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									                                                                                       Eco Mark Product
                                                                                       Category N0.131

 Brand name:                                                                        Civil Engineering
                                                                Date:                    Products
                                                                (Company name)
                                                                            Company seal
  <Preparing Attached Certificates>
  1. Indicate details of the product under application for certificate in “Fill in this
     Column.”
      Shaded areas in “Fill in this Column” do not require entry.
  2. Prepare yourself or have other interests prepare the certificates specified in
     “Documents to be submitted.” Submit these certificates with this document when
     applying for Eco Mark Product certificate or use.
  3. Prepare certificates referring to the examples provided.
  4. The issuer(s) in the “Issued by” column must prepare “Documents to be Submitted.”
  5. To complete the certificates, “Common criteria”, “Criteria for material” for
     appropriate material category (A-D), “Criteria on individual products” for each
     products (A-N), and “Quality criteria” should be filled in. Appropriate certificates
     should be selected according to the product under application.
             Item                              Fill in this Column            Issued by
 Planned Display of Eco Mark            < > Yes
                                          < > Product < > Packaging
                                          < > Catalogue/leaflet < > User manual
                                          < > Other (                        )
                                        < > No (If an Eco Mark is displayed, design
                                              drawing must be submitted)

                                        (Select where appropriate If you choose <Yes>,
                                        please submit design drawing given below.)           Applicant
 Article 3 of Usage Regulations
 Display of intended location of E
 co Mark, display of environmenta
 l information below mark               Design drawing to be provided (Format free,
 Article 7 of Usage Regulations         text)
 Display of Eco Mark user name
 and address, display of certificate
 number


        Item                      Fill in this Column                Documents to be        Issued by
                                                                       Submitted
                                                                    If developed by other
                         < > Other companies      < > Own company
Manufacturer of                                                     companies,      attach
                                                                                           Applicant
product                                                             Application Consent
                                        (Select where appropriate))
                                                                    Form (Example 1).
                                                                       A copy of notice of
                                                                     Eco Mark
                                                                     certificate review
                        Are there any changes in addition to brand results
If a product with Eco
                        name?            < > Yes/< > No                Product category
Mark certificate
                        (Select where appropriate)                   match table
under the category is
                                                                     between the
submitted for
                      (If only the brand name has been changed, existing eco product
approval as another
                      the following items do not have to be and one under
brand
                      proved.)                                       application
                                                                    Documents certifying
                                                                    changes, if any, meet
                                                                    applicable criteria




                                       131(Certificate)
                    < >A. Wooden tiling/blocks (         )
                    < >B. Steel construction materials(       )
                    < >C. Aggregates (         )
                    < >D. Cement (         )
                    < >E. Concrete admixture (          )
                    < >F. Concrete products
                    < >G. Pavement materials (           )
                    < >H. Landscaping/revegetation materials
                    (      )
                    < >I. Traffic signs/traffic lane lines (    )
 Subject
                    < >J. Materials for temporary structures(         )
                    < >K. Road materials (         )
                    < >L. Sewage/waterworks materials (           )
                    < >Materials for bridges/rivers/harbors (       )
                    < >N. Other materials (          )

                    Select where appropriate, and fill the product
                    number on the Attachment 1 in the
                    parenthesis.

                    Example: For “Permeable steel sheet piles”,
                    check “B. Steel construction materials” and fill
                    in “2”.

<Common criteria>

                                                                           Documents to be
       Item                       Fill in this Column                                           Issued by
                                                                             Submitted
                                                                                              Manager      of
 4-1.(1)                                                                                      finished
 Environmental                                                            Certificate         product
 laws and                                                                 (Example 2)         manufacturing/
 regulations                                                                                  assembly plant


 <Criteria for material>

                                                                            Documents to be
           Item                    Fill in this Column                                           Issued by
                                                                              Submitted
                       < >A. Wood
                       < >B. Plastic
                       < >C. Glass
 4-1.2 Composition     < >D. Fiber
 of materials          < >E. Others (        )

                       Select   where     appropriate,  excluding
                       functionally essential small parts on the
                       product.




                                        131(Certificate)
                                                                 Documents to be
     Item                     Fill in this Column                                     Issued by
                                                                   Submitted
                Use of wood termicides, wood preservatives,
                   wood pesticides, and wood fungicides      Reasons of wood
  4-1.(2) Wood                  < > Yes/< > No              preservative use,
                                                                              Japan Wood
 preservatives           (Select where appropriate)             documents
                                                                               Preserving
 (product with                                                certifying that
                                                                              Association,
  “A” selected)   If “Yes,” documents provided in the right preserving agents
                                                                                  etc.
                        column should be submitted.           have attained
                                                            JWPA certificate

                                                                    Certificate
                                                                 (Example 3) or       Raw
                                                                 result of heavy    material
  4-1.(3) Use of
                                                                   metal test       supplier
 toxic chemical
                                                                (cadmium, lead,       (raw
   substances
                                                                    hexavalent      material/
 (product with
                                                               chromium, arsenic, molding) or
  “B” selected)
                                                                  total mercury,   third party
                                                                    selenium)     testing body

4-1.(4) Halogens
 (product with
  “B” selected)
                                                                 Results of tests
                                                                based on the soil
                                                                  contamination
                                                                   requirement
4-1.(5) Safety of                                                (Environmental Third party
   glass cullet                                                  Ministry Notice testing body
 (product with                                                 No. 29) (cadmium, or public
  “C” selected)                                                 lead, hexavalent institution
                                                               chromium, arsenic,
                                                                  total mercury,
                                                                selenium, boron,
                                                                     fluorine)
                                                               Certificate
     4-1.(6)                   Name of dye plant                   (Example 4)       Applicant
   Chemical
   substance         (If there are multiple plant names, and Certificate
                                                                                       Dye plant
 (product with      space is inadequate to list all, write on a      (Example 5)
                                                                                       manager
  “D” selected)                   separate sheet)               (for each materials of
                                                                     fiber part)




                                   131(Certificate)
  <Criteria on individual products>
  A. Wooden tiling/blocks

                                                                      Documents to be Issued by
      Item                       Fill in this Column
                                                                        Submitted
                                                                      Entry Table A1  Applicant

                                                                      Entry TableA2: List
                                                                      of raw material
4-1. (7) (8)                                                          suppliers (10 or Applicant
Ratio of material                                                     more suppliers)
to the entire
product/name of
raw materials
                                                                      List of certificate of Raw
                                                                      the top 10 raw material
                                                                      material suppliers     supplier
                                                                      (Example 6)
                  Use of coating
                    < >Yes / < >No
                      If “Yes,” documents provided in the right
                   column should be submitted. The following A list of the used
4-1. (9) Chemical
                   information should be entered if coating with amount of concerned Paint
substances     of
                   Eco Mark certificate (Version 1.0) is used.   substances          manufacturer
coating
                    < > Certificated brand name (              ) (Example 7)
                    < > Certificated number       (            )
                  (Select where appropriate)


                 Use of halogens
4-1.(10) Halogens < >Yes / < >No

                                        (Select where appropriate)
4-1.(11)
                    Name of packaging material:
Packaging
material
                    Way of packaging:
4-1. (11) Halogens
used            for
packaging
                     < > Use /< > No use
materials      (for
plastic packaging
material only)
                                         (Select where appropriate)



                                                                      Result    of    tests Applicant or
4-2. (108) Product
                                                                      according to the JIS third     party
Quality
                                                                      or JAS                testing body




                                    131(Certificate)
  <Criteria on individual products>
   B. Steel construction materials

                                                         Documents to be
      Item                     Fill in this Column                              Issued by
                                                           Submitted
4-1.(12)                                                Written      materials
Consideration to                                        regarding          the
the reduction of                                        reduction amount of
                                                                               Applicant
waste generation                                        waste generation in
                                                        a ton of crude steel
                                                        production
                                                        Written      materials
4-1.(13) Balance                                        regarding          the
of materials form                                       quantity     of   new
production      to                                      resources        used,
                                                                               Applicant
recycling                                               energy consumption
                                                        and CO2 emission in
                                                        a ton of crude steel
                                                        production
4-1.(14) Product                                        Certificate of product
specification and                                       specification
construction                                            including size and Applicant
method (common)                                         used materials


                                                        Construction method Applicant
                                                        Certificate to prove
4-1.(14)                                                that the product is
Permeable steel                                         designed to facilitate
sheet piled (if                                         hydrological
                                                                               Applicant
applicable)                                             circulation between
                                                        land and water
                                                        (for             each
                                                        construction method)
                                                        Certificate to
                                                        prove     that     the
                                                        product is with low
4-1.(14)        Low                                     displacement
displacement                                            (for             each
steel piles                                             construction method)
                                                                               Applicant
(if applicable)                                         Information         to
                                                        confirm about the
                                                        displacement volume
                                                        to the surface at the
                                                        pile             body
                                                        construction stage

