公益財団法人 日本環境協会エコマーク事務局



Eco Mark Product Category No.155 “Imaging Equipment

Such As Copiers, Printers, etc. Version1” Attached Certificate

This attached certificate shall be submitted accompanied with “Application for Eco Mark product certificate and utilization” when applying for the product category No. 155 “Imaging Equipment Such As Copiers, Printers, etc. Version1”.

|Date of application: |

|Brand Name | |

|Applicant | |(company seal) |

|(company name) | | |

| |

|1. Required items on the product under application shall be checked or entered in “Fill in this Column” or “Compliant/ |

|noncompliant”. |

|2. Prepare the certificates specified in “Certificate to be submitted”. Submit these certificates with this attached certificate |

|when applying for Eco Mark Product certification and use. |

|* Shaded areas in “Certificate to be submitted” do not require a submission. |

|3. Refer [Form] for preparing each certificate. |

|4. “The issuer(s) of the certificate to be submitted” shall prepare the “Certificate to be submitted”. |

|Item |Fill in this Column / documents attached |

| |(check all items that apply) |

|Planned Display of Eco Mark |( Product ( Packaging ( Instruction |

| |( Product manual (Catalogue/leaflet) ( Web |

|* in principal, Eco Mark shall be indicated on the product, |( Other ( ) |

|packaging, instruction, product manual (pamphlet, etc), etc. | |

|Planned design of Eco Mark indication |Please submit the design drawing of Eco Mark indication (Format free, draft) |

| | |

|Please refer Eco Mark use guideline for indication of Eco Mark | |

| |Reason (to plan) not to indicate Eco Mark |

| |[ ] |

|Item |Fill in this Column |Certificate to be submitted |issuer(s) of the |

| |(check all items that apply) | |certificate to be |

| | | |submitted |

|Company which developed the |< > Other company |If developed by other companies, attach |Approver of the |

|product |< > Own company |Approval of Eco Mark Application(Form0) |application |

|If a product certified under |Are there any changes in addition to brand name?|- A copy of notice of Eco Mark | |

|this product category is | |certification | |

|applied as another brand |< > Yes < > No |-Correspondence table between certified | |

| | |model and applying model, identical | |

| | |proof by each item (or indication on | |

| | |this Attached certificate) | |

| | |- Documents on 4-1-1.(5)-(7), (9)-(13), | |

| | |4-1-2.(15), 4-1-4.(32), (33) and | |

| | |certifying changes | |

|Model/product number | |

|Type |□Copier / □Printer / □Fax (facsimile machine) / □Scanner / □Multifunctional device |

|Size |□Standard format (A3 size □accommodate □not accommodate) / □Large format / |

| |□Small format |

|Marking Technologies(not |□Electoro-Photographic / □InkJet / □High performanceIJ / □Direct Thermal / |

|required for scanners) |□ Dye Sublimination / □ Impact / □Solid Ink / □ Thermal Transfer |

|Monochrome / colour |□Colour / □Monochrome |

|Module for Colourant, |□Toner cartridge / □Toner container / □Ink cartridge / □ Ink ribbon cartridges |

|Container (no entry required | |

|when these are not used) |Product number of cartridge/module |

| |Eco Mark cerfication number (if certified) |

| |Name on Form 7 |

| |Name on SDS |

| |Name on the result of Ames test (if no result of Ames test on SDS) |

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|Main purpose of use |□ Office use / □Household use / □ Other [ ] |

|Model/product number | |

|Type |□Copier / □Printer / □Fax (facsimile machine) / □Scanner / □Multifunctional device |

|Size |□Standard format (A3 size □accommodate □not accommodate) / □Large format / |

| |□Small format |

|Marking Technologies(not |□Electoro-Photographic / □InkJet / □High performanceIJ / □Direct Thermal / |

|required for scanners) |□ Dye Sublimination / □ Impact / □Solid Ink / □ Thermal Transfer |

|Monochrome / colour |□Colour / □Monochrome |

|Module for Colourant, |□Toner cartridge / □Toner container / □Ink cartridge / □ Ink ribbon cartridges |

|Container (no entry required | |

|when these are not used) |Product number of cartridge/module |

| |Eco Mark cerfication number (if certified) |

| |Name on Form 7 |

| |Name onSDS |

| |Name on the result of Ames test (if no result of Ames test on SDS) |

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|Main purpose of use |□ Office use / □Household use / □ Other [ ] |

*Duplicate the above table and fill out the form if 3 or more types/models are used at one application.

|Testing Bodies |Fill in this column |

| |*Check or Fill in the applicable items.. |

|□ Plan to utilize MRA with foreign ecolablling programs / □ No |

|4-1-2.(15) |Name of testing body | |

|Energy Efficiency | | |

| |Address of testing body | |

| |Requirements of testing body | |

| | |□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory|

| | |(LAB)( |

| | |Certified / registered number[ ] |

| | |Program name [ ] |

| | |□ Operating in accordance with ISO/IEC17025 ISO/IEC17025 (corresponding JIS Q17025). |

| | |□ Satisfying the requirements defined by Appendix A: “Requirements for the operation of a |

| | |Witnessed Manufacturers’ Testing Laboratory (WMTL) or Supervised Manufacturers’ Testing |

| | |Laboratory (SMTL) program” in the “Conditions and Criteria for Recognition of Laboratories |

| | |for the ENERGY STAR® Program” |

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| | | |

| | |□ monitors sampling and analysis processes |

| | |□received accreditation to perform analysis and testing by the supervisory agency |

| | |□Has established a quality system including sampling and analysis and is maintaining |

| | |ISO9001 (corresponding JIS Q9001). |

| | |□Performs measurements in accordance with a quality control system including sampling and |

| | |analysis conforming to ISO9001. |

|4-1-3.(19)-(21) |Name of testing body | |

|Emission of | | |

|Hazardous | | |

|Substances | | |

| |Address of testing body | |

| |Requirements of testing body | |

| | |□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory|

| | |(LAB)( |

| | |Certified / registered number[ ] |

| | |Program name [ ] |

| | |□ Operating in accordance with ISO/IEC17025 ISO/IEC17025 (corresponding JIS Q17025). |

| | | |

| | | |

| | |□ monitors sampling and analysis processes |

| | |□received accreditation to perform analysis and testing by the supervisory agency |

| | |□Has established a quality system including sampling and analysis and is maintaining |

| | |ISO9001 (corresponding JIS Q9001). |

| | |□Performs measurements in accordance with a quality control system including sampling and |

| | |analysis conforming to ISO9001. |

|4-1-3.(31) |Name of testing body | |

|Noise | | |

| |Address of testing body | |

| |Requirements of testing body | |

| | |□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory|

| | |(LAB)( |

| | |Certified / registered number[ ] |

| | |Program name [ ] |

| | |□ Operating in accordance with ISO/IEC17025 ISO/IEC17025 (corresponding JIS Q17025). |

| | | |

| | | |

| | |□ monitors sampling and analysis processes |

| | |□received accreditation to perform analysis and testing by the supervisory agency |

| | |□Has established a quality system including sampling and analysis and is maintaining |

| | |ISO9001 (corresponding JIS Q9001). |

| | |□Performs measurements in accordance with a quality control system including sampling and |

| | |analysis conforming to ISO9001. |

|Item |Applicable Criteria and |Compliant/ |Documents to be |issuer(s) of the |

| |Fill in this Column |noncompliant |Submitted |certificate to be |

| | | | |submitted |

|4-1-1. |Equipment shall conform to “Product Design Checklist”. |(Yes |Form 1 |person responsible |

|(1) | |(No | |for design |

|4-1-1. |Modules for Colourants or containers for colorants used for |(Yes | | |

|(2) |the equipment shall conform to “Product Design Checklist” |(No | | |

| | |□ No Modules for | | |

| | |Colourants or | | |

| | |containers for | | |

| | |colorants used | | |

|4-1-1. |Each individual plastic casing part of more than 25g shall be|(Yes |Form 2 |person responsible |

|(3) |made of one single polymer or polymer blends. |(No | |for design |

| |In addition, all plastic parts of more than 25g used for |(Yes | | |

| |casing parts shall be made of four or fewer types of mutually|(No | | |

| |separable polymers or polymer blends. | | | |

|4-1-1. |For equipment that falls under the Designated Resources |(Yes |Form 3 |person responsible |

|(4) |Reutilizing Industry of the Act on the Promotion of Effective|(No | |for design or in |

| |Utilization of Resources, any one of parts weighing more than|□ Equipment not | |charge |

| |25g shall be a recycled plastic part or reused plastic part |applicable | | |

| |at a minimum. | | | |

| |For any equipment that does not fall under the Designated |(Yes | | |

| |Resources Reutilizing Industry (equipment covered by the Act |(No | | |

| |on Promotion of Recycling of Small Waste Electrical and |□ Equipment not | | |

| |Electronic Equipment and scanners), it may also be acceptable|applicable | | |

| |if any one of parts is a recycled plastic part or reused | | | |

| |plastic part at a minimum. | | | |

|4-1-1. |Collection systems shall be available for toner cartridges, |(Yes |Explanatory documents for the |Control manager or |

|(5) |toner containers or ink cartridges. |(No |collection systems of toner |person in charge |

| | |□ No toner/ ink |containers or toner/ink | |

| | |cartridges, toner |cartridges. | |

| | |cartridges used. | | |

|4-1-1. |Systems shall be available for the material recycling of |(Yes |Explanatory documents |Control manager or |

|(6) |toner cartridges or ink cartridges |(No |describing the total weight of|person in charge |

| | |□No toner /ink |toner/ink cartridges, reuse | |

| | |cartridges used |and material recycling rates | |

| | |(no entry required |of parts, and the purposes of | |

| | |below) |reuse and material recycling. | |

| | | |(Form 4) | |

| |Reuse/material recycling rate of collected toner/ink |(Yes | | |

| |cartridge parts shall be 50% or more for the toner |(No | | |

| |cartridges, and 40% or more for the ink cartridges of the | | | |

| |total weight of collected used products (excluding | | | |

| |toner/ink). | | | |

|4-1-1. |The recovery rate of collected toner cartridges, toner |(Yes |Documents explaining the |Control manager or |

