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Form 9.0
TMMC CHEMICAL SUBSTANCES FORM Updated 1.1 If NO
Cambridge Woodstock Rearranged boxes
Added NOT REQUIRED
Section 1: TMC Banned List
1.1) Do any products to be used on-site contain chemicals on TMC Banned List? No Yes
TMC Banned List is available under Reference Material link at http://contractors.tmmc.ca/
If YES, product is not allowed on site. If NO, product is allowed on site and TMMC Env approval is not required.

Section 2: TMMC Restricted List

2.1) Do any products to be used contain chemicals on TMMC Restricted List? No Yes (identify applicable chemicals
below & fill in section 2.2)

Any products containing the following substances are restricted in TMMC operating facilities.
Acrylonitrile (D) Ethylene Oxide (D) Silica (D) CFC's
Arsenic (D) Isocyanates (D) Vinyl Chloride (D) HCFC's
Asbestos (D) Lead (D) Silicone
Benzene (D) Mercury (D) Polymer Microbeads
(D) = Denotes chemicals which are designated substances under OHSA Regulations 835-646

2.2) Complete the following section if "Yes" in section 2.1

Date: General Contractor:
TMMC Contact: Supervisor Name:
Department: Supervisor Phone #:
Location: Requestor Name:
Product Name: Quantity to be Used:
Supplier Name: Purpose of Chemical:
How will workers handle / apply product:

Disposal Method: (check all that apply) Domestic/Sanitary Waste removal offsite Waste Water (complete Waste Water
Discharge Request Form)
by contractor
Special disposal methods required:
Please Attach Safety Data Sheet and Risk Analysis for Review and Approval
Section 3: Crater Testing

3.1) Will the product be used in the Paint or Plastics shops? No Yes (arrange for TMMC crater testing and complete below)

Shop Test Pass (Y/N) Shop Analyst / Production Manager Signature Date

Paint

Plastics

Testing Method Used:

TO BE COMPLETED BY TMMC
TMMC Restricted Substances are not permitted on site unless this permit has been accepted

Environmental Engineering Print Name Signature Date

Analyst Approval
Special Instructions
Accepted Not Accepted Not Required

Health & Safety Print Name Signature Date

Analyst Approval
Special Instructions
Accepted Not Accepted Not Required

Requestor → Toyota Analyst → Environmental → Health & Safety → Requester (file) Rev3 (8/31/2020)