4-2.(109) Product
                                                        Certificate or result Applicant or
quality
                                                        of tests according to third    party
                                                        the JIS, etc.         testing body




                                     131(Certificate)
  <Criteria on individual products>
   C. Aggregates

                                                                      Documents to be
      Item                         Fill in this Column                                      Issued by
                                                                        Submitted
                  < > The percentage of the following
4-1.(15)      The raw material aggregates is 100% by
percentage     of mass of the entire product mass
recycled            < > Dismantled concrete blocks
aggregates           < > General waste, sewage sludge
                    < > Blast furnace slag, ferro-nickel slag
                                                and copper slag
                                    (Select where appropriate)

4-1.(15) Recycled
                                                                     Raw         material
aggregates                                                                                Raw materials
                                                                     certificate
                                                                                          supplier
                                                                     (Example 8)

                                                                     Written    materials
4-1.(16) Balance
                                                                     regarding        the
of materials form
                                                                     quantity   of   new Third party
production      to
                                                                     resources      used, testing body
recycling
                                                                     energy consumption or       public
                                                                     and CO2 emission in institution
                                                                     a ton of crude steel
                                                                     production
                                                                     Results of elution
                                                                     tests of the product
                                                                     based on the soil
                                                                     contamination
4-1.(17) Elution                                                     requirement
                                                                                           Third party
of       harmful “We will conduct the test once a year               (Environmental
                                                                                           testing body
substances        during certified period and disclose the           Ministry      Notice
                                                   result”
                                                                                           or      public
                                                                     No. 29) (cadmium,
                          < >Declare / < >Not declare                                      institution
                                                                     lead,     hexavalent
                               (Select where appropriate)            chromium, arsenic,
                                                                     total       mercury,
                                                                     selenium,     boron,
                                                                     fluorine)
                                                                     Results            of
                                                                     containing tests of
                                                                     the product based
                                                                     on       the     soil
4-1.(18)                                                             contamination
                     “We will conduct the test once a year           requirement
Containing      of
                      during certified period and disclose the                             Applicant or
harmful                                                              (Environmental
                                                       result”                             third    party
substances
                              < >Declare / < >Not declare
                                                                     Ministry      Notice testing body
                                        (Select where appropriate)   No. 29) (cadmium,
                                                                     lead,     hexavalent
                                                                     chromium, arsenic,
                                                                     total       mercury,
                                                                     selenium,     boron,
                                                                     fluorine)




                                       131(Certificate)
4-1.(110-112)
                                                                 Certificate or result Applicant or
Product quality
                                                                 of tests according to third    party
                                                                 the JIS, etc.         testing body



  *1 In case of using vitrified aggregates or slag aggregates as raw materials, the following
  eight substances shall be tested: cadmium, lead, hexavalent chromium, arsenic, total
  mercury, selenium, boron and fluorine.


  <Criteria on individual products>
   D. Cement

                                                                  Documents to be
      Item                     Fill in this Column                                         Issued by
                                                                    Submitted
4-1.(19) Supply of
                                                                 Raw           material
raw materials
                                                                 certificate              Applicant


4-1.(20)       The
percentage      of
recycled
materials
                                                                 Entry table C            Applicant




                                                                 Certificate for the
                                                                 production    process
                                                                 with heat treatment
                                                                 without         using
4-1.(21)    CO2
                                                                 recycled materials,
emission amount
                                                                 and to compare the Applicant
                                                                 value      of    CO2
                                                                 emission      amount
                                                                 (amount of energy
                                                                 consumption         is
                                                                 applicable)
                                                                 Results of elution
                                                                 tests of the product
                                                                 based on the soil
4-1.(22) Elution                                                 contamination
of       harmful                                                 requirement          Third party
substances
                                                                 (Environmental       testing body
                                                                 Ministry      Notice or     public
                                                                 No. 29) (cadmium, institution
                                                                 lead,     hexavalent
                                                                 chromium, arsenic,
                                                                 total       mercury,
                                                                 selenium)




                                   131(Certificate)
                                                   Results of
                                                   containing tests of
4-1.(23)                                           the product based
Containing of                                      on the soil
                                                                          Third party
harmful                                            contamination
                                                                          testing body
substances                                         requirement
                                                                          or public
                                                   (Environmental
                                                                          institution
                                                   Ministry Notice
                                                   No. 29) (cadmium,
                                                   lead, arsenic, total
                                                   mercury, etc.)
4-2.(113) Product
                                                   Certificate or result Applicant or
quality
                                                   of tests according to third party
                                                   the JIS, etc.         testing body




  <Criteria on individual products>
   E. Concrete admixture

                                                    Documents to be
      Item                  Fill in this Column                             Issued by
                                                      Submitted
4-1.(24)        The
percentage       of
recycled                                                                  Recycled
materials                                          Entry table C          material
                                                                          collector



4-2.(114) Product
                                                   Certificate or result Applicant or
quality
                                                   of tests according to third    party
                                                   the JIS               testing body




                                131(Certificate)
  <Criteria on individual products>
   F. Concrete products

                                                                    Documents to be
      Item                         Fill in this Column                                     Issued by
                                                                      Submitted

4-1.(25) Choice
                       < >a/< >b



4-1.(25)a.
                                                                                          Applicant or
Permeability                                                       Test   results      of
                                                                                          third    party
                                                                   permeability factor
                                                                                          testing body

4-1.(25)b.     The
percentage      of
recycled
materials                                                          Entry table C         Applicant



                                                                   Results of elution
                                                                   tests of the product
                                                                   based on the soil
                                                                   contamination
4-1.(26) Elution                                                   requirement           Third party
of       harmful
                                                                   (Environmental        testing body
substances
                                                                   Ministry      Notice or       public
                                                                   No. 29) (cadmium, institution
                                                                   lead,     hexavalent
                                                                   chromium, arsenic,
                                                                   total       mercury,
                                                                   selenium)
                                                                   Results            of
                                                                   containing tests of
4-1.(27)                                                           the product based
Containing        of                                               on       the     soil
harmful                                                                                  Third party
                                                                   contamination
substances                                                                               testing body
                                                                   requirement
                                                                                         or      public
                                                                   (Environmental
                                                                                         institution
                                                                   Ministry      Notice
                                                                   No. 29) (cadmium,
                                                                   lead, arsenic, total
                                                                   mercury, etc.)
                   “The manuals on the right will be
                       provided to the constructor, the
4-1.(28) Providing                                                 Manuals to indicate
                    owner of an architectural structure,
information                                                        the items of 4-1. (28)
                           and the manufacturer of the                                    Applicant
                                                                   a.b.c.d.e
                                               product.”
                                                                   (manuscript)
                             < >Declare / < >Not declare
                                      (Select where appropriate)




                                      131(Certificate)
                                                           Explanation   about
4-1.(29) Recycling                                         separation  method
                                                                               Applicant
after use                                                  and recycling after
                                                           use


                                                           Certificate or result Applicant or
4-2.(115-118)
                                                           of tests according to third    party
Product quality
                                                           the JIS, etc.         testing body




  <Criteria on individual products>
   G. Pavement materials
  G-1. Pavement materials (Rubber pavement materials and antifreezing pavement material
  containing rubber particles)

                                                             Documents to be
      Item                  Fill in this Column                                    Issued by
                                                               Submitted
4-1.(30) Supply of                                         Certificate of   raw
raw materials                                              materials/             Raw material
                                                           pre-treatment          supplier
                                                           (Example 8)

4-1.(30)      The
percentage     of
recycled
materials                                                  Entry table C          Applicant




4-1.(31) Recycling                                         Certificate         to
after use                                                  indicate the recycling
                                                                                  Applicant
                                                           method           after
                                                           disposal

4-1.(32) Balance                                           Written    materials
of materials from                                          regarding        the
obtaining                                                  quantity   of   new
resources       to                                         resources      used,
                                                                                Applicant
recycling                                                  energy consumption
                                                           and CO2 emission in
                                                           a ton of crude steel
                                                           production
                                                           Results of elution
                                                           tests of the product
                                                           based on the soil
4-1.(33) Elution                                           contamination        Third party
of       harmful
                                                           requirement          testing body
substances
                                                           (Environmental       or      public
                                                           Ministry      Notice institution
                                                           No. 29), results of
                                                           elution    test   of
                                                           rubber particles