|(7) |containers or ink cartridges shall be 95% or more of the |(No |recovery rate and |person in charge |

| |total weight of collected used products (excluding |□No toner |demonstrating that the system | |

| |toner/ink). |cartridges, toner |for processing/disposing of | |

| | |containers or ink |any part that cannot be | |

| | |cartridges used (no|recovered has been established| |

| | |entry required |(capacity of processing, | |

| | |below) |content of processing, etc.). | |

| | | |(Form 4) | |

| |Parts of collected toner cartridges, toner containers or ink |(Yes | | |

| |cartridges which cannot be recovered shall not be simply |(No | | |

| |landfilled but be appropriately processed after the weight | | | |

| |reduction. | | | |

|4-1-1. |If paper to be used falls under a. to c. listed below, based |(Yes | | |

|(8) |on the provisions on quality control of each company, use of |(No | | |

| |at least one or more type of paper shall be possible: |□ applies to a | | |

| |Applicable scope “PPC paper, business forms and coated paper |scanner and imaging| | |

| |for color printers (paper for ink jet printing)” of Eco Mark |equipment which | | |

| |Product Category No. 106 “Paper for Communication Version 3” |uses only thermal | | |

| |Applicable scope “Printing paper (Excluding drawing papers |paper, continuous | | |

| |included in the “writing and art papers” category designated |forms, large format| | |

| |in the “Paper and Pulp Statistics Annual Report” by the |forms or photo / | | |

| |Ministry of Economy, Trade and Industry.) of Eco Mark Product|postcard paper. | | |

| |Category No. 107 “Printing Paper Version 3” | | | |

| |[Information Paper] “Copier paper, forms, coated inkjet color| | | |

| |printer paper”, and [Printing Paper] “Non coated printing | | | |

| |paper, coated printing paper” of “2. Paper” of the Law | | | |

| |Concerning the Promotion of Procurement of Eco-Friendly Goods| | | |

| |and Services by the State and Other Entities | | | |

| |Paper possibly used | | | |

| |□a / □b / □c | | | |

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| |Manufacturer | | | |

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| |Brand name | | | |

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| |Eco Mark certification no. | | | |

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| |* Eco Mark certification No. shall be specified only when | | | |

| |certified paper is used | | | |

| |* If several types of paper are available, indicate the major| | | |

| |type. | | | |

|4-1-1. |Equipment to which TEC of ENERGY STAR® Product Specification |(Yes |each model, a certificate |Person in charge |

|(9) |for Imaging Equipment Version 2.0 is applied shall meet the |(No |describing the automatic | |

| |requirements of the automatic duplexing function in Table 1. |□ Equipment not |duplex function (e.g., a | |

| |However, this item does not apply to equipment intended to |covered |written notice on products | |

| |print on special single-sided media for the purpose of single| |using the ENERGY STAR® logo) | |

| |sided printing (e.g., release coated paper for labels, direct| |or a document on the | |

| |thermal media, etc.). | |capability of reducing paper | |

| |Equipment to which the Operation Mode is applied (excluding | |usage (e.g., a hard copy of | |

| |scanners) or equipment to which the automatic duplexing | |the printer driver). | |

| |function as described above is not applied shall have a | | | |

| |printer driver with the capability of reducing paper usage | | | |

| |(reduced printing, page layout printing, etc.). | | | |

|4-1-1. |Maintenance and repair subcontract systems shall be |(Yes |For a. and b, copies of | |

|(10) |available, and repairs shall be carried out as requested by |(No |product documentation showing | |

| |the users (repair system). | |that the proper system is | |

| |The following items a to c shall be satisfied to improve the | |available (processing ability,| |

| |system: | |details of provided | |

| |a. Information that repair services are available shall be | |information specified in | |

| |provided; | |criteria, etc.). | |

| |b. Information that the scope of repair (details of | | | |

| |services), repair time, costs, how services are provided to | | | |

| |users, etc. shall be provided. | | | |

| |c. The system shall be such that maintenance of equipment | | | |

| |(referring to maintenance to be provided by an operator) is | | | |

| |performed only by persons who have undergone training and | | | |

| |persons with the required technical expertise. | | | |

|4-1-1. |Supply of the spare parts shall be ensured for 5 years after |(Yes |Copies of product | |

|(11) |production of the product stops. |(No |documentation indicating the | |

| | | |matters related to this item. | |

|4-1-1. |Equipment that falls under the Designated Resources |(Yes |Explanatory documents |Control manager or a |

|(12) |Reutilizing Industry of the Act on the Promotion of Effective|(No |indicating the collection, |person in charge |

| |Utilization of Resources shall have a system for equipment |□ Equipment not |reuse, material recycling, | |

| |collection and part reuse, or a material recycling system for|covered |recovery of the products and | |

| |materials. | |establishment of the system | |

| | | |for processing/disposing of | |

| | | |any part that cannot be | |

| | | |recovered (details of the | |

| | | |collection system, collection | |

| | | |rate, reuse, material | |

| | | |recycling, content of | |

| | | |recovery, capacity of | |

| | | |processing, content of | |

| | | |processing, etc. Form 4) or | |

| | | |those (printouts of the | |

| | | |website, etc.) on efforts to | |

| | | |increase the collection rate, | |

| | | |etc.. | |

| | | | | |

| |For equipment that does not fall under the Designated |□ established a | | |

| |Resources Reutilizing Industry (equipment covered by the Act |collection and | | |

| |on Promotion of Recycling of Small Waste Electrical and |recycling system | | |

| |Electronic Equipment and scanners), efforts to establish a |□ made effort to | | |

| |collection and recycling system and to increase the |increase the | | |

| |collection rate, reuse/material recycling rate and recovery |collection rate, | | |

| |rate are made. |etc. | | |

| | |(No | | |

| | |□ Equipment not | | |

| | |applicable | | |

| |The recovery rate of collected equipment shall be 75% or |Check if the | | |

| |more. |in-house collecting| | |

| | |system is | | |

| | |available. | | |

| | |(Yes | | |

| | |(No | | |

| |Parts that cannot be recovered shall not be simply landfilled|Check if the | | |

| |but be appropriately processed after the weight reduction. |in-house collecting| | |

| | |system is | | |

| | |available. | | |

| | |(Yes | | |

| | |(No | | |

|4-1-1. |Systems for collecting and material recycling of |(Yes |explanatory documents |Control manager or a |

|(13) |photoconductor drums shall be available. |(No |indicating the collection, |person in charge |

| | |□ Equipment not |material recycling, recovery | |

| | |applicable |of photoconductor drums and | |

| | | |establishment of the system | |

| | | |for processing/ disposing of | |

| | | |any part that cannot be | |

| | | |recovered (details of the | |

| | | |collection system, material | |

| | | |recycling, content of | |

| | | |recovery, capacity of | |

| | | |processing, content of | |

| | | |processing, etc.). Form 4 | |

| |The recovery rate of collected photoconductor drums shall be |(Yes | | |

| |75% or more. |(No | | |

| | |□ Equipment not | | |

| | |applicable | | |

| |Parts that cannot be recovered shall not be simply landfilled|(Yes | | |

| |but be appropriately processed after the weight reduction. |(No | | |

| | |□ Equipment not | | |

| | |covered | | |

|4-1-1. |Packaging or packing of equipment shall be as simple as |(Yes |Form 5 |Person responsible |

|(14) |possible and give consideration to ease of reuse and |(No | |for design or in |

| |environmental burden when packaging or packing materials are | | |charge |

| |disposed of (compliant with “Packaging Material Check List”).| | | |

|4-1-2. |A product shall conform to the ENERGY STAR® “Product |(Yes |a written notice on products |Person in charge |

|(15) |Specification for Imaging Equipment: Eligibility Criteria” |(No |using the ENERGY STAR® logo, | |

| |that is applied at the time of application. | |etc, | |

| | | |(If the submission is | |

| | | |difficult at the time of | |

| | | |application, a signed consent | |

| | | |form shall be submitted.) | |

|4-1-3. |Polymer containing halogen shall not be used for plastic |(Yes |Form 2 |Person responsible |

|(16) |casing parts. In addition, organohalogen compounds as flame |(No | |for design or in |

| |retardants shall not be added as prescribed constituents. | | |charge |

| |This item shall not apply to a part that falls under one or | | | |

| |more of the following a. to e.: | | | |

| |a. Fluoroorganic additives (for example, anti-dripping | | | |

| |agents, etc.) used to improve the physical properties of | | | |

| |plastics, provided that they do not exceed 0.5wt%. | | | |

| |b. Fluoroplastics, for example, PTFE, etc. | | | |

| |c. Plastic materials of 25g or less (this criterion applies | | | |

| |to keys of the keyboard even if it weighs 25g or less.) | | | |

| |d. Plastic parts installed adjacent to heating and fusing | | | |

| |units. | | | |

| |e. Large-sized reused plastic parts which are marked in | | | |

| |accordance with Appendix 1 “Product Design Checklist” B10. | | | |

| |(please clarify the confirmation method) | | | |

| |□A confirmation is performed based on JIS Z 7201 “Management | | | |

| |of chemical substances in products - Principles and | | | |

| |guidelines” | | | |

| |□ B. Applicant (or manufacturer) confirms by tests | | | |

| |□C. Applicant (or manufacturer) prepares “green procurement | | | |

| |criteria”, etc. including the applicable materials and | | | |

| |confirms the inclusion (amount) with parts supplier. | | | |

| |Name of Green procurement criteria: | | | |

| |URL (if posted): | | | |

| |*if not posted, submit it at the first certification and when| | | |

| |revising the criteria. | | | |

| |□ D. Applicant (or manufacturer) requires a parts supplier to| | | |

| |submit test results of the applicable material. | | | |

| |□ E. Other ( ) | | | |

|4-1-3. | |(Yes |Form 2 |Person responsible |

|(17) |Each substance listed in the following a. to e. shall not be |(No | |for design or in |

