Hazardous Air Pollutant Emissions: Group I Polymers and Resins; or
  - Canadian Council of Ministers of the Environment (CCME) Environmental Guidelines for Controlling Emissions of Volatile Organic Compounds for Above-ground Storage Tanks.

5. Other factor to consider in preparing the plan

In addition to the applicable substance-specific factors to consider in section 4, the Minister requires any person or class of persons identified in section 2 of the Notice to also consider the following general factor when preparing their plan:

(1) The use of pollution prevention planning as a means of addressing the release to the environment of substances on Schedule 1 of the Act, or other pollutants. 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. Period within which the plan is to be prepared

(1) For a person or class of persons subject to the Notice or to an amendment 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 or any amendments to the Notice, as referenced in column 8 of the Table.

(2) For a person or class of persons becoming subject to the Notice or to an amendment 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 within 12 months from becoming subject to the Notice or any amendments to the Notice, as applicable.

7. Period within which the plan is to be implemented

(1) For a person or class of persons subject to the Notice or to an amendment 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 48 months from the date of publication of the Notice or any amendments to the Notice, as referenced in column 8 of the Table.

(2) For a person or class of persons becoming subject to the Notice or to an amendment 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 48 months from becoming subject to the Notice or any amendments to the Notice, as applicable.

8. Content of the 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 and any amendments to the Notice. The plan must also contain the information required to file the Declaration of Preparation referred to in section 10 of the Notice and have the capacity to generate the information required to file the Declaration of Implementation referred to in section 11 and the Interim Progress Reports referred to in section 13 of the Notice.

9. Requirement to keep the 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 period referred to in section 7 of the Notice.

10. 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 6 or extended under section 15, a written “Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector (Subsection 58(1) of CEPA 1999).” This Declaration must be submitted 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 or class of persons has prepared a single plan for several facilities, a separate Declaration of Preparation must be filed for each facility.

11. 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 7 or extended under section 15, a written “Declaration That a Pollution Prevention Plan Has Been Implemented — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector (Subsection 58(2) of CEPA 1999).” This Declaration must be submitted to the Minister using the form that the Minister provides that contains the information set out in Schedule 5 of the Notice. Where a person or class of persons has prepared a single plan for several facilities, a separate Declaration of Implementation must be filed for each facility.

12. 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 10 and 11 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 10 or 11 of the Notice.

13. Interim progress reports

A person or class of persons identified in section 2 of the Notice must, unless it is not required as specified in column 8 of the Table, file to the Minister a written “Interim Progress Report — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector.” Interim Progress Reports must be filed using the form that the Minister provides and that contains the information set out in Schedule 4 of the Notice, no later than the dates below. 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 — deadline: 24 months after the date of publication of the Notice in the Canada Gazette, as referenced in column 8 of the Table; and
Interim Progress Report No. 2 — deadline: 36 months after the date of publication of the Notice in the Canada Gazette, as referenced in column 8 of the Table.

(2) For a person or class of persons becoming subject to the Notice or to an amendment to the Notice after the date of publication in the Canada Gazette, Part Ⅰ,

Interim Progress Report No. 1 — deadline: 24 months after the date the person or class of persons becomes subject to the Notice; and
Interim Progress Report No. 2 — deadline: 36 months after the date the person or class of persons becomes subject to the Notice.

Each Interim Progress Report will report data pertaining to its corresponding reporting year. Where a person or class of persons has prepared a single plan for several facilities, a separate Interim Progress Report must be filed for each facility.

14. 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 13 of the Notice or any amendments to 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 or any amendments to 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. A person or class of persons using existing plans must still file the Declaration of Preparation referred to in section 10 of the Notice, the Declaration of Implementation referred to in section 11 of the Notice, and any amended declarations under section 12 of the Notice, where applicable, and any Interim Progress Reports required under section 13 of the Notice.

15. 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 6 is needed to prepare the plan, or that further time beyond the period referred to in section 7 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 — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector (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 6 or section 7 of the Notice or before the expiry of any extended period.

16. 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 the applicable factors to consider in preparing the plan in section 4 or section 5, 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 Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector (Subsection 56(5) of CEPA 1999).” The written request must be submitted using the form that the Minister provides and must 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 6 of the Notice or before the expiry of any extended period.