                                131(Certificate)
4-1.(34) Providing                                            Manuals to indicate
information                                                   the items of 4-1. (32) Applicant
                                                              (manuscript)

                                                              Adoption for the
                                                              traffic      volume
4-2. (119) Product                                            categories           Applicant or
quality                                                       established by the third      party
                                                              Japan     Automobile testing body
                                                              Tire Manufacturers
                                                              Association
  <Criteria on individual products>
  G-2. Pavement materials (Recycled sub-base materials and recycled asphalt mixture)


                                                               Documents to be
      Item                   Fill in this Column                                       Issued by
                                                                 Submitted
4-1.(35) Supply of                                            Certificate of   raw
                                                                                     Recycled
raw materials                                                 materials/
                                                                                     material
                                                              pre-treatment
                                                                                     collector
                                                              (Example 8)

4-1.(35)      The
percentage     of
recycled
materials                                                     Entry table C          Applicant




                                                              Adoption for the
4-2.(120) Product                                                                Applicant or
                                                              guideline of plant
quality                                                                          third    party
                                                              recycled pavement
                                                                                 testing body
                                                              technology




                                 131(Certificate)
  <Criteria on individual products>
   H. Landscaping/revegetation materials


                                                      Documents to be
      Item                    Fill in this Column                           Issued by
                                                        Submitted
4-1.(36) Supply of                                   Certificate of raw
raw materials                                        materials/pre-treatm Raw material
                                                     ent                  supplier
                                                     (Example 8)

4-1.(36)      The
percentage     of
recycled                                             Entry table C        Applicant
materials

                                                     Results of elution
                                                     tests of the product
                                                     based on the soil
4-1.(37) Elution                                     contamination
of       harmful                                     requirement           Third party
substances
                                                     (Environmental        testing body
                                                     Ministry      Notice or       public
                                                     No. 29) (cadmium, institution
                                                     lead,     hexavalent
                                                     chromium, arsenic,
                                                     total       mercury,
                                                     selenium)
                                                     Results            of
                                                     containing tests of
4-1.(38)                                             the product based
Containing      of                                   on       the     soil
harmful                                                                    Third party
                                                     contamination
substances                                                                 testing body
                                                     requirement
                                                                           or      public
                                                     (Environmental
                                                                           institution
                                                     Ministry      Notice
                                                     No. 29) (cadmium,
                                                     lead, arsenic, total
                                                     mercury, etc.)
4-1.(39) Balance
of materials from                                    Written    materials
obtaining                                            regarding        the
resources       to                                   quantity   of   new
recycling                                            resources      used,
                                                                          Applicant
                                                     energy consumption
                                                     and CO2 emission in
                                                     a ton of crude steel
                                                     production




                                  131(Certificate)
4-1.(40) Providing                                                 Manuals to indicate
information                                                        the items of 4-1. (37)
                                                                                          Applicant
                                                                   (38)
                                                                   (manuscript)

                      Materials of packaging:
                      Packaging method:
4-1.(41)
                      “This product is designed to allow
Packaging        of
                      separation/sorting to facilitate recycling
product
                       after disposal”
                      < > Applicable/< >Not applicable
                               (Select where appropriate)
4-1.(41) Use of
halogens      for
packaging         < >Used/< >Not used
(only for plastic        (Select where appropriate)
packaging
materials)

                                                                   Result    of    tests Applicant or
4-2.(121) Product
                                                                   according to the JIS third     party
quality
                                                                   or JAS                testing body




  <Criteria on individual products>
  I. Traffic signs/traffic lane lines
  I-1. Traffic sign boards

                                                                    Documents to be
      Item                         Fill in this Column                                     Issued by
                                                                      Submitted
                                                                   Explanatory
4-1.(42)                                                           document          about
Collection system                                                  collection     system,
                                                                                           Applicant
                                                                   treatment       ability
                                                                   and contents of used
                                                                   products
                                                                   Certificate          to
                                                                   indicate that this
                                                                   product              is
                                                                   applicable to 4-1.(3) Raw material
4-1.(43) Materials                                                 (Example      3),    or supplier (raw
for      reflective                                                result of heavy metal materials or
sheets                                                             test       (cadmium, molding)       or
                                                                   lead,     hexavalent third       party
                                                                   chromium, arsenic, testing body
                                                                   total     mercury,
                                                                   selenium)




                                        131(Certificate)
                                                      Certificate regarding
4-1.(44) Design of                                    the applicable part
Separation/                                           for        separation,
sorting                                               sorting           and Applicant
                                                      switching,        and
                                                      method to change
                                                      the part

4-2.(122-124)                                         Certificate or result Applicant or
Product quality                                       of tests according to third    party
                                                      the JIS, etc.         testing body



  I-2. Traffic sign materials

                                                       Documents to be
      Item                      Fill in this Column                          Issued by
                                                         Submitted
4-1.(45) Supply of
                                                      Raw         material
raw materials                                                              Raw material
                                                      certificate
                                                                           supplier
                                                      (Example 8)

4-1.(45)      The
percentage     of
recycled
materials                                             Entry table C        Applicant



                                                      Results of elution
                                                      tests of the product
                                                      based on the soil
4-1.(46) Elution                                      contamination
of       harmful                                      requirement           Third party
substances                                            (Environmental        testing body
                                                      Ministry      Notice or       public
                                                      No. 29) (cadmium, institution
                                                      lead,     hexavalent
                                                      chromium, arsenic,
                                                      total       mercury,
                                                      selenium)
                                                      Results            of
                                                      containing tests of
4-1.(47)                                              the product based
Containing        of                                  on       the     soil
                                                                            Third party
harmful                                               contamination
                                                                            testing body
substances                                            requirement
                                                                            or      public
                                                      (Environmental
                                                                            institution
                                                      Ministry      Notice
                                                      No. 29) (cadmium,
                                                      lead, arsenic, total
                                                      mercury, etc.)




                                   131(Certificate)
4-1.(48) Balance                                                     Written      materials
of materials from                                                    regarding          the
obtaining                                                            quantity     of   new
resources       to                                                   resources       used,
                                                                                            Applicant
recycling                                                            energy consumption
                                                                     and CO2 emission in
                                                                     a ton of crude steel
                                                                     production
                                                                     Certificate regarding
4-1.(49) Design of
                                                                     the applicable part
Separation/
                                                                     for        separation,
sorting
                                                                     sorting           and Applicant
                                                                     switching,        and
                                                                     method to change
                                                                     the part

                      Addition of chromium, cadmium and
4-1.(50)
                                     arsenic
Prescribed
                     < >Added/< >Not added
constituents
                                      (Select where appropriate)

                     “The manuals on the right will be
                         provided to the constructor, the
                                                                     Manuals to indicate
                      owner of an architectural structure,
4-1.(51) providing                                                   the items of 4-1. (51)
                             and the manufacturer of the                                    Applicant
information                                                          a.b.c.d.e.f
                                                 product.”
                                                                     (manuscript)
                               < >Declare / < >Not declare
                                        (Select where appropriate)
4-1.(52) Use of
halogens        for
packaging           < >Used/< >Not used
(only for plastic                       (Select where appropriate)
packaging
materials)
                                                                     Alkali-aggregates
                                                                     reaction
                                                                                          Applicant or
4-2.(125,126)                                                        Ordinance of Prime
                                                                                          third    party
Product quality                                                      Minister’s
                                                                                          testing body
                                                                     Office/Ministry   of
                                                                     Construction




                                     131(Certificate)
  <Criteria on individual products>
   I-3. Traffic lane lines (Glass beads for road marking paint)

                                                                    Documents to be
      Item                        Fill in this Column                                    Issued by
                                                                      Submitted
4-1.(53) Supply of
                                                                   Raw         material
raw materials                                                                           Raw material
                                                                   certificate
                                                                                        supplier
                                                                   (Example 8)

4-1.(53)      The
percentage     of
recycled
materials                                                          Entry table C       Applicant



                     Materials of packaging:
                     Packaging method:
4-1.(54)
Packaging       of
                     “This product is designed to allow
product
                     separation/sorting to facilitate recycling
                      after disposal”
                     < > Applicable/< >Not applicable
                                     (Select where appropriate)
4-1.(54) Use of
halogens      for
packaging
(only for plastic
packaging         < >Used/< >Not used
materials)                   (Select where appropriate)