| |added to plastic casing parts as prescribed constituents. | | |charge |

| |Carcinogenic substances based on Category 1A or 1B of Table | | | |

| |3.1 in Annex VI of EC Regulation 1272/2008/EC | | | |

| |Mutagen based on Category 1A or 1B of Table 3.1 in Annex VI | | | |

| |of EC Regulation 1272/2008/EC | | | |

| |Reproductive toxic substances based on Category 1A or 1B of | | | |

| |Table 3.1 in Annex VI of EC Regulation 1272/2008/EC | | | |

| |Persistent, bio-accumulative and toxic substances (PBTs) or | | | |

| |very persistent or very bio-accumulative substances (vPvBs) | | | |

| |based on the criteria in Annex XIII of the REACH Regulation | | | |

| |Substances of very high concern in the list (so-called “list | | | |

| |of SVHC candidates”) in REACH Regulation, Article 59, para. | | | |

| |1. | | | |

| |For d. and e, refer Appendix R-L2 of RAL-UZ171 (effect on | | | |

| |December 14, 2010). | | | |

| |Please clarify the confirmation method in this item. (refer | | | |

| |confirmation methods A to D in 4-1-3.(16)) | | | |

| |□A / □B / □C /□D | | | |

| |□E Other:[                      ] | | | |

|4-1-3. |The content rate of lead, mercury, cadmium in the product, |(Yes | | |

|(18) |hexavalent chromium compounds, Polybrominated biphenyl (PBB) |(No | | |

| |or Polybrominated diphenylether (PBDE) in the product shall | | | |

| |comply with Annex II (Table 2) of the amended RoHS Directive | | | |

| |(2011/65/EU). | | | |

| |However, this does not apply to those substances specified in| | | |

| |Annex III. | | | |

| |In addition, the product shall have no flame retardant of | | | |

| |short-chain chlorinated paraffin (the number of chained C is | | | |

| |10 to 13 and contained chloride concentration is 50% or over)| | | |

| |added as formulated components. | | | |

| |Please clarify the confirmation method in this item. (refer | | | |

| |confirmation methods A to D in 4-1-3.(16)) | | | |

| |□A / □B / □C /□D | | | |

| |□E Other:[                      ] | | | |

|4-1-3. |For electrophotographic equipment, values obtained with the |(Yes |Form 6 |Testing manager, |

|(19) |measuring method defined by RAL-UZ171 shall confirm to Table |(No |(If the submission is |control manager or |

| |3 for emission of hazardous substances during operation of |□ Equipment not |difficult at the time of |person in charge |

| |monochrome equipment as well as during the monochrome and |covered |application, a signed consent | |

| |color operation phases of color equipment. | |form shall be submitted.) | |

| |The large format equipment shall be measured in accordance | | | |

| |with Table 3-1. | | | |

| |If the emission rate during the color operation phase of | | | |

| |color equipment satisfies the monochrome criteria, | | | |

| |measurements during the monochrome operation phase can be | | | |

| |omitted. | | | |

| |For equipment on which measurements took place before April | | | |

| |2014, test results according to the Blue Angle RAL-UZ122 | | | |

| |shall also be acceptable. | | | |

|4-1-3. |For electrophotographic equipment (250L or less), values |(Yes |Form 6 |Testing manager, |

|(20) |obtained with the measuring method defined by RAL-UZ171 shall|equipment (250L or |(If the submission is |control manager or |

| |meet the following for emission of fine particles and |less) |difficult at the time of |person in charge |

| |particles in the size region of ultra-fine particles during |(No |application, a signed consent | |

| |operation of monochrome equipment and during the color |□ Equipment not |form shall be submitted.) | |

| |operation phase of color equipment. The large format |covered | | |

| |equipment shall be measured in accordance with Table 3-1. | | | |

| |Equipment whose equipment volume exceeds 250L shall be |(Yes | | |

| |measured and a result thereof shall be reported, according to|equipment (exceeds | | |

| |the specification of RAL-UZ171. |250L) | | |

| | |(No | | |

| | |□ Equipment not | | |

| | |applicable | | |

|4-1-3. |For equipment other than electrophotographic equipment |(Yes |Form 6 |Tesging manager, |

|(21) |(excluding scanners), values obtained with the measuring |(No |(If the submission is |control manager or |

| |method defined by RAL-UZ171 shall conform to Table 4 for |□ Equipment not |difficult at the time of |person in charge |

| |emission of hazardous substances during operation of |covered |application, a signed consent | |

| |monochrome equipment as well as during the monochrome and | |form shall be submitted.) | |

| |color operation phases of color equipment. | | | |

| |The large format equipment shall be measured in accordance | | | |

| |with Table 3-1. | | | |

| |If the emission rate during the color operation phase of | | | |

| |color equipment satisfies the monochrome criteria, | | | |

| |measurements during the monochrome operation phase can be | | | |

| |omitted. | | | |

| |For equipment on which measurements took place before April | | | |

| |2014, test results according to the Blue Angle RAL-UZ122 | | | |

| |shall also be acceptable. | | | |

|4-1-3. |Cadmium, lead, mercury Selenium and their compounds shall not|(Yes | | |

|(22) |be added as prescribed constituents to photoconductor drums |(No | | |

| |used in the product. |□ Equipment not | | |

| | |applied | | |

| |Please clarify the confirmation method in this item. (refer | | | |

| |confirmation methods A to D in 4-1-3.(16)) | | | |

| |□A / □B / □C /□D | | | |

| |□E Other:[                      ] | | | |

|4-1-3. |Toner cartridges or toner containers shall be sealed to |(Yes | | |

|(23) |prevent toners from leaking during storage, transport, and |(No | | |

| |handling. |□ Equipment not | | |

| | |applied | | |

|4-1-3. |Each substance listed in the following a. to f. shall not be |(Yes |Form 7 and Safety Data Sheet |Responsible person of|

|(24) |added to toners, inks or solid inks, etc. (colourants) as |(No |(SDS) of colourants. |toner/ink |

| |prescribed constituents. |□ Equipment not |(If the SDS does not contain |manufactuere or |

| |Carcinogenic substances according to Category 1A, 1B or 2 of |applied |any description of the Ames |person in charge |

| |Table 3.1 in Annex VI of EU Regulation 1272/2008/EC | |test result, the applicant | |

| |Mutagen according to Category 1A, 1B or 2 of Table 3.1 in | |shall submit a test report. | |

| |Annex VI of EU Regulation 1272/2008/EC | |The test report shall include | |

| |Reproductive toxic substances according to Category 1A, 1B or| |at least a name of the testing| |

| |2 of Table 3.1 in Annex VI of EU Regulation 1272/2008/EC | |institute, name of the tested | |

| |Persistent, bio-accumulative and toxic substances (PBTs) or | |substances, testing period, | |

| |very persistent or very bio-accumulative substances (vPvBs) | |used strain (5 strains) and | |

| |according to the criteria in Annex XIII of the REACH | |test result.) | |

| |Regulation | | | |

| |Alternatively, substances of very high concern, particularly | | | |

| |warned for other reasons, or for being indicated in the list | | | |

| |(the so-called “list of SVHC candidates) according to REACH | | | |

| |Regulation, Article 59, para. 1. | | | |

| |Substances which require labelling of the mixtures that | | | |

| |contains the following H or R phrases according to Table 3.1 | | | |

| |or 3.2 in Annex VI of EU Regulation 1272/2008/EC, or those | | | |

| |which meet the requirements for homogeneous mixture | | | |

| |classification: | | | |

| |H 370 (R 39/23/24/25/26/27/28) Causes damage to organs | | | |

| |H 371 (R 68/20/21/22) May cause damage to organs | | | |

| |H 372 (R 48/25/24/23) Causes damage to organs | | | |

| |H 373 (R 48/20/21/22) May cause damage to organs | | | |

| |For d. and e, refer Appendix R-L2 of RAL-UZ171 (effect on | | | |

| |December 14, 2010). | | | |

|4-1-3. |Cadmium, lead, mercury, hexavalent chromium, nickel or |(Yes |Form 7 |Responsible person of|

|(25) |compounds thereof shall not be added as prescribed |(No | |toner/ink |

| |constituents in toners, inks or solid inks (colourants), etc.|□ Equipment not | |manufactuere or |

| |(excluding complex compounds of high molecular weight nickel |applied | |person in charge |

| |as a colouring agent) | | | |

|4-1-3. |Toners, inks, or solid inks, etc. (colourants) shall not use |(Yes |Form 7 |Responsible person of|

|(26) |azo colouring agents (dyes and pigments) that generate amines|(No | |toner/ink |

| |listed in Table 5 due to the reduction of one or more azo |□ Equipment not | |manufactuere or |

| |groups (according to the official test method corpus based on|applied | |person in charge |

| |the German Law on Foods and Sundries Article 35:Amitliche | | | |

| |Sammlung Von Untersuchungsverfahren nach 35 LMBG). | | | |

|4-1-3. |If any biocidal product is used in toners, inks or solid |□ Yes |Form 7 |Responsible person of|

|(27) |inks, etc. (colourants), only constituents listed in Annex I |(no biocidal | |toner/ink |

| |of “REGULATION (EU) No 528/2012 OF THE EUROPEAN PARLIAMENT |product used) | |manufactuere or |

| |AND OF THE COUNCIL of 22 May 2012 concerning the making |□ No | |person in charge |

| |available on the market and use of biocidal products” shall |(biocidal product | | |

| |be added as prescribed constituents. |used) | | |

| |If use of a substance not listed in the Annex is planned, |□ No | | |

| |addition thereof will be permitted provided that an |□ Equipment not | | |

| |application for approval is submitted based on said |applied | | |

| |directive. However, the addition will not be permitted if it | | | |

| |is determined that the application should be rejected. | | | |

|4-1-3. |In manufacturing the applied product, related environmental |(Yes |Form 8 |Factory manager of |

