EPA Form 6300

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### ATTACHMENT B 

# Safer Detergents Stewardship Initia tive Instructions for Application Form

EPA developed the Sa fe r Detergents Ste wardship Initiative (SDSI) to recognize environmental leaders wh o voluntarily commit to the use of sa fe r surf actants. Leadi ng product manuf acturers have made great progress in developing sa fe r, highly eff

ective cleaners. These manuf ac turers believe that producing the sa fe st products possible is important to their role as ste wards of the environment and public health. A numbe r of U.S. corporations have acted in advance of SDSI to use sa fe r sur factants in their entire product lines.
Safer surfactants are surfactants that break down quickly to non

- polluting compounds 1

. CleanGredients  is a resource for information on safer surfactants (www.cleangredients.org). To be eligible for recognition under SDSI, candidates should do the following:
o Complete this application and have it signed by a company authority (e.g., CEO or vice president for health and environment).
o Post a statemen t on their website describing the actions that qualify them for recognition under SDSI. EPA reserves the right to request at any time, on a confidential basis, appropriate documentation (including but not limited to bills of lading, invoices, material saf ety data sheets, and list of ingredients) to confirm that candidates have achieved the appropriate criteria for recognition. If documentation is requested but not received within a reasonable time, EPA may deny or withdraw recognition from that candidate. There are two categories for recognition under SDSI: Champion and Partner.

1 An example of a class of safer surfactants is linear alcohol ethoxylates (LAE). LAEs are toxic to aquatic life, but break down quickly to non

- polluting compounds. Nonylphenol ethoxylates, commonly referred to as NPEs, are a surfactant class th at does not meet the definition of a safer surfactant. Both NPEs and their breakdown products, such as nonylphenol, are toxic to aquatic life. 

###  Champion is the highest level of recognition offered under SDSI. At this level, the participant is invited to t he SDSI Awards ceremony, listed on the EPA SDSI website as a cham pion, and may use a special logo in their literature to help explain their participation in the program.



###  The Partner category provides recognition of significant accomplishment towards the use of safer surfactants. Partners will be listed on the EPA SDSI website and may be granted recognition as a Champion in the future, if appropriate. Partner recognition will sunset on the commitment date provided in Section 3 of the Application. Guidelines for achieving Champion or Partner Status are provided in Table 1. Both Champions and Partners will receive a certificate of recognition from DfE. Application Process : The application is available online and may be filled out and submitted in hard copy by mail or scanned and emailed to SDSI@epa.gov. Unless you clai m information as confidential , all applications received will be considered public information and no materials submitted will be returned. For security purposes, confidential information should not be submitted electronically. If youEPA Form 6300

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choose to send the a pplication electronically, the application and signed signature page must be scanned and sent to SDSI@epa.gov. If you choose to submit a hard copy application, sen d your completed application via regular / certified mail or overnight mail to the following address: Safer Detergent Stewardship Initiative Attn: Emily Connor 4550 Montgomery Avenue, Suite 800 North Bethesda, MD 20814

- 5341 301

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- 5197 Conf irmation of

Receipt: EPA will confirm receipt of applications, usually by email. If you have not receive d an acknowledgment within two weeks of sending your applications, please contact David Difiore at SDSI@epa.gov or 202

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- 8786 Notif ication: Winners will be notified prior to the official public announcement. Awards will be presented to the primary spo nsor of the application. Questions: Questions about eligibility, nomination procedures, or the Safer Detergent Stewardship Initiative should be directed to David Difiore of EPA’s Design for the Environment Program at SDSI@epa.gov or 202

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- 8796
Pape rwork Burden Estimate The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response, including the time for reviewing instructions, gathering information, posting information to the interne t, and reviewing and completing the application. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collect ion is 2070

- 0171. Approval expires on 03/31/2011. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated co llection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed applica tion to this address.Additional n otes about Table 1 guidelines :

 CleanGredientsTM is a resource for information on safer surfactants.

 The SDSI participation deadline for using only safer surfactants in third

- party finished goods and Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA)

- registered products is May 3 0, 2009.

 Products include those whose use routinely results in their discharge to the environment (e.g., all

- purpose cleaners, laundry detergents, pesticides, airplane de

- icers, fire

- fighting foams and gels).

 An example of a strategy is a letter that is se nt to suppliers requiring them to provide products with only safer surfactants. The retailer/distributor or institutional purchaser will not be eligible for Champion recognition until only safer surfactants are sold or purchased.

 Examples of efforts that w ould qualify include developing means for surfactant users to identify safer surfactants, taking action to educate industry or the public about safer surfactants, and encouraging business to move toward safer surfactants. Participant Type 

### Table 1: Guidelines for Achieving: Champion Status Partner Status

Chemical Manufacturers 

###  Demonstrate that you only manufacture safer surfactants



###  Document a strategy for ensuring that you manufacture only safer s urfactants 

###  Commit to manufacturing only safer surfactants by a date that is reasonable for your circumstances



###  Document a strategy for ensuring that you will manufacture only safer surfactants

Formulators 

###  Demonstrate that you only use safer surfactants in products



###  Document a strategy for ensuring that only safer surfactants are used in products 

###  Commit to using only safer surfactants in your products by a date that is reasonable for your circumstances



###  Document a strategy for ensuring that only safer surfact ants will be used in products

Retailers / Distributors 

###  Demonstrate that only safer surfactants are included in products intended for sale



###  Document a strategy for ensuring that only safer surfactants are included in products intended for sale 

###  Commit to se ll only products containing safer surfactants by a date that is reasonable for your circumstances



###  Document your active encouragement of the use of safer surfactants

Institutional Purchasers 

###  Demonstrate that you only purchase products containing safer su rfactants



###  Document a strategy for ensuring that purchased products only contain safer surfactants 

###  Commit to only use products that only contain safer surfactants by a date that is reasonable for your circumstances



###  Document your active encouragement of the use of safer surfactants

Others (e.g., non
- profits, unions, academia) 

