Pacific Bearing Company's Materials Composition Declaration Form for Equipment
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PART / PRODUCT INFORMATION
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Part / Product Name
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ALL PRODUCTS
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Part / Product Number
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ALL PRODUCTS
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Part Number Revision
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Effective Date of Part Revision
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Material/Substance Category Name
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Maximum Concentration Value (MCV)
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Above MCV? (Y/N)
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Intentionally Added? (Y/N)
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Provide concentration if available
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Describe All Uses (including allowable uses) and Physical Locations
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List A Substances
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Asbestos
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0 ppm
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N
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Azo Colorants
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0 ppm
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N
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Cadmium/Cadmium Coumpounds
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100 ppm
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N
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Hexavalent Chromium/Hexavalent Chromium Compounds
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1000 ppm
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N
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Lead/Lead Compounds (Lead in PVC insulation)
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1000 ppm (300 ppm)
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N
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Mercury/Mercury Compounds
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1000 ppm
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N
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Include mass of mercury used in lamps (grams)
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Class I Ozone Depleting Substances
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0 ppm
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N
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Class II Ozone Depleting Substances
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1000 ppm
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N
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Polybrominated Biphenyls (PBB) and Polybrominated Diphenyls (PBDE)
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1000 ppm
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N
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Polychlorinated Biphenyls (PCB)
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0 ppm
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N
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Polychlorinated Naphthalenes (> 3 Cl)
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0 ppm
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N
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Radioactive Substances
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0 ppm
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N
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Short-chained Chlorinated Hydrocarbons (C10-C13)
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0 ppm
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N
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Tributyl Tin (TBT) and Triphenyl Tin (TPT)
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0 ppm
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N
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Tributyl Tin Oxide
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0 ppm
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N
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List B Substances
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Antimony/Antimony Compounds
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1000 ppm
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N
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Arsenic/Arsenic Compounds
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1000 ppm
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N
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Beryllium/Beryllium Compounds
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1000 ppm
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N
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Bismuth/Bismuth Compounds
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1000 ppm
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N
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Brominated Flame Retardants (other than PBB, PBDE)
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1000 ppm
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N
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Nickel
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1000 ppm
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N
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Phthalates
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1000 ppm
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N
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Polyvinyl Chloride (PVC)
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1000 ppm
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N
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Selenium/Selenium Compounds
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1000 ppm
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N
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List C Substances
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Carbon Black
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0 ppm
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N
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Crystalline Silica
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0 ppm
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N
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Fluoropolymers (No intentional additon except in part <500 grams (or <5% by weight)
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>500 gms or >5% by weight
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N
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Natural Rubber Latex
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0 ppm
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N
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Polyvinylidene Chloride (PVDC)
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0 ppm
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N
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I certify that I am authorized to declare this Material Composition Declaration Form on behalf of Pacific Bearing
Company. I also certify that I have implemented processes to ensure the accuracy of the data provided for the products I
manufacture, and methods of verifying and auditing the information acquired through my supply chain, as necessary.
Certified By: Michael Moss
Title: President
Date: 01/01/2010