|(28) |laws, etc. are followed in the area where the plant |(No | |product assembling |

| |performing the final manufacturing process is located. | | |plant |

| |There is no violation of the Environmental Laws, etc. for the|(Yes | | |

| |last five years from the date of application. Or if there |(No | | |

| |were any violation, proper remedies and preventive measures | | | |

| |have been already taken, and the related Environmental Laws, | | | |

| |etc. are followed appropriately. | | | |

|4-1-3. |A battery built in the product shall comply with the EU |(Yes |test results or a compliance |Testing laboratory or|

|(29) |Directive 2013/56/EU (Table 6). |(No |certificate issued by a |battery manufacturer |

| |If a battery is used, please specify the model/product number|□No built-in |battery manufacturer (with | |

| |of the battery used in the applying product. |battery used |product number or types of | |

| |[ ] | |battery) | |

|4-1-3. |Mercury or compounds thereof shall not be added to light |(Yes | | |

|(30) |sources (light sources for scanner units and control panel |(No | | |

| |backlight) used in the product as prescribed constituents. | | | |

| |Please clarify the confirmation method in this item. (refer | | | |

| |confirmation methods A to D in 4-1-3.(16)) | | | |

| |□A / □B / □C /□D | | | |

| |□E Other:[                      ] | | | |

|4-1-3. |For the noise emitted from the equipment, based on actual |(Yes |Form 9 |Testing manager, |

|(31) |measurements obtained with the measuring method specified in |(No |*For scanners and small format|control manager or |

| |the Blue Angel RAL-UZ171 (or ISO 7779 [corresponding to JIS |□ Equipment not |equipment, the certificate |person in charge |

| |X7779]), “the declared A-weighted sound power level LWad” |applicable |shall also indicate the | |

| |specified in ISO 9296 (corresponding to JIS X 7778) shall | |measurement conditions. | |

| |satisfy the criteria during the monochrome copying and color | |(If submission is difficult at| |

| |copying phases of color equipment, respectively, which are | |the time of application, the | |

| |listed in Table 7. | |applicant shall submit a | |

| |Note that for equipment on which measurements took place | |signed consent form.) | |

| |before April 2014, test results according to the Blue Angle | | | |

| |RAL-UZ122 shall also be acceptable. | | | |

|4-1-4. |Information on the matters (table below) related to |(Yes |Copies of a corresponding part| |

|(32) |collection/recycling, resource saving, energy saving, and |(No |in an instruction manual, | |

| |impact on human health shall be provided to users. | |leaflet, web site, etc. that | |

| |Basically, information shall be provided in instruction | |indicates the matters related | |

| |manuals in an easy-to-understand manner, and attempts shall | |to this item | |

| |be made to widely distribute information by utilizing | | | |

| |websites, leaflets, etc. | | | |

| |However, for the items 1), 2), and 3) a, if up-to-date or | | | |

| |detailed information is provided through websites, leaflets, | | | |

| |etc., it shall be accepted as being equivalent to that | | | |

| |described in the instruction manuals. | | | |

| | |

| |Items |

| |Target |

| | |

| |1) Information on collection/recycling and appropriate disposal |

| |a. Specific information on collection of used equipment (method of collection, contact address for collection, etc.) |

| |οYes / οNo |

| |οEquipment having no collection/recycling system |

| | |

| |b. Information on disposal of equipment. |

| |οYes / οNo |

| |οEquipment having a collection/recycling system |

| | |

| |c. Information on collection, reuse, material recycling, recovery, or waste disposal (including method of collection, contact address |

| |for collection, etc.) of used consumables (modules/containers for colourants, photoconductor drums, etc.) and information on waste |

| |disposal of ink ribbon cartridges, etc. |

| |οYes / οNo |

| |οNot applicable |

| | |

| |d. Information on collection/recycling of used secondary batteries. |

| |οYes / οNo |

| |οNo secondary battery is used |

| | |

| |2) Information on resource saving |

| |a. Provision of information on paper that can be used |

| | |

| |οYes / οNo |

| |οScanners (not covered in this item) |

| | |

| |b. Description on the automatic duplexing function. For equipment without the automatic duplexing function, information on |

| |capabilities of reducing usage of printing paper. |

| |οYes / οNo |

| |οScanners (not covered in this item) |

| | |

| |3) Information on energy saving |

| |a. Description on consumed power (amount) based on the ENERGY STAR® Program. |

| |However, for equipment that is required by the law, etc. to indicate the consumed power (amount) (energy efficiency, rated consumed |

| |power, etc.), indication of consumed power during downtime (during standby phase, etc.) together with the consumed power (amount) |

| |shall be able to replace the above description. |

| | |

| |οYes / οNo |

| | |

| | |

| |b. Method of using or setting, which results in energy saving |

| |οYes / οNo |

| | |

| |4) Information on effect on human health |

| |A.Cautions when using products |

| |a. Information for air ventilation when using equipment (e.g., should ventilate when using products, should avoid extended use in |

| |poorly ventilated rooms, or should encourage appropriate ventilation at the time of mass copying/printing) |

| | |

| |οYes / οNo |

| |οNot applicable |

| | |

| |b. Indication of conformance with the test based on RAL-UZ171 for emission of hazardous substances. |

| |οYes / οNo |

| |οNot applicable |

| | |

| |c. Information on exchange of an ozone or powder dust filter. |

| |οYes / οNo |

| |οNot applicable |

| | |

| |d. Information that recommends placement in a room different from the office, of imaging equipment whose declared A-weighted sound |

| |power level LWad exceeds 63dB. |

| |οYes / οNo |

| |οNot applicable |

| | |

| |B. Module/container for colourant |

| |a. Proper use (method of replacement). |

| | |

| |οYes / οNo |

| |οNot applicable |

| | |

| |b. The toner cartridge/container should not be forced to open. |

| |οYes / οNo |

| |οNot applicable |

| | |

| |c. If toner dust leaks out as a result of inappropriate handling, inhalation of and skin contact with dust should be avoided (toner |

| |cartridge/container). |

| |οYes / οNo |

| |οNot applicable |

| | |

| |d. Measures to take in case the toner/ink adheres to clothing or hand, or should it enter eyes or mouth |

| |οYes / οNo |

| |οNot applicable |

| | |

| |e. The toner modules must be kept out of the reach of children. Measures in case a child swallows the toner/ink accidentally. |

| |οYes / οNo |

| |οNot applicable |

| | |

|4-1-4. |If the number of printed sheets with a module for |οYes / οNo |Copies of a corresponding part| |

|(33) |colourants/container to be supplied with the equipment at the|οNot applicable |in a leaflet, etc. | |

| |time of purchase is extremely smaller than that with a normal| | | |

| |module for colourants/container, the fact shall be indicated | | | |

| |in a leaflet, etc. | | | |

5. Considerations

In manufacturing products, it is desirable to consider the following, although they are not requirements for certification.

|Item |Applicable criteria & Fill in this column *check where applicacle | |

|5.(1) |Location of the printing plant |οJapan / οOverseas | |

| |a. The binding method shall not impede waste paper recycling. However, use of hot melt |οYes / οNo | |

| |adhesive is approved. | | |

| |b. Chlorine gas shall not be used in the bleaching process of waste paper pulp. |οYes / οNo | |

| |c. The percentage of waste paper in the pulp mixture shall be over 70%. |οYes / οNo | |

| |d. The percentage of waste paper in the pulp mixture shall be over 30%, if printed |οYes / οNo | |

| |overseas | | |

|5.(2) |To facilitate recycling of rare metals (neodymium, dysprosium, cobalt, tungsten, and |οConducted / οNot conducted | |

| |tantalum) contained in equipment, it is desirable that a system (provision of | | |

| |information, ease of part identification, etc.) is available that can identify parts |(If conducted, input the table below) | |

| |containing many rare metals and provide the information to recycling operators | | |

| |(recyclers). | | |

| |Specifically, the table below shall be checked for parts that especially contain many | | |

| |rare metals. | | |

| |Rare metals | |

| |Parts to be checked | |

| |Fill in this column | |

| |Example of efforts to improve ease of recycling | |

| |(If used, check and full in the applicable item(s).) | |

| | | |

| |Neodymium, dysprosium | |

| |Whether or not HDD is used | |

| |Whether or not a neodymium magnet is used | |

| |Whether or not it is used in a motor | |

| |□Neodymium, dysprosium are used | |

| |□Not used | |

| |□Unclear | |

| |ο Providing information on whether or not there is a corresponding part, as per a request from a recycling operator | |

| |ο Ease of separation of the corresponding part | |

| |ο Other [ ] | |

| | | |

| |Cobalt | |

| |Use of cobalt in a positive electrode of a lithium ion battery | |

| |□Cobalt is used | |

| |□Not used | |

| |□Unclear | |

| |□No lithium ion battery is used | |

| |ο Providing information on whether or not there is a corresponding part, as per a request from a recycling operator | |

| |ο Ease of identification of parts: Indication of “Maximum amount of metal contained in the positive electrode” based on “Guideline | |

| |for Recycling Marking (5th Edition)” | |

| |ο Other [ ] | |

| | | |

| |Tungsten | |

| |Whether or not it is used in a wire section of a printer of the wire dot method | |

| |□Tungsten is used | |

| |□Not used | |

| |□Unclear | |

| |□Not a wire dot method | |

| |ο Providing information on whether or not there is a corresponding part, as per a request from a recycling operator | |

| |ο Ease of separation of the corresponding part | |

| |ο Other [ ] | |

| | | |

| |Tantalum | |

| |Whether or not a tantalum capacitor is used | |

| |□Tantalum is used | |

| |□Not used | |

| |□Unclear | |

| |ο Providing information on whether or not there is a corresponding part, as per a request from a recycling operator | |

| |ο Identification by color of a capacitor to be used | |

| |ο Ease of separation of the corresponding part | |

| |ο Other [ ] | |

| | | |

Appendix 1 Product Design Check List

■Intention of Product Design Checklist

Equipment must be easily recyclable. The “Product Design Checklist” includes indices for improving ease of recycling by reference to the Blue Angel RAL-UZ171 in Germany. The indices are based on the following design concepts:

[Structural Design and Joining Techniques]

・ Non-use of any joint (e.g. glued or welded) that does not allow release of the joint between different materials unless it is technically required

・ Use of easily detachable mechanical joints in equipment

・ Easy disassembly of equipment which can be carried out by hand or by machine

[Material Selection]

・ Casing parts: In order to limit the variety of materials, individual plastic casing parts (>25g) have to consist of one single polymer or a polymer blend. All plastic parts used in the plastic casings shall consist of up to four separable polymers or polymer blends.