                                                                   Results of elution
                                                                   tests of the product
                                                                   based on the soil
                                                                   contamination
4-1.(55) Elution                                                   requirement
of       harmful                                                                        Third party
                                                                   (Environmental
substances                                                                              testing body
                                                                   Ministry      Notice
                                                                                        or      public
                                                                   No. 29) (cadmium,
                                                                                        institution
                                                                   lead,     hexavalent
                                                                   chromium, arsenic,
                                                                   total       mercury,
                                                                   selenium,     boron,
                                                                   fluoride)
                      Addition of cadmium, lead, mercury,
4-1.(56) Coloring
                  chromium, arsenic, selenium, and the
agents
                            other chemical compounds
                     < >Added/< >Not added
                                      (Select where appropriate)




                                       131(Certificate)
                                                      Manuals to indicate
4-1.(57) Providing                                    the items of 4-1.
                                                                          Applicant
information                                           (55)(56)
                                                      (manuscript)


                                                      Certificate  to  be Applicant or
4-2.(127) Product
                                                      applicable to the third      party
quality
                                                      target standards    testing body




  <Criteria on individual products>
   J. Materials for temporary structures

                                                       Documents to be
      Item                     Fill in this Column                           Issued by
                                                         Submitted
4-1.(58) Supply of
                                                      Raw         material
raw materials                                                              Raw material
                                                      certificate
                                                                           supplier
                                                      (Example 8)

4-1.(58)      The
percentage     of
recycled
materials                                             Entry table C        Applicant



                                                      Results of elution
                                                      tests of the product
                                                      based on the soil
4-1.(59) Elution                                      contamination
of       harmful                                      requirement           Third party
substances                                            (Environmental        testing body
                                                      Ministry      Notice or       public
                                                      No. 29) (cadmium, institution
                                                      lead,     hexavalent
                                                      chromium, arsenic,
                                                      total       mercury,
                                                      selenium)
                                                      Results            of
                                                      containing tests of
4-1.(60)                                              the product based
Containing      of                                    on       the     soil
                                                                            Third party
harmful                                               contamination
                                                                            testing body
substances                                            requirement
                                                                            or      public
                                                      (Environmental
                                                                            institution
                                                      Ministry      Notice
                                                      No. 29) (cadmium,
                                                      lead, arsenic, total
                                                      mercury, etc.)




                                   131(Certificate)
4-1.(61)
                        Addition of chromium, cadmium and
Prescribed
                                       arsenic
constituents
                       < >Added/< >Not added
                                      (Select where appropriate)

                       “This is the disposable product”
4-1.(62)
                       < >Yes /< >No
Disposable                                                              Certificate regarding
                                           (Select where appropriate)                         Applicant
products                                                                recycling after use
                          If “yes”, the attached certificate on the
                        right is required.

                                                                        Manuals to indicate
4-1.(63) providing
                                                                        the items of 4-1. (59)
information                                                                                    Applicant
                                                                        (60)
                                                                        (manuscript)


                                                                                            Applicant or
4-2.(128) Product                                                       In-house standards,
                                                                                            third    party
quality                                                                 etc.
                                                                                            testing body



  <Criteria on individual products>
  K. Road materials
  K-1. Road lighting

                                                                         Documents to be
      Item                          Fill in this Column                                         Issued by
                                                                           Submitted
4-1.(64)                                                                The      data      of
Electricity                                                             comparing electricity
consumption                                                             consumption of the Applicant
                                                                        product         with
                                                                        mercury lamps
                                                                        Certificate regarding
4-1.(65)       Light
                                                                        the design to reduce
leakage
                                                                        light    leakage   to Applicant
                                                                        areas beyond the
                                                                        roadside

4-2.(129) Product
                                                                        Certificate or result Applicant or
quality
                                                                        of tests according to third    party
                                                                        the JIS, etc.         testing body




  K-2. High-performance noise reduction equipment

                                                                         Documents to be
      Item                          Fill in this Column                                         Issued by
                                                                           Submitted
4-1.(66) Product                                                        Certificate of product
                                                                                               Applicant
specification and                                                       specification
construction                                                            including size and
method (common)                                                         used materials




                                        131(Certificate)
                                                     Construction
                                                     method, the total
                                                     height     of   sound
                                                                            Applicant
                                                     insulation       walls
                                                     before    and    after
                                                     installing
                                                     Certificate to prove
                                                     noise reduction
4-1.(67)     Noise
                                                     (for             each
reducing effect
                                                     construction method) Applicant
                                                     Written materials to
                                                     confirm the effect
                                                     quantitatively

4-2.(130,131))
                                                     Calculation form of Applicant or
Product quality
                                                     structure strength, third    party
                                                     etc.                testing body




  <Criteria on individual products>
   K-3. Other road materials

                                                      Documents to be
      Item                     Fill in this Column                           Issued by
                                                        Submitted

4-1.(68) Supply of
                                                     Raw         material
raw materials                                                             Raw material
                                                     certificate
                                                                          supplier
                                                     (Example 8)

4-1.(68)      The
percentage     of
recycled
materials                                            Entry table C         Applicant



                                                     Results of elution
                                                     tests of the product
                                                     based on the soil
4-1.(69) Elution                                     contamination
of       harmful                                     requirement          Third party
substances                                           (Environmental       testing body
                                                     Ministry      Notice or     public
                                                     No. 29) (cadmium, institution
                                                     lead,     hexavalent
                                                     chromium, arsenic,
                                                     total       mercury,
                                                     selenium)




                                  131(Certificate)
                                                       Results           of
                                                       containing tests of
4-1.(70)                                               the product based
Containing        of                                   on      the     soil
harmful                                                                     Third party
                                                       contamination
substances                                                                  testing body
                                                       requirement
                                                                            or      public
                                                       (Environmental
                                                                            institution
                                                       Ministry     Notice
                                                       No. 29) (cadmium,
                                                       lead, arsenic, total
                                                       mercury, etc.)
4-1.(71) providing                                     Manuals to indicate
information                                            the items of 4-1.
                                                                           Applicant
                                                       (69)(70)
                                                       (manuscript)

4-1.(72)
Information
                                                       Manuals to indicate
regarding
                                                       the     item     of
treatment
                                                       treatment method of Applicant
method      after
                                                       waste
disposal
                                                       (manuscript)


4-1.(73) Measures
to control the                                         Figure of the facility
release into the                                       to           conduct Applicant
air of                                                 incineration
incinerator ash

                                                       Certificate      and
                                                                             Applicant or
4-2.(132-135)                                          result     of   tests
                                                                             third    party
Product quality                                        according to the JIS
                                                                             testing body
                                                       or JAS



  <Criteria on individual products>
   L. Sewage/waterworks materials

                                                        Documents to be
      Item                   Fill in this Column                              Issued by
                                                          Submitted
4-1.(74) Supply of
                                                       Raw         material
raw materials                                                               Raw material
                                                       certificate
                                                                            supplier
                                                       (Example 8)

4-1.(74)      The
percentage     of
recycled
materials                                              Entry table C        Applicant




                                    131(Certificate)
                                                                   Results of elution
                                                                   tests of the product
                                                                   based on the soil
4-1.(75) Elution                                                   contamination
of       harmful                                                   requirement           Third party
substances                                                         (Environmental        testing body
                                                                   Ministry      Notice or       public
                                                                   No. 29) (cadmium, institution
                                                                   lead,     hexavalent
                                                                   chromium, arsenic,
                                                                   total       mercury,
                                                                   selenium)
                                                                   Results            of
                                                                   containing tests of
4-1.(76)                                                           the product based
Containing      of                                                 on       the     soil
harmful                                                                                  Third party
                                                                   contamination
substances                                                                               testing body
                                                                   requirement
                                                                                         or      public
                                                                   (Environmental
                                                                                         institution
                                                                   Ministry      Notice
                                                                   No. 29) (cadmium,
                                                                   lead, arsenic, total
                                                                   mercury, etc.)
4-1.(77) Balance                                                   Written    materials
of materials from                                                  regarding        the
obtaining                                                          quantity   of   new
resources       to                                                 resources      used,
                                                                                        Applicant
recycling                                                          energy consumption
                                                                   and CO2 emission in
                                                                   a ton of crude steel
                                                                   production
4-1.(78)
                      Addition of chromium, cadmium and
Prescribed
                                     arsenic
constituents
                     < >Added/< >Not added
                                      (Select where appropriate)

                                                                   Certificate          to
                                                                   indicate the average
                                                                   year of use the
4-1.(79)
                   Average year to use the product                 product     and     its
Appropriate
                   < > 20 years or more                            reason         (actual
treatment      and                                                                         Applicant
                   < > Less than 20 years                          results     of     the
handling        at
                   (Select where appropriate)                      product, or        the
disposal
                                                                   test result of the
                                                                   same       type      of
                                                                   product)

                                                                   Manuals to indicate
4-1.(80) Providing                                                 the items of 4-1.
                                                                                       Applicant
information                                                        (75)(76)
                                                                   (manuscript)