17. 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);
the Pollution Prevention Planning section of Environment Canada’s Web site (www.ec.gc.ca/planp2-p2plan);
the CEPA Environmental Registry (www.ec.gc.ca/lcpe-cepa); and
the Canadian Pollution Prevention Information Clearinghouse Web site (www.ec.gc.ca/ccipp-cppic).

18. Notice Reference Code: P2SRM

For administrative purposes, all communication with Environment Canada concerning the Notice should refer to the following Notice Reference Code: P2SRM.

19. Public disclosure of information and forms

The Minister intends to publish information submitted in response to the Notice in Schedules 1, 4 (if applicable) and 5 in 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 may be amended from time to time as appropriate for the purpose of adding substances which are specified on Schedule 1 of the Act, along with any other required amendments. If the Notice is amended to add other substances, a separate set of substance-specific schedules will be published, if necessary, as a part of the amendment.

The Notice includes the following forms:

Schedule 1: Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented (Subsection 58(1) of CEPA 1999);
Schedule 2: Request for Waiver of the Requirement to Consider a Factor or Factors for Preparation of a Pollution Prevention Plan (Subsection 56(5) of CEPA 1999);
Schedule 3: Request for Time Extension for Preparation or Implementation of a Pollution Prevention Plan (Subsection 56(3) of CEPA 1999);
Schedule 4 (if applicable, as specified in column 8 of the Table): Interim Progress Report concerning the Implementation of a Pollution Prevention Plan; and
Schedule 5: Declaration That a Pollution Prevention Plan Has Been Implemented (Subsection 58(2) of CEPA 1999).

Forms referred to in the Notice (Schedules 1 to 5) are published as part of the Notice and may 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.

The Schedules (1 to 5) to be used for each substance listed in the Notice are identified by the Notice Reference Code (P2SRM), followed by a dash and the substance name or abbreviation (i.e. P2SRM-XXX).

20. Environment Canada contact information

For technical questions about the Notice, please contact or send queries to

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 or reporting online, please contact

Regulatory Innovation and Management Systems
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 Canadian Environmental Protection Act, 1999 (hereinafter referred to as 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.

The Act is enforced in accordance with the Compliance and Enforcement Policy for the Canadian Environmental Protection Act, 1999 available at www.ec.gc.ca/lcpe-cepa/default.asp?lang=En&n=5082BFBE-1. Suspected violations under the Act can be reported to the Enforcement Branch by email at environmental.enforcement@ec.gc.ca.

NOTE: Please contact Environment Canada for more information about electronic reporting, as provided in sections 19 and 20 of the Notice. Do not fill out this form as it appears in the Canada Gazette; it is for information only.

Schedule 1: Declaration That a Pollution Prevention Plan Has Been Prepared and Is Being Implemented — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector — Isoprene (Subsection 58(1) of CEPA 1999)

Notice Reference Code: P2SRM-Isoprene

For guidance on how to complete this Declaration, please refer to the “Instructions for Completing the Schedules Required by the Pollution Prevention Planning Notice for the Synthetic Rubber Manufacturing Sector — Isoprene.” These instructions are available from Environment Canada upon request.

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 of this Declaration.

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: _________________________________________________

Position/Job Title: ____________________________________________

Email: _____________________________________________________

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 the 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 (select all that apply):

Isoprene and Manufacturing of butyl rubber (including isoprene storage in tanks)

Isoprene and Manufacturing of halobutyl rubber (including isoprene storage in tanks)

Isoprene and Manufacturing of styrene-isoprene-styrene block copolymers (including isoprene storage in tanks)

Isoprene and Manufacturing of polyisoprene (cis-1,4-polyisoprene) rubber (including isoprene storage in tanks)

Isoprene and Manufacturing of styrene-isoprene rubber (including isoprene storage in tanks)

Isoprene and Manufacturing of any other type of synthetic rubber (including isoprene storage in tanks)

Isoprene and Any other manufacturing activity within the synthetic rubber manufacturing sector that involves the use of isoprene

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

Notes:

a) Wherever possible, the data collected in Part 4.1 of this Declaration are consistent with the reporting requirements of the National Pollutant Release Inventory (NPRI).

b) In Part 4.0, where indicated, use the following Basis of Estimate Codes to describe how each quantity reported in this part of the Declaration 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 (please specify)

c) This Declaration requires reporting of data from the 2012 Preparation Year (January 1 to December 31) and Base Year data from the 2009 calendar year.