・ Large-sized plastic casing parts must be designed in a way that the contained plastics can be reused for the production of high-quality durable products by applying available re-cycling techniques.

・ The use of coatings for parts is to be reduced to a minimum. If applied, an appropriate reason for this use is to be given. Galvanic coatings are not permissible.

・ Devices shall use, or shall be permitted to use, recycled plastics.

[Utilization of used equipment]

・ Parts and materials that may contain any hazardous materials shall be easily identifiable or removable (e.g., modules for colourants, mercury lamp for backlighting of liquid crystal displays, and liquid crystal display panels).

・ Operators shall gather information on reutilization of parts used in equipment and take advantage of it in product designing (e.g., information on a disassembly method, reuse of parts, and recycling).

[Module for colourant/container for colourant]

For modules for colourants that the applicant includes as original supplies or use of which the applicant recommends for each of equipment in product documentation as well as containers for colourants such as toners, inks, gels, waxes, etc., the “Product Design Checklist” includes the indices that enable them to be reused or utilized as materials. The indices are based on the following design concept:

・ Equipment that does not allow reuse of a module for colourant must not be attached to the module.

■Items

1) Equipment must be configured to be suitable for recycling, and must satisfy all Must (M) items of the requirements in the following groups. In addition, it is desirable to satisfy the Should (S) items, although they are not requirements for certification.

A: Design and Joining Technique

B: Selection and Marking of Materials

C: Longevity

D: Resource Saving

2) Each requirement applies to specific assemblies listed in the column “Target”: Casing, mechanical parts, electronic assemblies, modules for colourants, or containers for colourants

3) Terminology

|Casing parts |Parts comprising external covers that protect equipment from environmental influences and that prevents users|

| |from contacting moving, light-emitting or high-voltage components. |

|Chassis |Parts with functions serving as a frame to support the main parts of machines. |

|Assembly |Unit composed of at least two components linked by power or design. |

|Electric/electronic assemblies|Assemblies (parts) which include at least one electric or electronic component. |

|and parts | |

|Colourant |Mixture in which dyes, pigments and other additives are dissolved or dispersed in a carrier material such as |

| |a polymer matrix (e.g. for toners), liquids (e.g. for inks), gels or waxes (e.g. for solid inks). |

|Module for Colourant |A complex module (of a printer, copier or a fax)which in addition to a container for colourants can include |

| |other components for transferring the colourant onto the print media (e.g. toner container, photoconductor, |

| |charging unit, cleaning unit and toner cartridge having waste toner container or ink print head with nozzle |

| |system and one or more integrated ink tanks). |

|Container for Colourant |Containers for storing colourants such as toners (e.g. toner bottles) etc. |

|Recycling |In this checklist, the term refers to utilization as materials for used (plastic) parts. |

|Mechanical parts |Parts not contained in an electric/electronic assembly with either mechanical or optical function (except for|

| |casing and chassis). |

|Reused parts |Parts that have previously been used, and reused. |

4) Category classification

Any requirements are classified as either “M” or “S”.

|Must-Requirement (M) |Requirements which must be met |

|Should-Requirement (S) |Requirements which should be met |

Date: (year/month/date):

Company name:

Department, person responsible for design: seal

Model / product number:

|Requirement |

|A1 |Are assemblies made of mutually |Casing parts, chassis, |M |(Yes/ |Connections between casing and chassis as |

| |incompatible materials separable or |electric/electronic | |(No |well as between chassis and |

| |connected by separation aids? |assemblies, modules for | | |electric/electronic assemblies are important.|

| | |colourants | | |Their separability is a prerequisite for |

| | | | | |separate reuse/recycling of assemblies and |

| | | | | |materials and for a quick and reliable |

| | | | | |separation of components containing hazardous|

| | | | | |substances. Glued nameplates (i.e. company |

| | | | | |logos and stickers) are also included. The |

| | | | | |term “separation aids” refers to |

| | | | | |predetermined breaking points, for example. |

|A2 |Are electric/electronic assemblies |Entire unit, including |M |(Yes/ |The minimal strategy for recycling is to |

| |easy to find and remove? |lamps | |(No |remove hazardous substances. |

| | | | | |For example, electric/electronic assemblies |

| | | | | |and components listed in Annex VII of the |

| | | | | |revised WEEE Directive (2012/19/EU |

| | | | | |Directive), such as batteries and condensers |

| | | | | |which have a risk of containing constituents |

| | | | | |having hazardous substances, as well as |

| | | | | |fluorescent lamps containing mercury, must be|

| | | | | |easy to find and separate. |

|A3 |Are connections that must be |Casing parts, chassis, |S |(Yes/ |Connections that have to be detached during |

| |detached easy to find? |modules for colourants | |(No |disassembly must be easy and quick to find. |

| | | | | |If they are hidden, this should be stated on |

| | | | | |the product (e.g. by laser labeling or |

| | | | | |injection moulding). |

|A4 |Can disassembly be done exclusively |Casing, chassis, |M |(Yes/ |The term ’general-purpose tools‘ refers to |

| |with general-purpose tools? |electric/electronic | |(No |widely used, commercially available tools. |

| | |assemblies | | |This requirement does not apply to |

| | | | | |connections where legal regulations have |

| | | | | |limited the choice of joining technique. |

|A5 |Has consideration been given to the |Casing parts, chassis, |M |(Yes/ |The point of application is where the force |

| |point of application and the work |electric/electronic | |(No |of the tool is to be transmitted to the |

| |space required for disassembly? |assemblies | | |connecting element. Then, in order to enable |

| | | | | |disassembly operation to be performed with |

| | | | | |the tool, there must be adequate work space. |

| | | | | |This requirement especially covers snap-on |

| | | | | |connections, which, in contrast to the |

| | | | | |assembly process, can often be loosened with |

| | | | | |the tool. |

|A6 |Are all connecting elements that |Casing parts, chassis, |S |(Yes/ |If connections to be disassembled are |

| |have to be disassembled for |electric/electronic | |(No |difficult to access or not directly |

| |recycling axially accessible? |assemblies | | |accessible, disassembly requires extra |

| | | | | |man-hours. For example, it takes time to |

| | | | | |release screw connections if they can be only|

| | | | | |accessible radially. |

|A7 |Can screw connections for fastening |Casing parts, chassis, |M |(Yes/ |Standardised and uniform connecting elements |

| |assemblies be released with no more |electric/electronic | |(No |facilitate disassembly. The fewer tools |

| |than three tools? |assemblies | | |needed are, the simpler assembly and |

| | | | | |disassembly are. A tool is characterised by |

| | | | | |its type of drive (e.g. Phillips-head |

| | | | | |screwdriver) and size of drive (wrench size).|

|A8 |Are at least half of connections |Casing parts |S |(Yes/ |Based on the proportion of click and snap-on |

| |that have to be detached between | | |(No |connections, determine whether joining |

| |plastic parts click/snap-on | | | |techniques have been selected by considering |

| |connections? | | | |ease of disassembly. |

|A9 |Can the disassembly be performed by |Entire unit |M |(Yes/ |If the undercut angle is more than 90º, any |

| |one person? | | |(No |number of snap-on connections in the same |

| | | | | |joining direction can be assembled |

| | | | | |simultaneously, whereas this may not hold for|

| | | | | |disassembly. It is considered that this |

| | | | | |requirement is not met if more than three |

| | | | | |snap-on connections have to be loosened at |

| | | | | |the same time. |

|A10 |Can the supporting surface be |Unit to be handled |S |(Yes/ |The ‘supporting surface’ refers to the |

| |maintained during the entire | | |(No |product surface for wrecking workers to work |

| |disassembly process? | | | |on. This requirement is to indirectly check |

| | | | | |whether or not the unit has a hierarchical |

| | | | | |structure. ‘The unit to be handled’ refers to|

| | | | | |the unit which exceeds 5 kg, or can be turned|

| | | | | |over in case of less than 5kg. |

|A11 |Are casing parts free of |Casing parts |M |(Yes/ |To facilitate the clean and fast removal and |

| |electric/electronic assemblies? | | |(No |separation of hazardous substances from the |

| | | | | |electronic components, all |

| | | | | |electric/electronic assemblies must be |

| | | | | |fastened to the chassis. The casing must not |

| | | | | |contain any electric/electronic assemblies. A|

| | | | | |control element fastened to the casing and |

| | | | | |casing parts at the same time fulfilling the |

| | | | | |function of the chassis are not considered as|

| | | | | |casing parts here. |

|A12 |Has the manufacturer carried out a |Entire unit |M |(Yes/ | |

| |trial disassembly (e.g. in | | |(No | |

| |accordance with A1 to A11) and | | | | |

| |recorded it with a focus on weak | | | | |

| |spots? | | | | |

|B: Selection and Marking of Materials |

|B1 |If labels, etc. to be attached to |Casing parts of 25g or |M |(Yes/ |In order to recycle as high-quality |

| |plastic casing parts are difficult |more | |(No |materials, labels, etc. must be easily |

| |to separate, they must be made of | | | |separable from plastic parts to which they |