                                     131(Certificate)
4-1.(81) Use of
halogens      for
packaging         < > Used/< > Not used
(only for plastic                  (Select where appropriate)
packaging
materials)

                                                                  Certificate or result Applicant or
4-2.(136) Product
                                                                  of tests according to third    party
quality
                                                                  the JIS, etc.         testing body




  <Criteria on individual products>
   M. Materials for bridges/rivers/harbors

                                                                   Documents to be
      Item                     Fill in this Column                                        Issued by
                                                                     Submitted
4-1.(82) Supply of                                                Certificate of   raw Raw material
raw materials                                                     material/            supplier
                                                                  pre-treatment
                                                                  (Example 8)

4-1.(83) (86) The
percentage     of
recycled
materials
                                                                  Entry table C         Applicant




                                                                  Certificate of product
                                                                                         Applicant
4-1.(83)–(85),(87)                                                specification
Product                                                           including size and
specification and                                                 used materials
construction
method (common)                                                   Construction
                                                                  method, etc.          Applicant

                                                                  Certificate        to
                                                                  indicate the reason
4-1.(83)
                                                                  to utilize earth and
Impermeable-       < >Double-wall type
                                                                  sand/gravel
type steel erosion < >Steel frame type
                                                                  generated at the site
control weirs                          (Select where appropriate)                       Applicant
                                                                  as hearing materials
(if applicable)
                                                                  for 70% or more of
                                                                  the weir volume
                                                                  (for            each
                                                                  construction method)




                                   131(Certificate)
                                         Certificate        to
                                         indicate the reason
                                         to allow water, sand
                                         and gravel to flow in
                                         order to control the
4-1.(84)                                 lowering of the river
Permeable-                               bed or the erosion of
type steel erosion                       beaches
control weirs                            (for             each
                                                               Applicant
(if applicable)                          construction
                                         method),
                                         Certificate        to
                                         indicate the reason
                                         to      allow     the
                                         movement of flora
                                         and fauna
                                         (for             each
                                         construction method)
                                         Certificate        to
                                         indicate the reason
4-1.(85)                                 to utilize earth and
Special-type mat                         sand/gravel
cylinders                                generated at the site
                                                               Applicant
(if applicable)                          as hearing materials
                                         for 70% or more of
                                         the mats or cylinders
                                         (for             each
                                         construction method)
                                         Certificate        to
4-1.(87)      Steel                      indicate the reason
sheet piles with                         to have landscaping
pots for bank                            functions to cover
                                                              Applicant
protection      and                      the steel sheet pile
tree planting                            surface with plants
(if applicable)                          (for            each
                                         construction method)

                                                               Applicant or
                                         Certificate or result
4-2.(137,138)                                                  third    party
                                         of tests according to
Product quality                                                testing body
                                         the JIS, etc.




                      131(Certificate)
  <Criteria on individual products>
  N. Other materials
  N-1. Drainage materials/backfill materials

                                                      Documents to be
      Item                    Fill in this Column                            Issued by
                                                        Submitted
4-1.(88) Supply of                                   Certificate of   raw
raw materials                                        material/              Raw material
                                                     pre-treatment          supplier
                                                     (Example 8)

4-1.(88)      The
percentage     of
recycled
materials
                                                     Entry table C          Applicant




4-1.(89) Balance                                     Written    materials
of materials from                                    regarding        the
obtaining                                            quantity   of   new
resources       to                                   resources      used,
                                                                          Applicant
recycling                                            energy consumption
                                                     and CO2 emission in
                                                     a ton of crude steel
                                                     production
                                                     Results of elution
                                                     tests of the product
                                                     based on the soil
4-1.(90) Elution                                     contamination
of       harmful                                     requirement           Third party
substances
                                                     (Environmental        testing body
                                                     Ministry      Notice or       public
                                                     No. 29) (cadmium, institution
                                                     lead,     hexavalent
                                                     chromium, arsenic,
                                                     total       mercury,
                                                     selenium)*1
                                                     Results            of
                                                     containing tests of
4-1.(91)                                             the product based
    Containing of                                    on       the     soil
                                                                           Third party
harmful                                              contamination
                                                                           testing body
substances                                           requirement
                                                                           or      public
                                                     (Environmental
                                                                           institution
                                                     Ministry      Notice
                                                     No. 29) (cadmium,
                                                     lead, arsenic, total
                                                     mercury, etc.)*1
                                                     Test result to show
                                                                         Third    party
4-1.(92) Dioxins                                     compliance with the
                                                                         testing body
                                                     Environmental
                                                     Agency Notification or      public
                                                     No. 68              institution



                                  131(Certificate)
                                                              Manuals to indicate
4-1.(93) Providing                                            the items of 4-1.
                                                                                  Applicant
information                                                   (90)(91)(92)
                                                              (manuscript)


                                                                                       Applicant or
4-2.(139,140)                                                 Certificate     to    be third    party
Product quality                                               applicable               testing body



  *1 In case of using cold molding products, vitrified products and baked products that use
  vitrified recycled materials only, the following eight substances shall be tested: cadmium,
  lead, hexavalent chromium, arsenic, total mercury, selenium, boron and fluorine.


  N-2. Revegetation base materials

                                                               Documents to be
      Item                   Fill in this Column                                          Issued by
                                                                 Submitted
4-1.(94) Supply of                                            Certificate of       raw
raw materials                                                 material/                  Raw material
                                                              pre-treatment              supplier
                                                              (Example 8)

4-1.(94)      The
percentage     of
recycled
materials
                                                              Entry table C              Applicant




                                                              Results of elution
                                                              tests of the product
                                                              based on the soil
4-1.(95) Elution                                              contamination
of       harmful                                              requirement          Third party
substances
                                                              (Environmental       testing body
                                                              Ministry      Notice or     public
                                                              No. 29) (cadmium, institution
                                                              lead,     hexavalent
                                                              chromium, arsenic,
                                                              total       mercury,
                                                              selenium)*1




                                 131(Certificate)
                                                              Results            of
                                                              containing tests of
4-1.(96)                                                      the product based
    Containing of                                             on      the      soil
                                                                                    Third party
harmful                                                       contamination
                                                                                    testing body
substances                                                    requirement
                                                                                    or      public
                                                              (Environmental
                                                                                    institution
                                                              Ministry     Notice
                                                              No. 29) (cadmium,
                                                              lead, arsenic, total
                                                              mercury, etc.)*1
                                                              Test result to show
                                                                                  Third    party
4-1.(97) Dioxins                                              compliance with the
                                                                                  testing body
                                                              Environmental
                                                              Agency Notification or      public
                                                              No. 68              institution

                                                                                     Applicant or
4-2.(141,142)                                                 Certificate   to   be third    party
Product quality                                               applicable             testing body


  *1 In case of using cold molding products, vitrified products and baked products that use
  vitrified recycled materials only, the following eight substances shall be tested: cadmium,
  lead, hexavalent chromium, arsenic, total mercury, selenium, boron and fluorine.


  N-3. Non-chloride type antifreezing agents
                                                               Documents to be
      Item                   Fill in this Column                                      Issued by
                                                                 Submitted
4-1.(98)   Acetic
acid-based                                                    List of prescribed
materials                                                     constituents of the Applicant
                                                              product

4-1.(99)
Information   for
use and handling
                                                              Instruction   manual
                                                                                     Applicant
                                                              and MSDS



4-2.(143)
Product quality                                                                      Third   party
                                                              Certificate or result
                                                                                    testing body
                                                              of tests according to
                                                              the JIS or JAS
                                                                                    or     public
                                                                                     institution




                                 131(Certificate)
  N-4 Slope protection nets (rock fall protectors and slope fall protectors with less impact
      on the environment)
                                                                 Documents to be
     Item                     Fill in this Column                                      Issued by
                                                                    Submitted
                                                                       Certificate of product
                                                                                              Applicant
                                                                       specification
4-1.(100)(101)
                                                                       including size and
Product
                                                                       used materials
specification and
construction
                                                                       Explanatory
method (common)
                                                                       material          for
                                                                       construction method Applicant


                                                                       Certificate      to
                                                                       indicate the reason
                                                                       to    be    able to
4-1.(100)(101)                                                          conserve          the
Protection         of <>Rock fall-protectors with less impact           natural         slope
natural slope                               on the environment          without felling trees
(if applicable)         <>Slope fall protectors with less impact        over 70% or more of
                                                                                              Applicant
                                            on the environment          the face of slope
                                             (Select where appropriate) within the range of
                                                                        the     construction
                                                                        target area
                                                                        (for             each
                                                                        construction
                                                                        method)
4-2.(144)
Product                                                                                        Third   party
                                                                       Certificate or result
quality                                                                                      testing body
                                                                       of tests according to
                                                                       the JIS, etc.
                                                                                             or     public
                                                                                               institution