If you are reporting data for a year other than the above specified years, select all that apply.

Person or class of persons became subject to the Notice on the date of publication in the Canada Gazette, Part Ⅰ, but gathered all the data required by the Notice for a calendar year between the 2009 Base Year and the 2012 Preparation Year, that are representative of the facility’s normal operating conditions before putting into practice BATEA.

If the above is applicable, indicate the new Preparation Year for which you are reporting: _____________. All references to the Preparation Year 2012 throughout this Declaration will be replaced by this new Preparation Year.

Provide justification on how this data is representative of the facility’s normal operating conditions before putting into practice BATEA.

Person or class of persons subject to the Notice has been granted a time extension to prepare a plan that results in a Preparation Year other than 2012.

Person or class of persons became subject to the Notice after the date of publication that results in a Preparation Year other than 2012. In this case, the Base Year will be replaced by the Preparation Year.

If either of the last two items above is applicable, indicate the new Preparation Year for which you are reporting: ___________. If this is not a calendar year, please provide your start and end date representing one full year’s duration (e.g. 2015-10-23 to 2016-10-22): _____________________ to __________________________. 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, distributed or otherwise used, and the nature of such activity at the facility for the Preparation Year 2012 or since the Base Year 2009. More than one nature of activity may be identified. Select all that apply.

Manufacture:

For on-site use/processing
For sale/distribution
As a by-product
As an impurity
Description: ____________________

Process:

As a reactant
As a formulation component
As an article component
Repackaging only
As a by-product
Description: ___________________________

Distribution:

Sold or distributed on its own
Sold or distributed as part of a 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

For the activity identified in Part 3.0 of this Declaration, did this facility use the substance on site in the Preparation Year 2012, the Base Year 2009, or both?

Preparation Year 2012: Yes No

Base Year 2009: Yes No

If yes for either year, report the total quantity of all on-site uses of the substance, in kilograms(kg), for that year, and the Basis of Estimate Code (see Part 4.0, Note b) in the appropriate field below. Indicate how the substance was used.

If no for both years, proceed to Part 4.3 of this Declaration.

Total Quantity of all On-site Uses for the Preparation Year (kg)	Basis of Estimate Code	Type of On-site Use	Total Quantity of all On-site Uses for the Base Year (kg)	Basis of Estimate Code	Type of On-site Use

4.3 On-site Releases — On-site releases data to be reported in Part 4.5 of this Declaration

4.4 Off-site Transfers — No data required for Part 4.4 of this Declaration

4.5 Additional Baseline Information — On-site Industrial Emissions of Isoprene

For the activity identified in Part 3.0 of this Declaration, did this facility release the substance on site to air in the Preparation Year 2012, the Base Year 2009, or both?

Preparation Year 2012: Yes No

Base Year 2009: Yes No

If yes for either year, report the facility operation information and the measured or estimated quantity of all actual on-site releases of the substance to air, for that year, in the appropriate fields below.

If no for both years, proceed to Part 5.0 of this Declaration.

Indicate the annual operation time of the facility, in hours (h), for the Preparation Year 2012:

_________________________________

For the Preparation Year 2012, indicate if the facility has

A continuous operation
A batch operation
A multi-process location where isoprene is involved
Isoprene used continuously in grades or products
Isoprene used in some different grades or products
Other (please specify): _____________

Fill out the following table to report information for the Preparation Year 2012.

Type of Releases to Air	Actual Exhaust Air Volume Rate (m³/s)	Temperature of the Gas Emitted from the Stack (°C)	Typical/ Current Concentration of Isoprene Released to Air (mg/m³)	Measurement Method or Estimation Method (see footnote 4)	Date the Stack Test was Completed (YYYY-MM-DD)
a) Stack or point releases (including process building vents) [Factor stated in subparagraph 4(1)(c)(i) of the Notice]
b) Storage tank releases [Factor stated in subparagraph 4(1)(c)(ii) of the Notice]	n/a	n/a			n/a
c) Fugitive releases [Factor stated in subparagraph 4(1)(c)(iii) of the Notice]	n/a	n/a			n/a
d) Wastewater process releases [Factor stated in subparagraph 4(1)(c)(iv) of the Notice]	n/a	n/a			n/a
e) Accidental or non-routine spills	n/a	n/a			n/a
f) Other releases (please specify)					n/a
TOTAL	n/a	n/a	n/a	n/a	n/a

Indicate the annual operation time of the facility, in h, for the Base Year 2009: ________

For the Base Year 2009, indicate if the facility has

Fill out the following table to report information for the Base Year 2009.