| |the same material as the plastic | | | |are attached, or it is desirable that they |

| |parts, or any material that does not| | | |are made of same materials |

| |prevent recycling. | | | |(compatibilization). |

|B2 |Is the variety of materials used for|Casing parts, chassis, |M |(Yes/ |For instance, "similar functions" refer to |

| |plastic parts having similar |and mechanical parts of | |(No |functionality such as “impact resistance” and|

| |functions limited to one kind? |25 g or more | | |“abrasion resistance”. |

| | | | | |The smaller the varieties of materials are, |

| | | | | |the more efficient the separation and |

| | | | | |recycling processes are. This requirement |

| | | | | |does not apply to parts that are demonstrably|

| | | | | |reused. |

|B3 |Are parts made of the same plastic |Casing parts, modules for|S |(Yes/ |Adoption of uniform colours for parts made |

| |material colored uniformly or |colourants | |(No |of the same plastic material improves |

| |compatibly? | | | |possibilities to introduce material cycles |

| | | | | |for recycling. ‘Compatible colouring’ refers |

| | | | | |to a same colour with different degrees of |

| | | | | |brightness (e.g. grey and anthracite). In |

| | | | | |addition, if different types of plastic |

| | | | | |materials have different colours, this |

| | | | | |"colour code" facilitates reliable |

| | | | | |type-specific sorting of the plastic |

| | | | | |materials. This requirement does not apply to|

| | | | | |control elements on the equipment. |

|B4 |Has the coating of plastic parts |Casing parts, modules for|M |(Yes/ |‘Coating’ refers to a layer of coating |

| |been limited to a minimum? |colourants | |(No |material, vapor-deposited layer, and print. |

| | | | | |Galvanic coatings are not permissible. |

| | | | | |Large-area coating layer, vapour-deposited |

| | | | | |layer and print on plastic parts require |

| | | | | |additional treatment for removal if the |

| | | | | |materials are to be recycled subsequently. |

| | | | | |Reasons must be given for coatings of special|

| | | | | |parts. Laser markings are not considered as |

| | | | | |prints referred to herein. This requirement |

| | | | | |does not apply to demonstrably reused parts. |

| | | | | |It is considered, however, that the product |

| | | | | |conforms to this item if the coating |

| | | | | |materials that do not prevent recycling are |

| | | | | |used, or coating works are conducted with |

| | | | | |consideration for occupational safety and |

| | | | | |health of coating workers and reduction of |

| | | | | |environmental burden. |

| | | | | |“Coating materials that do not prevent |

| | | | | |recycling” refers to the coating materials |

| | | | | |that have compatibility with materials of |

| | | | | |parts to be coated, and do not prevent |

| | | | | |high-level material recycling (horizontal |

| | | | | |recycling for in-house products). |

| | | | | |’Considerations for occupational safety and |

| | | | | |health of coating workers‘ means that a |

| | | | | |coating workshop is ventilated/vented and |

| | | | | |workers wear protective gear. ‘Considerations|

| | | | | |for reduction of environmental burden’ |

| | | | | |includes the measures to control VOC emission|

| | | | | |into the air, such as the removal equipment, |

| | | | | |the devices in coating process, or |

| | | | | |replacement by low-VOC coating materials. |

|B5 |Are recyclable materials and |Casing parts, chassis, |M |(Yes/ |’Recyclable material‘ means that recycled |

| |material composites used? |modules for colourants | |(No |material identical to the original material |

| | | | | |(recycling at the original level) can be |

| | | | | |manufactured. |

| | | | | |This item asks the intention and goals upon |

| | | | | |designing and does not ask whether recycling |

| | | | | |is actually conducted. |

|B6 |Is partial use of recycled plastic |Casing parts, chassis, |M |(Yes/ |’Permitted’ means that a material that meets |

| |material permitted? |modules for colourants | |(No |the requirements provided in the |

| | | | | |specifications may be used if it is |

| | | | | |available. ’Partial‘ means some available |

| | | | | |plastic components are appropriate. (This |

| | | | | |does not require all available components.) |

| | | | | |A closed cycle is realized only if the |

| | | | | |manufacturer has already used recycled |

| | | | | |materials, or if they announce the commitment|

| | | | | |to do so in the product specifications. |

|B7 |Is the percentage of recycled |Casing parts, casing |S |(Yes/ |’Total plastic weight‘ means the total weight|

| |material to the total plastic weight|parts of modules for | |(No |of all applicable plastic parts. ’Recycled |

| |constantly 5% at a minimum? |colourants | | |material‘ means recycled plastic pellets |

| | | | | |themselves, and not plastic parts that |

| | | | | |contain recycled plastics. The source of |

| | | | | |recycled pellets does not matter. In other |

| | | | | |words, the recycled plastic does not have to |

| | | | | |be recycled pellets obtained from parts in |

| | | | | |used printers or copiers; it may include |

| | | | | |recycled plastic from other product families |

| | | | | |on the market. |

| | | | | |Using appropriate recycled materials |

| | | | | |considerably contributes to resource saving |

| | | | | |and the use within the scope of availability |

| | | | | |is strongly desirable. |

|B8 |Are parts and materials that fall |Entire unit |M |(Yes/ | |

| |under Appendix 1 of the EU WEEE | | |(No | |

| |Directive easy to remove? | | | | |

|B9 |selected according to B1 to B6 and |Casing parts, chassis, |M |(Yes/ | |

| |has this been documented? |modules for colourants | |(No | |

|B10 |Are plastic parts weighing 25 g or |Entire unit (Plastic |M |(Yes/ |The marking of plastics shall enable all |

| |more and having a flat surface |parts contained in reused| |(No |recycling companies to sort plastics by type.|

| |larger than 200 mm2 marked in |complex assemblies are | | | |

| |accordance with ISO 11469, taking |not included.) | | | |

| |ISO 1043 into consideration? | | | | |

|B11 |Do secondary batteries have |Internal battery |M |(Yes/ |Secondary batteries need to be identified in |

| |identifications indicating a type? | | |(No |order to promote collection and recycling |

| | | | |(No use of |thereof. |

| | | | |internal | |

| | | | |battery | |

|C: Longevity |

|C1 |Are at least 50% or more of |Entire unit |M |(Yes/ | |

| |components of equipment, excluding | | |(No | |

| |standard parts, used as common parts| | | | |

| |to other models of the same | | | | |

| |generation and the same performance | | | | |

| |category of the same manufacturer? | | | | |

|C2 |Is use of recycled assemblies or |Entire unit |M |(Yes/ |This means that the manufacturer should be |

| |parts scheduled or permitted? | | |(No |willing to reuse assemblies and components as|

| | | | | |spare parts or ETN (Equivalent To New) parts |

| | | | | |under his responsibility. |

|C3 |Can modules or containers for |Modules for colourants, |S |(Yes/ |The separate replacement by color contributes|

| |colourants be replaced separately |containers for colourants| |(No |to saving of materials. |

| |for each colour? | | |□Not covered. | |

| | | | |(No use of | |

| | | | |modules for | |

| | | | |colourants, | |

| | | | |containers for | |

| | | | |colourants, | |

| | | | |single-color | |

| | | | |machine) | |

|C4 |Can modules for colourants be |Modules for colourants |M |(Yes/ |Constructive measures shall not prevent |

| |reused? | | |(No |reuse. |

| | | | |□Not covered. | |

| | | | |(No use of | |

| | | | |modules for | |

| | | | |colourants) | |

|C5 |When batteries installed in |Printed circuit board, |M |(Yes/ |A structure that allows easy replacement of |

| |equipment reach the end of their |etc. | |(No |batteries at the end of their life leads to |

| |life or are repaired, replacement or| | |(No use of |avoidance of disposal of the equipment and to|

| |removal thereof shall be possible, | | |internal |a longer life. |

| |without removing an entire printed | | |battery | |

| |circuit board, etc. on which the | | | | |

| |batteries are mounted. | | | | |

|D. Resource Saving |

|D1 |Equipment shall be designed in |Products |M |(Yes/ |This results in weight reduction/volume |

| |consideration of weight | | |(No |reduction of equipment. |

| |reduction/volume reduction. | | |□No | |

| | | | |conventional | |

| | | | |machine having | |

| | | | |equivalent | |

| | | | |functionality | |

| | | | |is present. | |

| | |Specifically, is a comparison | | | | |

| | |with a conventional machine of a| | | | |

| | |same type (or standard machine) | | | | |

| | |made in terms of weight | | | | |

| | |reduction or volume reduction | | | | |

| | |rate, etc.? However, if no | | | | |

| | |conventional machine having | | | | |

| | |equivalent functionality is | | | | |

| | |present, a comparison with a | | | | |

| | |conventional machine does not | | | | |

| | |apply. The equivalent | | | | |

| | |functionality refers to an | | | | |

| | |equipment configuration in which| | | | |

| | |the printing method, PIM, | | | | |

| | |corresponding paper size, etc. | | | | |

| | |are identical. | | | | |

| | | | | | |Comparison with equipment used in conventional machines |

| | | | | | |Name of conventional machine |

| | | | | | | |

| | | | | | | |

| | | | | | |Rate of weight reduction |

| | | | | | | |

| | | | | | | |

| | | | | | |Rate of volume reduction |

| | | | | | | |

| | | | | | | |

| | | | | | |Either the rate of weight reduction or rate of volume |

| | | | | | |reduction may serve the purpose. |

|Are all “M” requirements satisfied and “Yes” answers given to them? |M |(Yes/ | |

| | |(No | |

B8 Appendix 1

As a minimum, the following substances, mixtures, and components have to be removed from any separately collected waste electrical/electronic equipment.

