Statement of Product Specification Form (Form 6003)

• Guidance for Completing the Statement of Product Specification Form
• New/Old Form Conversion Instructions / Batch Import Sequence
• Form

Guidance for Completing the Statement of Product Specification Form

To obtain an electronic copy of the document, Guidance for Completing the Statement of Product Specification Form (Form 6003), please contact our publications office.

Should you require further information please contact the Pest Management Information Service.

Summary

This Statement of Product Specification Form (SPSF) is designed for reporting the composition of technical grade active ingredients (TGAIs), integrated system product (ISPs), manufacturing concentrates (MAs) and end-use products (EPs) registered by the PMRA. A separate SPSF must be completed for each type of product.

Note: A TGAI typically contains an active ingredient and impurities. An ISP typically contains an active ingredient, impurities and a stabilizer. A MA typically contains a TGAI and a diluent. An EP typically contains a TGAI, diluent and other formulants.

New/Old Form Conversion Instructions / Batch Import Sequence

To obtain an electronic copy of the document, New/Old Form Conversion Instructions / Batch Import Sequence, please contact ourpublications office.

Should you require further information please contact the Pest Management Information Service.

Summary

The Statement of Product Specification Form (SPSF) batch import file is intended to be used to import form data from the 09/2002 version of the SPSF into the 05/2006 version number of the SPSF. The version number of a SPSF can be found at the bottom of the first page.

To obtain a copy of the SPSF batch import file please contact Pest Management Information Service.

This batch process is supported in Adobe 5.0 Standard version or Adobe Acrobat Professional version 6.0 and above. The batch import cannot be used in Adobe Reader.

If Adobe Acrobat 6 or 7 Standard version is being used, please indicate this when requesting the batch file and an alternate automated import mechanism will be provided.

Form

Precedent Reg #:

Form.:

Version:

1. Page: of
   Date Received:
2. Registration #:
   Submission #:
3. Product Name:
4. Formulation Type Code:
   • DF
   • DU
   • DV
   • EC
   • GR
   • IF
   • LI
   • LO
   • MS
   • PA
   • PE
   • PP
   • PT
   • SG
   • SN
   • SO
   • SP
   • SR
   • SU
   • TA
   • WD
   • WG
   • WP
5. Formulation #:
6. Version #:
7. Name of Registrant/Proposed Registrant:
8. Name and address of site of Manufacture/ Formulation
   Name:
   Address:
   Select if multiple formulation sites (Multiple manufacturing sites require a separate SPSF)
9. If the SPSF is confidential to a 3^rd Party enter contact information
   Name:
   Address:
   E-mail:
   Phone:
   Fax:
10. Specific Gravity/Density @: °C
    Lower:
    Upper:
    Units:
    • g/cm³
    • g/L
    • g/mL
    • kg/L
    • kg/m³
11. Flash point (°C):
12. Flame Extension (cm):
13. Viscosity (mPa(s)):
14. pH:

Components

Row 1

1. Trade Name:
2. Common Name:
3. Chemical Name:
4. Act in
   Name:
   Address:
   Address Multiple Suppliers? Yes
5. Reg #:
6. Purity:
7. CAS #:
8. List #:
9. %w/w
10. NACT
    Purpose:
11. List
    % LCL:
12. % Nominal:
13. % UCL:
14. Actions
    1. Label Guarantee:
    2. Value:
    3. Units:
    4. LCL:
    5. UCL:
15. Act Out
    Other Info:

Row 2

1. Trade Name:
2. Common Name:
3. Chemical Name:
4. Act in
   Name:
   Address:
   Address Multiple Suppliers? Yes
5. Reg #:
6. Purity:
7. CAS #:
8. List #:
9. %w/w
10. NACT
    Purpose:
11. List
    % LCL:
12. % Nominal:
13. % UCL:
14. Actions
    1. Label Guarantee:
    2. Value:
    3. Units:
    4. LCL:
    5. UCL:
15. Act Out
    Other Info:

Sum of the %w/w:

Certification of Approving Official

"I certify that all the information contained within this form is true and complete."

Printed Name:
Signature:
Date: (YYYY-MM-DD)
Telephone:
Fax:
E-Mail:

Screened By:
Date:
Reviewer:

Accepted by:
Date:
Reviewer:

Alternate Formulating Sites / Alternate Formulant Suppliers

Reference Page:
Row:
Name:
Address:

Reference Page:
Row:
Name:
Address:

Reference Page:
Row:
Name:
Address:

Reference Page:
Row:
Name:
Address: