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Enter Title Here - Enter Title Here

     Printed: January 9, 2011

    Information Request NSF Green Chemistry Product Information

About NSF

    NSF International (NSF) is an independent, not-for-profit organization of scientists, engineers, technicians, educators, and analysts.

    NSF currently provides testing, certification, and audit services for more than 130,000 products in 82 countries worldwide. It is a

    trusted neutral non-governmental agency, serving government, industry, and consumers in achieving solutions to problems relating to

    public health and the environment since 1944. The mission of NSF is to provide clients and the general public with objective, high

    quality, timely, third-party certification services. Services include development of consensus standards, voluntary product testing and

    certification with policies and practices which protect the integrity of registered Marks, education and training, and research and

    demonstration, all relating to public health and the environmental sciences.

NSF Green Chemistry Program

    NSF’s Green Chemistry Program performs reviews of product formulations and individual ingredients for conformity with environmental standards and recognition programs including:

    ; The U.S. Environmental Protection Agency, Design For the Environment (EPA - DfE) Formulator Program ; The GreenBlue Institute, for listing on the CleanGredients? website

    ; Green Seal environmental standards

    ; Environmental Choice standards

How does the process work?

    ; Submittal of the information requested on this form will initiate the process to obtain a time and cost estimate for NSF review

    services.

    ; NSF will review the information for completeness and provide the written cost estimate and corresponding contract. ; Upon receipt of a signed contract, and a 50% deposit, NSF will initiate the review process. NSF will request the following

    information as needed to complete the reviews:

    ; Test data and other product information to confirm the formulation complies with the criteria of the respective

    standard or recognition program (e.g. product performance test data, biodegradation studies for each ingredient, acute

    aquatic toxicity data, human health toxicity data, etc.)

    ; Proprietary ingredient disclosure from your ingredient suppliers NSF will provide forms that can be forwarded to

    your suppliers. The forms will explain the nature of the request, and provide an opportunity to submit the information

    directly and confidentially to NSF.

    ; An MSDS for each product and each ingredient

Confidentiality

    Only NSF authorized personnel are permitted accesses to the information provided on this form. The security of this form and the

    information it contains is maintained through our confidential business information procedures and will not be revealed or provided to

    unauthorized employees within the applicant’s company, ingredient suppliers, or other parties without your company’s prior written consent. See Section 4 of this form for EPA review for DfE recognition and CleanGredients? reviews.

AESOP 8284; ISSUE 3; STATUS-PUBLISHED; EFFECTIVE 15 AUG 2009 This document is the property of NSF International. Page 1 of 5

     Printed: January 9, 2011

Information Request NSF Green Chemistry NSF USE ONLY Product Information

     DCC:

     Corporate #: _________________________

    Project #: ___________________________

    The information requested on this form is critical to the review of your product.

    Please complete this form completely prior to submission. Please call 651-493-4247 for assistance.

1. Company information:

    Company name Company contact

     Job Title

    Address Telephone number ( )

     FAX number ( )

     Email

2. Review type:

    Please check the type of review you are seeking:

     EPA DfE Recognition

     Please attach: Product performance data

     Product MSDS

     Ingredient MSDS’s

     CleanGredients? listing

     In order to list on CleanGredients? you must be a current supplier subscriber on www.cleangredients.org

    Please attach: Biodegradability data

     Aquatic toxicity data

     Human health & safety data

     Product MSDS

     Ingredient MSDS’s

     Other (explain) ________________________

    Please check additional testing you are seeking:

     Product performance testing. EPA’s DfE Program requires product performance testing in order to recognize safer products.

     Market leading product you would like NSF to evaluate your product against:

     Compostability testing. EPA’s DfE Program requires compostability testing on all disposable wipe products.

     Biodegradation testing. NSF offers biodegradation testing to support CleanGredients? reviews.

    AESOP 8284; ISSUE 3; STATUS-PUBLISHED; EFFECTIVE 15 AUG 2009 This document is the property of NSF International. Page 2 of 5

     Printed: January 9, 2011

3. Product Information: (please submit one page per formulation, use additional sheets as needed)

    Company Name

    Product trade name: Type of product (all purpose cleaner, glass cleaner, surfactant, etc.)

    pH of product (at point of sale): Production volume (lbs/yr)

    Check if: Consumer