  N-5. Buried marker sheets

                                                                         Documents to be
       Item                          Fill in this Column                                        Issued by
                                                                           Submitted
4-1.(102) Supply                                                       Certificate of    raw
of raw materials                                                       material/               Raw material
                                                                       pre-treatment           supplier
                                                                       (Example 8)

4-1.(102)         The
percentage         of
recycled
materials
                                                                       Entry table C           Applicant




                                         131(Certificate)
                                                                          Applicant or
                                                    Certificate or result
4-2.(145)                                                                 third    party
                                                    of tests according to
Product quality                                                           testing body
                                                    the JIS, etc



  N-6. Protective tube for underground cable

                                                     Documents to be
      Item                   Fill in this Column                            Issued by
                                                       Submitted
4-1.(103) Supply                                    Certificate of   raw
of raw materials                                    material/              Raw material
                                                    pre-treatment          supplier
                                                    (Example 8)

4-1.(103)    The
percentage    of
recycled
materials
                                                    Entry table C          Applicant




                                                                          Applicant or
                                                    Certificate or result
4-2.(146)                                                                 third    party
                                                    of tests according to
Product quality                                                           testing body
                                                    the JIS, etc.



  N-7. Water bars

                                                     Documents to be
      Item                   Fill in this Column                            Issued by
                                                       Submitted
4-1.(104) Supply                                    Certificate of   raw
of raw materials                                    material/              Raw material
                                                    pre-treatment          supplier
                                                    (Example 8)

4-1.(104)    The
percentage    of
recycled
materials
                                                    Entry table C          Applicant




                                                                          Applicant or
                                                    Certificate or result
4-2.(147)                                                                 third    party
                                                    of tests according to
Product quality                                                           testing body
                                                    the JIS, etc.




                                 131(Certificate)
  N-8. Joint filter/joint bars

                                                        Documents to be
      Item                       Fill in this Column                           Issued by
                                                          Submitted
4-1.(105) Supply                                       Certificate of   raw
of raw materials                                       material/              Raw material
                                                       pre-treatment          supplier
                                                       (Example 8)

4-1.(105)     The
percentage     of
recycled
materials
                                                       Entry table C          Applicant




                                                                             Applicant or
                                                       Certificate or result
4-2.(148)                                                                    third    party
                                                       of tests according to
Product quality                                                              testing body
                                                       the JIS, etc.




  N-9. Foundation improvement materials

                                                        Documents to be
      Item                       Fill in this Column                           Issued by
                                                          Submitted
4-1.(106) Supply                                       Certificate of   raw
of raw materials                                       material/              Raw material
                                                       pre-treatment          supplier
                                                       (Example 8)

4-1.(106)     The
percentage     of
recycled
materials
                                                       Entry table C          Applicant




                                                       Results           of
                                                       containing tests of
                                                       the product based
                                                       on      the     soil
4-1.(107)                                                                   Third party
                                                       contamination
Containing        of                                                        testing body
                                                       requirement
harmful                                                                     or      public
substances                                             (Environmental
                                                                            institution
                                                       Ministry     Notice
                                                       No. 29) (cadmium,
                                                       lead, arsenic, total
                                                       mercury, etc.)




                                    131(Certificate)
                                                           Applicant or
                                     Certificate or result
4-2.(149)                                                  third    party
                                     of tests according to
Product quality                                            testing body
                                     the JIS, etc.




                  131(Certificate)
     Example 1-131
                                                                     Date

           Director                                    Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                      XXXXX XXXXX
                                                      Company name
Address to send                                            Seal
this certificate


                                                                             Issuer of
                                                                             certificate

                                                                        *Issuer: Applicant




                   Approval of Eco Mark Use Application


     This is to consent to the application for Eco Mark certificate and use
     of XXX (your company name) (Eco Mark certified) brand name XXXX
     (certificate no. XX) by XXX (applicant) as brand name XXXX.




                                   131(Certificate)
     Example 2-131
                                                                              Date

           Director                                               Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                                XXXXX XXXXX
                                                                Company name
Address to send                                                      Seal
this certificate


                                                                                            Issuer of
                                                                                            certificate
                                               *Issuer: Manger of finished product manufacturing/assembly plant




              Environmental Laws and Agreements Compliance
                               Certificate

     This is to certify that (the finished product manufacturer) has been
     observing the following requirements in the manufacturing of the
     (product under application for Eco Mark certificate).


     The production process has been conforming to relevant environmental laws and
     regulations and agreements on pollution control for preventing air pollution,
     water contamination, noise, vibration, odor, and emission of hazardous materials
     in the past five years (*) since application.

        Example of relevant regulations:
           Air Pollution Control law
           Water Pollution Control law                       The plant shall specify the applicable
           Noise Regulation Law                              laws and agreements.
           Vibration Regulation Law
           Offensive Odor Control Law
                                                             Ordinances or agreements shall be
           XX Prefecture XX Environment
                                                             specified if any is effective in the local
           Protection Ordinance
                                                             community in which the plant is located.
           XX City Agreement on Pollution Control



     (*) Otherwise, provide a statement indicating no laws and agreements have been
     violated since the establishment of the company.

     If the issuer is other than the plant manager, indicate the issuer is a person who also holds
     the post of plant manager or who is in an executive position equivalent to plant manager.
     The certificate is effective, if the date of issue is within about three months before/after
     application for Eco Mark certificate.




                                     131(Certificate)
Example 3-131
                                                                                    Date
      Director
      Eco Mark Office                                              Date of issue of this certificate
      Japan Environment Association
                                                                 XXXXX XXXXX
                                                                 Company name
                                                                      Seal
                                                                                           Issuer of
                                                                                           certificate

                                                                    * Issuer: Raw material supplier
                                           Certificate*1

 (The following should be clarified for materials used in your manufacturing by plastic
 type (regenerated or virgin).)
 Scope: (regenerated or virgin material); Material:                ; Manufacturing process:
4-1. (3) Hazardous substance, etc.                  Fill in this Column       Attachment, etc
   Plastic additive
                                                                                     If “yes,” the following should
                                                                                     be attached:
                                                                                     Results of heavy metal tests
 Additive                                                           Yes/No           or certificate for registration
             Use of additive other than below
                                                                (PL #           )    number of the additive
                                                                                     positive list*2


           Use of flame retardant (If “yes,”                                         If “yes,” a copy of the
                                                                    Yes/No
  Flame    indicate below.)                                                          certificate issued by the
retardant Is PBB, PBDE, or chlorinated paraffin                                      Japan Fire Retardant
                                                                    Yes/No
           contained?                                                                Association
           Use of stabilizer, lubricant (If “yes,”
                                                                    Yes/No
Stabilizer indicate below)
Lubricant Is a lead, cadmium, or tin organic
                                                                    Yes/No
           compound agent contained?*3
                                                                                     If “yes,” the following should
                                                                    Yes/No           be attached:
             Use of colorant (pigment, dye)                                          Results of heavy metal tests
                                                                (PL #           )
 Colorant                                                                            or certificate for registration
                                                                                     number of the additive
                                                                                     positive list*2

*1 This certificate should be issued by the manager of each manufacturing process to indicate the use of
   focused chemicals. The suppliers of each process are not required to issue this certificate. Instead of this
   certificate, a positive list of resin or a copy of the results of heavy metal test will be accepted for
   certificate of virgin resin supplier.

*2 Heavy metal tests on products containing additives, colorants (pigment, dye) are admitted.
*3 Tributyltin, triphenoltin, dibutyltin, diphenyltin, monophenyltin compounds




                                      131(Certificate)
        Example 4-131
                                                                            Date

           Director                                           Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                             XXXXX XXXXX
                                                             Company name
Address to send                                                   Seal
this certificate


                                                                                    Issuer of
                                                                                    certificate

                                                                                 *Issuer: Applicant


                       Production Process Certificate
     This is to certify that the fiber materials used for the product are as follows:



     (Check the Yes/No items, and if yes, attach the corresponding documents.)
     Processing    Performed         If yes, documents to be submitted
     Mildew proof < > Yes < > No Certificate (MSDS) of agent used for finishing (chemical
     finishing                       substances used)
     Flame proof < > Yes < > No Quantity used (                   ) Unit (     )
     finishing
     Fluorescent   < > Yes < > No Quantity used (                 ) Unit (     )
     whitening
     Softening     < > Yes < > No Quantity used (                 ) Unit (     )
     Sanitization  < > Yes < > No Certificate (MSDS) of agent used for finishing (chemical
                                     substances used)
     Product       < > Yes < > No Certificate (MSDS) of agent used for finishing (chemical
     bleaching                       substances used)
     Fireproofed   < > Yes < > No Certificate (MSDS) of agent used for finishing (chemical
     finishing                       substances used) or certificate that the product is
                                     flame-retarding part or product (copy of certificate of
                                     Japan Flame Retardant Association).


