Transcription of Instructions for Toxic Substances Control Act (TSCA ...
1 Instructions for Toxic Substances Control Act (TSCA) Certification Each one of the TSCA Certifications attached has a specific intended purpose: 1. The version with the Waybill or reference number section is to be used for single-shipment certifications Please enter the shipment international air waybill number (IAWB) of the shipment in this area Note that completing the Company name, Company address, and Certifier title fields is OPTIONAL The single-shipment certifications are to be included with the shipment documents at the time the shipment is created 2. The annual certification is the version with the valid for twelve months language and is to be used for filing multiple commodity TSCA articles with fedex Trade Networks (FTN) Check either positive or negative certification for the TSCA articles being submitted All three columns do NOT have to be completed; just the ones you use for your specific TSCA article(s) Note that completing the Company name, Company address, and Certifier title information blocks below the three columns is OPTIONAL Once completed, the annual version can be sent to Please note: Only the annual version (covering the 12- month period) can be sent to this contact address.
2 09/2019 Toxic substance Control Act (TSCA) Certification Date: _____ Waybill or other reference (invoice/lot) number: _____ Positive Certification I certify that all chemicals Substances in this shipment comply with all applicable rules or orders under TSCA and that I am not offering a chemical substance for entry in violation of TSCA or any applicable rule or order thereunder. OR Negative Certification I certify that all chemicals in this shipment are not subject to TSCA. Company name: _____(optional) Company address: _____(optional) Certifier name: _____ Certifier title: _____(optional) Certifier phone number: _____ Certifier email address: _____ Certifier signature: _____ Product description 1. _____ 2. _____ 3. _____ 4. _____ 5. _____ 6. _____ 7. _____ If the certifier is unsure if their chemical substance is subject to TSCA compliance, contact the Environmental Protection Agency, TSCA Hotline at or between 8:30 and 5:00 , or 09/2019 Toxic substance Control Act (TSCA) Certification Date: _____ This certification is valid for twelve months from the date submitted and will only cover the products listed.
3 Check only one: Positive Certification I certify that all chemical Substances in this shipment comply with all applicable rules or orders under TSCA and that I am not offering a chemical substance for entry in violation of TSCA or any applicable rule or order thereunder. Negative Certification I certify that all chemicals in this shipment are not subject to TSCA. Company name:_____(optional) Company address:_____(optional) Certifier name: _____ Certifier title: _____(optional) Certifier phone number: _____ Certifier email address: _____ Certifier signature: _____ If the certifier is unsure if their chemical substance is subject to TSCA compliance, contact the Environmental Protection Agency, TSCA Assistance Office at between 8:30 and 5:00 Product Number Product Name Product Description