(Annex VII of Revised WEEE Directive (2012/19/EU Directive))

|— polychlorinated biphenyls (PCB) containing capacitors in accordance with Council Directive 96/59/EC of 16 September 1996 on the disposal |

|of polychlorinated biphenyls and polychlorinated terphenyls (PCB/PCT), |

|— mercury containing components, such as switches or backlighting lamps, |

|— batteries, |

|— printed circuit boards of mobile phones generally, and of other devices if the surface of the printed circuit board is greater than 10 |

|square centimetres, |

|— toner cartridges, liquid and paste, as well as colour toner, |

|— plastic containing brominated flame retardants, |

|— asbestos waste and components which contain asbestos, |

|— cathode ray tubes, |

|— chlorofluorocarbons (CFC), hydrochlorofluorocarbons (HCFC) or hydrofluorocarbons (HFC), hydrocarbons (HC), |

|— gas discharge lamps, |

|— liquid crystal displays (together with their casing where appropriate) of a surface greater than 100 square centimetres and all those |

|back-lighted with gas discharge lamps, |

|— external electric cables, |

|— components containing refractory ceramic fibres as described in Commission Directive 97/69/EC of 5 December 1997 adapting to technical |

|progress for the 23rd time Council Directive 67/548/EEC on the approximation of the laws, regulations and administrative provisions |

|relating to the classification, packaging and labelling of dangerous substances, |

|— components containing radioactive substances with the exception of components that are below the exemption thresholds set in Article 3 of|

|and Annex I to Council Directive 96/29/Euratom of 13 May 1996 laying down basic safety standards for the protection of the health of |

|workers and the general public against the dangers arising from ionizing radiation, |

|— electrolyte capacitors containing substances of concern (height > 25 mm, diameter > 25 mm or proportionately similar volume). |

These substances, mixtures and parts shall be disposed of or recovered in compliance with Directive 2008/98/EC.

Form 2 List of Plastic materials used for plastic housing parts

Date:

Company:

Title, name of person responsible for design or in charge: seal

Applying model/product number:                          

■List of plastic housing parts weighing over 25g (including keys of the keyboard weigning 25g or below.)

|No. |Name of part |Plastic producer |Plastic product name |Name of |part >25g |consist of one |Flame retardant, etc. |

| | | | |material |(Y:apply |single polymer or a | |

| | | | | |-:not apply) |polymer blend. | |

| | | |

* This refers to addition as prescripted constituents or not.

□ No keyboard used (no keyboard used in the casing parts)

< reason of exemption >

a. Fluoroorganic additives (e.g., anti-dripping agents, etc.) used to improve the physical properties of plastics, provided that they do not exceed 0.5wt%. b. Fluoroplastics, for example, PTFE, etc.

d. Plastic parts installed adjacent to heating and fusing units. e. Large-sized reused plastic parts which are marked in accordance with Appendix 1 “Product Design Checklist” B10.

■This is to certify the materials used for plastic housing parts as in the table below.

|Target substances |Compliance |

|a. Carcinogenic substances according to Category 1A, 1B or 2 of Table 3.1 in Annex VI of EU Regulation 1272/2008/EC |As a presctiptive constituent, |

|b. Mutagen according to Category 1A, 1B or 2 of Table 3.1 in Annex VI of EU Regulation 1272/2008/EC |□ added / □ not added |

|c. Reproductive toxic substances according to Category 1A, 1B or 2 of Table 3.1 in Annex VI of EU Regulation 1272/2008/EC | |

|d. Persistent, bio-accumulative and toxic substances (PBTs) or very persistent or very bio-accumulative substances (vPvBs) according to the criteria in Annex XIII of the REACH| |

|Regulation | |

|e. Substances of very high concern, particularly warned for other reasons, or for being indicated in the list (the so-called “list of SVHC candidates) according to REACH | |

|Regulation, Article 59, para. 1. | |

d. and e shall conform to Appendix R-L2 of RAL-UZ171.

Form 3

4-1-1.(3)List of recycled plastic parts and reused plastic parts in use

Date:

Company:

Title, name of person responsible for design or in charge: seal

Applying model/product type:

This certifies the recycled plastic parts and reused plastic parts used in the equipment as below.

|part |Wight of |Type of plastic |category |Content rate |Type pf recycled plastic |

| |part(g) | | |(for recycled |(post-consumer materials collected from own products, open post-consumer|

| | | | |plastic) |materials, pre-consumer materials) |

| | | |Recycled plastic|Reused plastic | | |

|(e.g.1) roller part |30 |PC-ABS |○ |- |25%* |post-consumer materials collected from own products |

|(e.g.2) catch tray | 5 |PP |- |○ |- |- |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

* For content rate, such descriptions as “○ - ○%” , “more than ○%”, etc. are acceptable.

Form 4

Reuse/material recycling rate and recovery rate (This form is a sample. Any form with the contents here is acceptable.)

Date:

Company:

Title, name of a control manager or a person in charge: seal

■coverage of this certification

□equipment / □toner cartridge / □toner container / □ink cartridge / □photoconductor

■counting period : from dd mm, 20yy to dd mm, 20yy

Input the total weight (collected, other than toner./ink) of the coverage above in the whole company. (Prepare each sheet for equipment and cartridge/container.)

| |Name of product/part |Total weight(t) |Name of material reused |

|1 | | | % |

|2 | | | % |

|3 | | | % |

| |Total | | |

Entry examples of the packaging materials in use: cardboard, polyethylene, foamed polystyrene, pulp mold.

■Packaging material checklist

It is determined that the product conforms to the criteria if it implements (“Yes”) all requirements (excluding Should items).

|No. |Requirement |Compliance |Remarks |

|1 |Is the product designed giving consideration to weight |(Yes/(No | |

| |reduction/volume reduction? | | |

| | |Specifically, whether a comparison of weight reduction or | |Comparison with packaging materials used for conventional machine |

| | |volume reduction for, etc. However, if no conventional | |Name of conventional machine |

| | |machine having equivalent functionality is present, a | | |

| | |comparison with a conventional machine does not apply. The| | |

| | |equivalent functionality refers to an equipment | |Rate of weight reduction |

| | |configuration in which the printing method, IPM, | | |

| | |corresponding paper size, etc. are identical. | | |

| | | | |Rate of volume reduction |

| | | | | |

| | | | | |

| | | | |You may enter any of the weight reduction rate or volume reduction |

| | | | |rate. |

| | | | |(No conventional machine having equivalent functionality is present. |

|2 |Is the product designed giving consideration to use of |(Yes/(No |If any recycled material is used, indicate it in|

| |recycled materials? | |the above list. |

| |(Waste paper, recycled plastic, etc.) | | |

|3 |Is the product designed giving consideration so that the |(Yes/(No |Usage of ink, etc. can be reduced by adoption of|

| |amount of ink to be used in printing on a surface of packaging| |a design that reduces a printing area. |

| |materials is reduced? | | |

|4 |Is the product such designed that sharing of materials is |(Yes/(No |It is desirable to share materials by products |

| |promoted? | |of a same company or standardize packaging |

| | | |materials used for a same product. |

|5 |Is the product designed giving consideration to selection of a|(Yes/(No |It is desirable to select a material that |

| |material that is easy to recycle or reuse? | |consumers can easily send to recycling, etc. |

|6 |If dissimilar materials are used in combination, is the |(Yes/(No |Dissimilar materials herein stated refer to |

| |product such designed that separation of parts is easy? |(No combined use of |metals and plastics, paper and plastics, etc., |

| | |dissimilar materials |and do not mean a difference by a type of |

| | | |plastic. |

|7 |Whether materials are indicated according to the regulations |(Yes/(No |It is necessary to provide an appropriate |

| |or JIS standard, etc., so that the product can be easily | |indication so that consumers can send the |

| |recycled or reused. | |product to recycling, etc. |

|8 |Are materials to be used in packaging selected so that use of |(Yes/(No |If any chemical substance that affects the |

| |any chemical substances which affect the environment is | |environment is used, it will be a problem when |

| |avoided or reduced? (Non-use of polymers containing halogens, | |the product is recycled or disposed of. |

| |CFC, HCFC, etc. (Appendix 3)) | | |

|9 |Is there a system for collection and reuse or recycling of |[Should] |As stated in the considerations of Act for |

| |packaging materials? |(Yes/(No |Promoting Green Purchasing, it is desirable that|

| | | |the product has a collection/recycling system. |

Form 6 Test results on emission of hazardous substances

Date:

Company:

Title, name of a testing manager or a person in charge: seal

This certifies the test on emission of hazardous substances as below.

|Name of testing laboratory | |

|Address | |

|Report number | |

|Name of manufacturer | |

|Tested model/ product number | |Serial number | |

|Model/ product number which is| |

|included in this test result | |

|due to the same test | |

|classification. | |

|Year manufactuered | |Date of testing | |

|Type of equipment |□Desktop Devices / |Device Volume |□≤ 250L / □> 250L |

| |□Floor-mounted Devices | | |

|Chamber volume |m3 |

|Types |□Copie / □Printer / □FAX / □Multifunctional Device |

|Prodouct speed |Monochrome: ipm / Color: ipm |

|Printing method |□Electrophotographic / □IJ / □High Performance IJ / □Direct Thermal / |

| |□Dye Sublimation / □Impact / □Solid Ink / □Thermal Transfer |

|Capable of |□Monochrome / □Color |

|Size format |□Standard □Large format (maximum size: ) □ Small format |

|Test method |RAL-UZ171 Appendix S-M |

| |Supplement of test conditions |

| |[                                ] |

| |Emission Rate (mg/h) |

| |Monochrome |Color |

| |Criteria |Measured value |Criteria |Measured value | |Pre-operating |

| | | | | | |Phase |

| | |Floor-mounted Devices, Device|≤ 2.0 | |≤ 2.0 | |

| | |Volume >250L | | | | |

|Print Phase |TVOC |≤ 10 | |≤ 18 | |

|(=Pre-operating + Print | | | | | |

|Phase) | | | | | |

| |Benzene | < 0.05 | | < 0.05 | |

| |Styrene |≤ 1.0 | |≤ 1.8 | |

| |Unidentified Single Substances VOC |≤ 0.9 | |≤ 0.9 | |

| |Ozone* |≤ 1.5 | |≤ 3.0 | |

| |Dust* |≤ 4.0 | |≤ 4.0 | |

| |PER10 PW (particles/10 minutes) |

| |Monochrome |Color |

| |Criteria |Measured value |Criteria |Measured value | |Print Phase |

| | |>250L |- |×1011 |- |×1011 |

* applied only for to electrophotographic equipment

Form 7

Certificate on hazardous substances in toners, inks or solid inks, etc. (colourants)