     Product under application for Eco Mark certificate is:< > wool < >non-wool              (Select
     where appropriate)
        If it is wool product, the following certificate is required.
     Process using < > Yes       < >     Documents certifying compliance with MHW Ordinance
      dieldrin/DT No                      No.34 of the concerned product.
     TB




                                       131(Certificate)
                                                                                    Total pages: 2
     Example 5-131
                                                                           Date
         Director
         Eco Mark Office
                                                                Date of issue of this certificate
         Japan Environment Association

                                                             XXXXX XXXXX
            Address to send this certificate                Company name
                                                                 Seal              Issuer      of
                                                                                   certificate
Be sure to indicate
name corresponding
    *
to Example 1 fabric                                                 *Issuer: Dye plant manager
item number

                            Dye Supplier Certificate
   This is to certify that the dyes supplied for fiber material (fiber material item no.) is as
   follows.
   *If there are several fabrics to be certified, indicated the item numbers of all three fabrics.


   The following dyes in (1), (2), and (3) are not added as ingredients.

   Fabrics shall not include chrome dye. (This item need not be included for lamb wool.)

     (1) Azo dyes which may generate the following carcinogenic amines in degradation
       (Stating that more than one of the amines in below exceeding 30mg per kg in the product
       have been detected by the analysis method set down in the Public Testing method Corpus
       based on Article 35 of the German Food and Household Goods Law.)
   Carcinogenicity Rank (A1)
   92-67-1       4-aminobiphenyl                                C1(EU),1(NTP,IARC)
   92-87-5       Benzidine                                      C1(EU),1(NTP,IARC)
   95-69-2       4-chloro-o-toluidine                           2A(NTP,IARC)
   91-59-8       2-naphthylamine                                C1(EU),1(NTP,IARC)
   Carcinogenicity Rank (A2)
   97-56-3       o-aminoazotoluene                              C2(EU), 2B(NTP,IARC)
   99-55-8       2-amino-4-nitrotoluene                         3(NTP,IARC)
   106-47-8      4-chloroaniline                                C2(EU), 2B(NTP,IARC)
   615-05-4      2,4-diaminoanisole                             2B(NTP,IARC)
   101-77-9      4,4'-diaminodiphenylmethane                    C2(EU), 2B(NTP,IARC)
   91-94-1       3,3-dichlorbenzidine                           C2(EU), 2B(NTP,IARC)
   119-90-4      o-dianisidine; 3,3'-Dimethoxybenzidine         C2(EU), 2B(NTP,IARC)
   119-93-7      o-tolidine; 3,3'-Dimethylbenzidine             C2(EU), 2B(NTP,IARC)
   838-88-0      4,4'-diamino-3,3'-dimethyldiphenylmethane      C2(EU), 2B(NTP,IARC)
   120-71-8      p-cresidine                                    2B(NTP,IARC)
   101-14-4      4,4'-diamino-3,3'-dichlorodiphenylmethane      C2(EU), 2A(NTP,IARC)
   101-80-4      4,4'-diaminodiphenylether                      2B(NTP,IARC)
   139-65-1      4,4'-diaminodiphenylsulfide                    2B(NTP,IARC)
   95-53-4       o-toluidine                                    C2(EU), 2B(NTP,IARC)
   95-80-7       2,4-diaminotoluene                             C2(EU), 2B(NTP,IARC)
   137-17-7      2,4,5-trimethylaniline
   90-04-0       o-anisidine                                    C2(EU), 2B(NTP,IARC)
   95-68-1       2,4-xylidine                                   3(NTP,IARC)



                                         131(Certificate)
87-62-7       2,6-xylidine                                  2B(NTP,IARC)
60-90-3       4amino-azo-benzen                             C2(EU)
  (2) Carcinogenic dyes
569-61-9      C.I. BASIC RED 9                   CI 42500   C2(EU), 2B(NTP,IARC),
                                                            Oeko-Tex
2475-45-8    C.I. DISPERSE BLUE 1                CI 64500   C2(EU), 2B(NTP,IARC),
                                                            Oeko-Tex
3761-53-3    C.I. ACID RED 26                    CI 16150   2B(NTP,IARC), Oeko-Tex
6459-94-5    C.I. ACID RED 114                   CI 23635   2B(NTP,IARC)
2602-46-2    C.I. DIRECT BLUE 6                  CI 22610   C2,R3(EU),2A(NTP,IAR
                                                            C), Oeko-Tex
1937-37-7    C.I. DIRECT BLACK 38                CI 30235   C2,R3(EU),
                                                            2A(NTP,IARC), Oeko-Tex
573-58-0      C.I. DIRECT RED 28                 CI 22120   C2,R3(EU) , Oeko-Tex
2932-40-8     C.I. DISPERSE YELLOW 3             CI 11855   Oeko-Tex
  (3) Skin sensitizing dyes
2475-46-9     C.I. DISPERSE BLUE 3               CI 61505   ETAD, Oeko-Tex
12222-75-2 C.I. DISPERSE BLUE 35                            ETAD, Oeko-Tex
              C.I. DISPERSE BLUE 106                        ETAD, Oeko-Tex
              C.I. DISPERSE BLUE 124                        ETAD, Oeko-Tex
2832-40-8     C.I. DISPERSE YELLOW 3             CI 11855   ETAD, Oeko-Tex
730-40-5      C.I. DISPERSE ORANGE 3             CI 11005   ETAD, Oeko-Tex
              C.I. DISPERSE ORANGE 37                       ETAD, Oeko-Tex
2872-52-8     C.I. DISPERSE RED 1                CI 11110   ETAD, Oeko-Tex
2475-45-8     C.I. DISPERSE BLUE 1               CI 64500   Oeko-Tex
3179-90-6     C.I. DISPERSE BLUE 7               CI 62500   Oeko-Tex
3860-63-7     C.I. DISPERSE BLUE 26              CI 63305   Oeko-Tex
              C.I. DISPERSE BLUE 102                        Oeko-Tex
              C.I. DISPERSE ORANGE 1             CI 11080   Oeko-Tex
              C.I. DISPERSE ORANGE 76                       Oeko-Tex
2872-48-2     C.I. DISPERSE RED 11               CI 62015   Oeko-Tex
              C.I. DISPERSE RED 17               CI 11210   Oeko-Tex
119-15-3      C.I. DISPERSE YELLOW 1             CI 10345   Oeko-Tex
              C.I. DISPERSE YELLOW 9             CI 10375   Oeko-Tex
              C.I. DISPERSE YELLOW 39                       Oeko-Tex
              C.I. DISPERSE YELLOW 49                       Oeko-Tex



Indicate that the issuer is the plant manager or someone in an executive position equiv
alent to plant manager.




                              131(Certificate)
     Entry Table A1-131    Product Weight Certificate
                                                                      Date

                                                                      (Company name)
     Product type (                )                                                        Seal
Submit the form for each product type. If the weight percentage of materials is identical
among several product types, notes should be added.

     Part           Raw material                                           Weight percentage
                (Example; thinned wood,    Name of raw material supplier    (%) in the entire
                   waste wood, etc.)                                             product
 Wooden
  Part

 Wooden
  Part

 Wooden
  Part

Total   of
wooden
part
Other
materials

 (          )

 (          )

 (          )

 (          )


* In case that there are 10 or more raw material suppliers, you should submit Entry Table B
(List of raw material suppliers).
* Total weight percentage (%) of each part in the entire product should be 100%.




                                 131(Certificate)
     Entry Table A2-131
                                                                             Date

           Director                                           Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                            XXXXX XXXXX
                                                            Company name
Address to send                                                  Seal
this certificate


                                                                                     Issuer of
                                                                                     certificate

                                                                               *Issuer: Applicant


                      Raw Material Certificate Table
     The following list includes reused/unused wood and waste plant
     fibers.

     No.           Reused/unused wooden material        Name of raw material supplier
       e.g.                Thinned wood                 XX Forest Association, XX Prefecture




                                     131(Certificate)
     Example 6 (Thinned wood) -131
                                                                       Date

           Director                                     Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                       XXXXX XXXXX
                                                       Company name
Address to send                                             Seal
this certificate


                                                                               Issuer of
                                                                               certificate
                                                            *Issuer: Raw material supplier

                          Raw Material Certificate
     This is to certify that the following thinned wood materials are supplied to (Eco
     Mark product manufacturer) as reused/unused wood. Photographs of the
     concerned forest should be attached.