Type of Releases to Air	Quantity Released to Air for the Base Year (kg)	Measurement Method or Estimation Method (see footnote 5)
a) Stack or point releases (including process building vents) [Factor stated in subparagraph 4(1)(c)(i) of the Notice]
b) Storage tank releases [Factor stated in subparagraph 4(1)(c)(ii) of the Notice]
c) Fugitive releases [Factor stated in subparagraph 4(1)(c)(iii) of the Notice]
d) Wastewater process releases [Factor stated in subparagraph 4(1)(c)(iv) of the Notice]
e) Accidental or non-routine spills
f) Other releases (please specify)
TOTAL		n/a

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 actionto 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 actionto be taken in implementing the Pollution Prevention Plan. If the anticipated action includes the use of alternative substances, please include the chemical name, common name, or CAS Registry Number of the substance.

5.1.1 Anticipated Action:

For the anticipated action reported above, identify whether it represents a pollution prevention method(s) in Part 5.1.2 OR an environmental protection method(s) in Part 5.1.3.

5.1.2 Types of Pollution Prevention Methods:

Select from the list of options provided below, one or more pollution prevention methods to describe the anticipated action reported in Part 5.1.1. 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&offset=2&toc=show#section2).

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 Types of Environmental Protection Methods:

Select from the list of options provided below, one or more environmental protection methods to describe the anticipated action reported in Part 5.1.1.

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 in annual

a) uses;
b) releases; or
c) both a) and b), as applicable,

of the substance, anticipated to be achieved by implementing that action in kg and in mg/m³. 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 anticipated actions, such as employee training, may not be possible.

5.1.4 Anticipated Changes: ___________________________________________

In Part 5.1.5, relate these changes to specific elements of the baseline information described in Part 4.0 of this Declaration (on-site uses and on-site releases). For more information, please refer to the instructions for completing the schedules which are available from Environment Canada upon request.

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 (YYYY-MM-DD): _____________________________

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 in annual uses of the substance, in kg and as a percentage, relative to both the Preparation Year 2012 and the Base Year 2009.

In the first two columns of the table, relative to the Preparation Year 2012, report the total anticipated changes to be achieved by implementing only the anticipated actions described in Part 5.1 of this Declaration.

In the last two columns of the table, relative to the Base Year 2009, include both the changes reported in the first two columns and those achieved between the Preparation Year 2012 and the Base Year 2009 as reported in Part 4.2 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 Use/Release/Transfer(see footnote 6)	Total Anticipated Change Relative to the Preparation Year (kg)	Total Anticipated Change Relative to the Preparation Year (%)	Total Anticipated Change Relative to the Base Year (kg)	Total Anticipated Change Relative to the Base Year (%)
5.2.1 On-site uses (related to Part 4.2)
5.2.2 On-site releases	To be reported in Part 5.3 of this Declaration	To be reported in Part 5.3 of this Declaration	To be reported in Part 5.3 of this Declaration	To be reported in Part 5.3 of this Declaration

5.3 Detailed Anticipated Results Information

Use the results of the actual on-site releases of isoprene to air identified in Part 4.5 of this Declaration to fill out the following tables and report information relative to both the Preparation Year 2012 and the Base Year 2009.