Date:

Company:

Address:

Title, name of a manager or a person in charge: seal

Name of colourant :

This certifies substances used in colourants as below.

|Category |Substance |Compliance |

|REACH |a. Carcinogenic substances according to Category 1A, 1B or 2 of Table 3.1 in Annex VI of EU|Added as prescribed constituents |

|regulation, |Regulation 1272/2008/EC |□Yes, added / |

|etc. |b. Mutagen according to Category 1A, 1B or 2 of Table 3.1 in Annex VI of EU Regulation |□No, not added |

| |1272/2008/EC | |

| |c. Reproductive toxic substances according to Category 1A, 1B or 2 of Table 3.1 in Annex VI| |

| |of EU Regulation 1272/2008/EC | |

| |d. Persistent, bio-accumulative and toxic substances (PBTs) or very persistent or very | |

| |bio-accumulative substances (vPvBs) according to the criteria in Annex XIII of the REACH | |

| |Regulation | |

| |e. Alternatively, substances of very high concern, particularly warned for other reasons, | |

| |or for being indicated in the list (the so-called “list of SVHC candidates) according to | |

| |REACH Regulation, Article 59, para. 1. | |

| |f. Substances which require labelling of the mixtures that contains the following H or R | |

| |phrases according to Table 3.1 or 3.2 in Annex VI of EU Regulation 1272/2008/EC, or those | |

| |which meet the requirements for homogeneous mixture classification: | |

| |H 370 (R 39/23/24/25/26/27/28) Causes damage to organs | |

| |H 371 (R 68/20/21/22) May cause damage to organs | |

| |H 372 (R 48/25/24/23) Causes damage to organs | |

| |H 373 (R 48/20/21/22) May cause damage to organs | |

|Heavy metals |Cadmium and cadmium compounds |Added as prescribed constituents |

| |Lead and lead compounds |□Yes, added / |

| |Mercury, and mercury compounds |□No, not added |

| |hexavalent chromium and hexavalent chromium compounds | |

| |Nickel and nickel compounds (excluding complex compounds with high molecular weight and | |

| |used as colorants) | |

|Azo colurants |list of Amines that must not be generated due to the reduction |Azo colurantswhich generate Amins |

| | |listed on the left |

| | |□not used / □ used |

| |4-aminobiphenyl |3,3’-dimethylbenzidine | |

| |Benzedrine |4,4’-diamino-3,3’ –dimethyldiphenylmethane | |

| |4-chloro-o-toluidine |p-cresidine | |

| |2-naphthylamine |4,4’-Methylene-bis – (2-Chloroaniline) | |

| |o-aminoazotoluene |4,4’-oxydianiline | |

| |2-amino-4-nitrotoluene |4,4’-4-Aminophenyl Sulfide Bis | |

| |p-chloroaniline |o-toluidine | |

| |2,4-diaminoanisole |2,4-diaminotoluene | |

| |4,4’-diaminodiphenylmethane |2,4,5-trimethylaniline | |

| |3,3’-dichlorbenzidine |o-anisidine | |

| |3,3’-dimethoxybenzidine |4-amino- azo- benzen | |

|Biocidal |Only constituents listed in Annex I of “REGULATION (EU) No 528/2012 OF THE EUROPEAN |biocidal product |

|product |PARLIAMENT AND OF THE COUNCIL of 22 May 2012 concerning the making available on the market |□used / □ not used |

| |and use of biocidal products” are added as prescribed constituents. If use of a substance | |

| |not listed in the Annex is planned, addition thereof will be permitted provided that an | |

| |application for approval is submitted based on said directive. However, the addition will | |

| |not be permitted if it is determined that the application should be rejected. | |

| | |If used, input below |

| | | □Only constituents listed in Annex |

| | |I are used. |

| | | □A substance not listed in the |

| | |Annex I is added |

| | |-> □submitted / □not submitted・not |

| | |permitted |

d. and e depend on RAL-UZ171 Appendix R-L2.

To: Japan Environment Association

Eco Mark Office

Certificate of Compliance with Environmental Laws, etc.

| Date of issue: | [date], |

|(Company name) | |

|(Plant name) |seal |

|(Name of the responsible person) title name |(company seal) |

|Plant address: |

|TEL:+ |

* Enter the manager (or the corresponding responsible person) of the plant manufacturing the finished goods in

the Name of the responsible person column.

* Effective issuing date of this Certificate shall be within three months from the date of application to Eco Mark.

We hereby certify that the following requirements are met:

1. We hereby certify that in manufacturing the applied product, we comply with related environmental laws and regulations and pollution control agreement (hereinafter referred to as the “Environmental Laws, etc.”) with respect to air pollution, water contamination, noise, offensive odor, and emission of hazardous substances.

(Please check the relevant boxes as follows to submit the Certificate. It is also acceptable to submit an attached list.)

|Name of the Environmental Laws, etc. related to the plant |Remarks |

|□ Air Pollution Control Law | |

|□ Water Pollution Control Law | |

|□ Noise Regulation Law | |

|□ Vibration Regulation Law | |

|□ Offensive Odor Control Law | |

|□ Other: | |

* In the “Other” column, enter the name of law applied to the plant, and if there are regulations or agreements of the area where the plant is located, also enter the names of such regulations and agreements (e.g., xx Prefecture xx Environmental Conservation Regulation, xx City Pollution Prevention Agreement).

2. We hereby certify that the state of compliance with the Environmental Laws, etc. prior to the date of issue of this Certificate is as follows:

(Please check the relevant boxes to submit the Certificate. Violation refers to administrative punishment or administrative guidance.)

□ We have not violated any related Environmental Laws, etc. for the past five years.

□ We have not violated any related Environmental Laws, etc. since foundation of the Company (year).

□ We violated related Environmental Laws, etc. in the past five years, have already taken proper remedies and recurrence prevention measures, and thereafter comply with the related Environmental Laws, etc. properly.

*If you committed any violation subject to administrative punishment or administrative guidance, you need to submit the following documents in a and b:

|a. For the fact of violation, the guidance document from the administrative agency (including a correction order and |

|warning) and copies of written answers to those documents (including reports on the cause and result of correction) |

|b. For the management system for compliance with the Environmental Laws, etc., the following materials (copies of |

|recording documents, etc) in 1)-5): |

|1) List of the Environmental Laws, etc. related to the area where the plant is located; |

|2) Implementation system (organizational chart with entry of roles, etc.); |

|3) Document stipulating retention of recording documents; |

|4) Recurrence prevention measures (future preventive measures); |

|5) State of implementation based on recurrence prevention measures (result of checking of the state of compliance, |

|including the result of onsite inspection). |

□ We violated Environmental Laws, etc. in the past, and have not yet taken corrective measures.

Form 9 Test result on noise

Date:

Company:

Title, name of a manager or a person in charge: seal

This certifies the test result regarding noise.

|Name of testing laboratory | |

|Address | |

|Report number | |

|Name of manufacturer | |

|Tested model/ product number | |Serial number | |

|Model/ product number which is| |

|included in this test result | |

|due to the same test | |

|classification. | |

|Year manufactuered | |Date of testing | |

|Types |□Copie / □Printer / □FAX / □Scanner / □Multifunctional Device |

|Prodouct speed |Monochrome: ipm / Color: ipm |

|Printing method |□Electrophotographic / □IJ / □High Performance IJ / □Direct Thermal / |

| |□Dye Sublimation / □Impact / □Solid Ink / □Thermal Transfer |

|Capable of |□Monochrome / □Color |

|Size format |□Standard □Large format (maximum size: ) □ Small format |

|Test method |□RAL-UZ171 / □ISO7779(JIS X7779) / □JBMS-74-2 |

| |□ECMA-74 / □RAL-UZ122 |

| |Supplement of test conditions |

| |[                                ] |

|Basic conditions for measuring |

|Environmental correction K2[dB] | |

|Background noise[dB] | |

|Dimention of equipment [m] | |

|Measured total area S[m2] | |

|10log(S/S0) [dB] | |

|Measuring conducted |□Copy mode / □ Print mode / □Scan mode |

| |Monochrome |Color |

| | |Measured value | |Measured value |

|Product speed |Smo | ipm |Sco |ipm |

|Sound power level* |LWA1,mo ** |dB |LWA1,co ** |dB |

| |LWA2,mo |dB |LWA2,co |dB |

| |LWA3,mo |dB |LWA3,co |dB |

|Average* |LWAm,mo |dB |LWAm,co |dB |

|the declared A-weighted sound power |LWAd,mo |dB |LWAd,co |dB |

|level * | | | | |

|Criteria * |□≤0.35×Smo +59 |dB |□≤0.3×Sco+61 |dB |

| |□≤75 | |□≤75 | |

| |□≤72(impact) | |□-(impact) | |

| | | |□Serial equipment | |

| | | |(electrographic) | |

|Conformance |(○, ×) | |(○, ×) | |

* rounded to the first decimal place

** when measuring one unit of equipment, LWAd can be led by the followining formula; LWAd=LWA1+3.0 dB.

Form 0 This form shall be submitted if products developed by other company or for OEM products are applied.

To: Japan Environment Association, Eco Mark Office

Approval of Eco Mark Application

|Date of issue: | |

|(issued by: Company name) |(company seal) |

*Issuer: Manufacturer of the product (Approver of application)

We hereby approve that (the applicant company) files an application for Eco Mark product certification and use under the brand name “______________” with respect to the product which has been Eco Mark certified under our brand name “____________” with certification number (only if already certified).

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Form 8

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