             Place of
                          Example: city, prefecture, country
            production

           Type of tree


             Amount

           Year of tree
            planting

          Percentage of   e.g.: 20%
          thinned trees        300 trees/1500 trees (per 1 ha)
                          e.g.: First thinning in 1980
          Which time of        Percentage of thinned trees: 30%
           thinning?           500 trees/2000 trees (per 1 ha)
                               Second thinning in 2004
              Tip end
                          Average distribution          cm to          cm
            diameter*
          * Information should be entered as a reference.
          Percentage of thinned trees: (Number of trees thinned per hectare)/
                                  (Number of trees planted per hectare) x 100
          Place of production: Place where woods were harvested.




                                   131(Certificate)
     Example 6 (Waste wood) -131
                                                                              Date

           Director                                            Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                             XXXXX XXXXX
                                                             Company name
Address to send                                                   Seal
this certificate


                                                                                      Issuer of
                                                                                      certificate
                                                                     *Issuer: Raw material supplier


                           Raw Material Certificate
     This is to certify that the following waste wood materials are supplied to (Eco
     Mark product manufacturer) as reused/unused wood or plant fibers.

                                  Details of waste wood material                         Content
                    < > Used wood
                      Recycled material: (                                    )                      %
                                      e.g.           packaging material
                    < > Remainder material generated in wood
                        processing plants
                    < > Shavings generated in plywood and lumber
         Waste
                        plants                                                                       %
         Wood       < > Low quality chips not used as raw material for
                        paper
                    < > Other (                           )
                    < > Trimmed branches                                                              %
                    < > Bark                                                                          %
                    < > Other (                           )                                           %
                                                                    Total                          100%

       If “Trimmed branches”, “Bark”, or “Other”, generation process, tree type, and
       other details should be given. (Separate forms are allowable.)




     * Check appropriate items and fill in blanks.




                                       131(Certificate)
     Example 6 (Construction waste wood) -131
                                                                        Date

           Director                                      Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                        XXXXX XXXXX
                                                        Company name
Address to send                                              Seal
this certificate


                                                                                Issuer of
                                                                                certificate
                                                               *Issuer: Raw material supplier


                          Raw Material Certificate
     This is to certify that the following construction waste wood materials are
     supplied to (Eco Mark product manufacturer) as reused/unused wood.

                                 Details of construction waste wood
                < > Wood from dismantled buildings (Wood and wooden materials
                    disposed as waste in construction work as dismantling of
        Const-      buildings)
        ruction < > Wood and wooden materials produced by construction of new
         waste      buildings and building extensions
         wood < > Wood and wooden materials produced by renovation

                   < > Wood and wooden materials disposed as waste in construction
                       related to other work

       Generation process, tree type, and other details should be given. (Separate
       forms are allowable.)




       For construction waste wood, separate documents should be submitted to
         demonstrate that materials subject to preservatives, termicides, and
         pesticides are differentiated and eliminated during recycling. (e.g.
         differentiation and elimination manual, work flow)



     * Check appropriate items and fill in blanks.




                                     131(Certificate)
         Example 6 (Less useful wood-1/3) -131
                                                                        Date

           Director                                      Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                        XXXXX XXXXX
                                                        Company name
Address to send                                              Seal
this certificate


                                                                                Issuer of
                                                                                certificate
                                                              *Issuer: Raw material supplier


                         Raw Material Certificate
     This is to certify that the following less useful wood materials are supplied to
     (Eco Mark product manufacturer) as reused/unused wood or plant fibers.

                          Raw material types of less useful wood                   Content
                   < > Abandoned lumber in the forest                                          %
                   < > Shrub                                                                   %
               < > Root                                                                        %
               < > Wood obtained from logs damaged by disease,
                                                                                               %
         Less      pests, disasters
        useful < > Bent logs                                                                   %
        wood       < > Small-diameter log                                                      %
                   < > Bamboo cut down in bamboo groves for the
                       purpose of maintenance and preservation of the                          %
                       surrounding environment.
                   < > Other                                                                   %
                                                                        Total                100%




                                    131(Certificate)
Example 6 (Less useful wood-2/3) -131

[Details] (Other than bamboo)
      Type of forest        < > Natural forests         < > Plantation forests

      Sustainable           Acquisition of third party certificate (a copy of
       managed              certificate should be applied)
       forests*1)           < >Yes (name                       ) < >No
        Place of
       production
      Type of tree

        Amount
          Year of
       planting*2)
         Tip end
                                                   cm
       diameter*3)
  *1) Fill in the blank if small diameter logs are used as raw materials, and
       appropriate case.
  *2) Fill in the blank if the forest is a plantation.
  *3) Fill in the blank if small diameter logs are used.

  Generation process, etc. should be given. (Separate forms are allowable.)




  Details of logging or cutting should be given if small diameter logs are used.
  (e.g. clear cutting, patch logging, and strip logging etc.)




  *

* Check appropriate items and fill in blanks.




                                131(Certificate)
Example 6 (Less useful wood-3/3)-131

[Details] (Bamboo)
   Bamboo type
                      (Place of production/Example)
                      - City, Prefecture, Country
      Place of
                      (Surrounding conditions)
   production and     - Forest or agricultural lands. Bamboo groves invade
    Surrounding         those lands and suppress appropriate growing.
     conditions         (Describe specifically)



 Explanation that To solve the problem stated above, explain what actions
     felling is    are taken.
 performed for the
    purpose of
 maintenance and
   preservation
                      State annual number of times felling is performed, as
                      well as the owner and manager of bamboo forest.
   Management
      plan


     Amounts
 Place of production: Place where bamboos were harvested.
                                                            End of the document




                          131(Certificate)
     Example 7-131
                                                                       Date

           Director                                      Date of issue of this certificate
           Eco Mark Office
           Japan Environment Association

                                                       XXXXX XXXXX
                                                       Company name
Address to send                                             Seal
this certificate


                                                                               Issuer of
                                                                               certificate

                                                                  *Issuer: Paint manufacturer
                   Certificate of Chemical Substance
     This is to certify that paints supplied for (product under application
     for Eco Mark certificate) meet Criterion 4-1.(8) in terms of chemicals
     listed in Attachment 1. Details are given in the following table.
                 Substance Name
      Total value of cadmium, mercury,                        %
      hexavalent chromium and lead
      Lead                                                   %
      Arsenic                                □Below standard/□Above
      Antimony                               □Below standard/□Above
      Tributyltin                            □No contained / □Contained
      Triphenyltin                           □No contained / □Contained
      Alkylphenol                            □No contained / □Contained
      Nonyl phenol                           □No contained / □Contained
      4-octyl phenol                         □No contained / □Contained
      Bisphenol-A                            □No contained / □Contained
      Butyl benzyl phthalate                 □No contained / □Contained
      Diethyl phthalate                      □No contained / □Contained
                                             □Below standard/□Above
      Formaldehyde
                                             □No contained / □Contained
      Toluene                                □Below standard/□Above
      Xylene                                 □Below standard/□Above
      Dthylbenzene                           □Below standard/□Above
      Styrene                                □Below standard/□Above
      Di-n-butyl phthalate                   □Below standard/□Above
      Tetradecane                            □Below standard/□Above
      Di-2-ethlhexyl phthalate               □Below standard/□Above
      Acetaldehyde                           □Below standard/□Above




                                   131(Certificate)
Example 8-131
                                                                   Date

     Director                                       Date of issue of this certificate
     Eco Mark Office
     Japan Environment Association

                                                  XXXXX XXXXX
                                                  Company name
                                                       Seal


                                                                           Issuer of
                                                                           certificate

                                                * Issuer: Raw material supplier




                      Raw Material Certificate

This is to certify that we are supplying (the Eco Mark product m
anufacturer) with (           *1).




In *1,   specific name of raw material should be given.




                             131(Certificate)
    Entry Table C-131      Product Weight Certificate
                                                                        Date

                                                                        (Company name)
    Product type (                 )                                                         Seal
Submit the form for each product type. Fill in the weight to be used for manufacturing of 1 ton
products.

Part               Raw material
                                           Name of raw material     Product weight (ton, weight
               (Example; Blast-furnace
                                                supplier                   percentage)
                     slag, etc.)
Recycled
material

Recycled
material

Recycled
material

Total     of
recycled
material
Other
materials
(        )

(        )

(        )

(        )

(        )




                                 131(Certificate)

								
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