###  Demonstrate outstanding efforts to encourage the use of safer surfactants 

###  Document your active encouragement of the use of safer surfactantsSafer Detergents Stewardship I nitiative OMB No. 2070

- [ 0171 ]

SECTION 1a: Enter requested information for the authorized representative Organization Name

Contact Name

Address

Address

Phone Fax

Email

Website

SECTION 1b: Indicate your type of organization Chemical Manufacturer

– Manufactures surfactants Formulator

– Purchases and blends chemicals (including surfactants) to create an end

- use product for retailers and/or distributors Retailer / Distributor

– Sells products containing surf actants Institutional Purchaser

– Purchases or specifies cleaning products for use in multiple facilities (e.g., janitorial service provider) Other

– Influences use of surfactants (e.g., non

- profit, trade association, academia)
SECTION 1c: Ind icate the level of recognition for which you are applying (refer to the instructions for a description of Champion and Partner status for each organization type) Champion (go to Section 2) Partner (go to Section 3)Safer Detergents Stewardship Initiative Page 2 of 5

SECTION 2: Fill out this section if you are applying f

or recognition as a Champion If you are a... Demonstrate in SECTION 2a that... And the n go to... Chemical Manufacturer You only manufacture safer surfactants Section 2b
Formulator You only use safer surfactants in products Section 2 b Retailer / Distributor Only safer surfactants are included in

products intended for sale Section 2 c Institutional Purchasers All the products you purchase contain only

safer surfactants Section 2 c Other You have made outstanding efforts to

encourage the use of safer surfactants Go to Section 4

SECTION 2a: Use this space to explain how you meet the above requi rements. Please include supporting documents when appropriate and note these documents in your statement. You may attach extra sheets as needed. To be eligible for recognition, candidates should post a statement on their website stating that they manufacture, use, or purchase products containing only safer surfactants. Use this space to provide the URL for that section of your website describing the actions that qualify you for recognition:Safer Detergents S tewardship Initiative Page 3 of 5

SECTION 2b (Chemical Manufacturers and Formulators only): Indicate or describe your product stewardship strategy for ensuring the manufacture or use of safer surfactants Use CleanGredients to choose surfactants

Other, p lease describe 2 :

SECTION 2c (Retailers/ Distributors and Institutional Purchasers only): Document your strategy for ensuring that all of your purchased products contain only safer surfactants. You may attach extra sheets as needed.* If you are a... Document a strategy for ensuring that... Retailer / Distributor Only safer surfactants are included in products intended for sale

Institutional Purchaser Purchased products co ntain only safer surfactants

* An example of a strategy would be the establishment of a policy that requires suppliers to provide products that contain only safer surfactants. This strategy may be evidenced by a letter that is sent to suppliers requiring them to provide products with only safer surfactants, or a comparable statement posted on a company’s website. The retailer / distributor will not be eligible for Champion recognition until it sells products with only safer surfactants.

2 For SDSI recognition, your strategy description should include an explanation of your due diligence in selecti ng safer surfactants. Along with the non

- use of NPE surfactants, examples of due diligence include : Only using surfactants from CleanGredients (www.cleangredients.org); only using surfactants that meet the DfE or CleanGredients surfactant screens (see Df E screen at http://www.epa.gov/dfe/pubs/projects/gfcp/index.htm); or only using surfactants that meet criteria similar to the DfE or CleanGredients screens (e.g., the EU Detergents Directive). In addition, a description of in

- house criteria that ensures t he use of safer surfactants may also qualify as due diligence.Safer Detergents Stewardship Initiative Page 4 of 5

SECTION 3: Fill out this section if you are applying f or recognition as a Partner If you are a... Document in SECTION 3a your commitment to...
Chemical Manufacturer Produce only safer surfactants
Formulator Use only safer surfactants in your products Retailer / Distributor Only sell products that only contain safer surfactants
Institutional Purchasers Only purchase products that only contain safer surfactants
Other (e.g., trade association, NGO, etc.) encouragement of safer surfactants

SECTION 3a: Use this space to describe how you meet the above requirements. * To be eligible for recognition, candidates should post a statement on their webs ite stating their commitment to completely transitioning to safer surfactants. Use this space to provide the URL for that section of your website describing the actions that qualify you for recognition:

* You should describe you r commitment to a complete transition to safer surfactants by a date that is reasonable for your circumstances. Please state this date explicitly and explain briefly why it is a reasonable date for your circumstances. 3 Include supporting materials when app ropriate and note these materials in your statement. You may attach extra sheets as needed.

3 Please note that Partner recognition will sunset on the commitment date. After this date, companies will need to apply for Champion recognition.Safer Detergents Stewardship Initiative Page 5 of 5

SECTION 4: Certification of Application Please have the appropriate company authority (e.g., CEO , vice president for health and environment , division head, or other authorized signatory) sign here to verify the accuracy of the application’s content.

Signature of Authorizing Entity Date

Print ed Name and Title Date I hereby affirm that the contents of this application are true and accurate to the best of my knowledge, and that I am an authorized representative of the company or organization named above and am duly authorized to sign this appl icatio n.