In the following table, relative to the Preparation Year 2012, report the total anticipated changes 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 Releases to Air	Total Anticipated Change to On-site Releases of Isoprene to Air Relative to the Preparation Year (%)	Total Anticipated Change in the Typical/Current Concentration of Isoprene Released to Air Relative to the Preparation Year (mg/m³)	Total Anticipated Change in the Typical/Current Concentration of Isoprene Released to Air Relative to the Preparation Year (%)
a) Stack or point releases (including process building vents) [Factor stated in subparagraph 4(1)(c)(i) of the Notice]
b) Storage tank releases [Factor stated in subparagraph 4(1)(c)(ii) of the Notice]
c) Fugitive releases [Factor stated in subparagraph 4(1)(c)(iii) of the Notice]
d) Wastewater process releases [Factor stated in subparagraph 4(1)(c)(iv) of the Notice]
e) Accidental or non-routine spills
f) Other releases (please specify)
TOTAL	n/a	n/a	n/a

In the following table, relative to the Base Year 2009, include both the changes reported in the previous table and those achieved between the Preparation Year 2012 and the Base Year 2009 as reported in Part 4.5 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 Releases to Air	Total Anticipated Change to On-site Releases of Isoprene to Air Relative to the Base Year (kg)	Total Anticipated Change to On-site Releases of Isoprene to Air Relative to the Base Year (%)
a) Stack or point releases (including process building vents) [Factor stated in subparagraph 4(1)(c)(i) of the Notice]
b) Storage tank releases [Factor stated in subparagraph 4(1)(c)(ii) of the Notice]
c) Fugitive releases [Factor stated in subparagraph 4(1)(c)(iii) of the Notice]
d) Wastewater process releases [Factor stated in subparagraph 4(1)(c)(iv) of the Notice]
e) Accidental or non-routine spills
f) Other releases (please specify)
TOTAL		n/a

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 elements of the Pollution Prevention Plan will meet the risk management objective for isoprene identified in column 6 of the Table in section 3 of the Notice. If you anticipate that this plan will not meet the risk management objective, 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 in the Preparation Year 2012 to take into account the “Substance-specific factors to consider in preparing the plan” in subparagraphs 4(1)(d)(i), 4(1)(d)(ii) and 4(1)(d)(iii) of the Notice and the “Other factor to consider in preparing the plan” in subsection 5(1) of the Notice, except those factors for which a waiver has been granted by the Minister.

4(1)(d)(i) Using BATEA to prevent or control the release of isoprene to air from the following emission sources: stack or point, storage or handling, fugitive, wastewater processes, and accidental or non-routine spills.

4(1)(d)(ii) Establishing and implementing a leak detection and repair (LDAR) program, as further described in subparagraph 4(1)(d)(ii) of the Notice.

4(1)(d)(iii) Adopting standards and operating practices for controlling air emissions, as further described in subparagraph 4(1)(d)(iii) of the Notice. Indicate which of the source(s) listed in this subparagraph you considered.

5(1) The use of pollution prevention methods as a means of addressing the release to the environment of isoprene, as further described in subsection 5(1) of the Notice.

9.0 Certification

I hereby certify that a Pollution Prevention Plan has been prepared and is being implemented in respect of isoprene 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

Schedule 2: Request for Waiver of the Requirement to Consider a Factor or Factors — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector — Isoprene (Subsection 56(5) of CEPA 1999)

Notice Reference Code: P2SRM-Isoprene

For guidance on how to complete this Request, please refer to the “Instructions for Completing the Schedules Required by the Pollution Prevention Planning Notice for the Synthetic Rubber Manufacturing Sector — Isoprene.” These instructions are available from Environment Canada upon request.

Is this an amendment to a Request 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 Request 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 of this Request.

Amendment Part(s)

Please specify the parts of the Request 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: ________________________________________________

Position/Job Title: ___________________________________________

Email: _____________________________________________________

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” is (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 in respect of isoprene 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

Schedule 3: Request for Time Extension — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector — Isoprene (Subsection 56(3) of CEPA 1999)

Notice Reference Code: P2SRM-Isoprene

Is this an amendment to a Request previously submitted Yes No

If no, please proceed to Part 1.0 of this Request.

Amendment Part(s)

Please specify the parts of the Request 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: __________________________________________

Position/Job Title: ____________________________________

Email: ______________________________________________

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 being 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 — YYYY-MM-DD).

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 in respect of isoprene 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

Schedule 5: Declaration That a Pollution Prevention Plan Has Been Implemented — Pollution Prevention Planning Notice in Respect of Specified Substances on Schedule 1 of the Canadian Environmental Protection Act, 1999, Related to the Synthetic Rubber Manufacturing Sector — Isoprene (Subsection 58(2) of CEPA 1999)

Notice Reference Code: P2SRM-Isoprene

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

If no, please proceed to Part 1.0 of this Declaration.

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: ________________________________________________________