104.针对IOS-MAT-0010聚合物包括塑料、硅胶、和橡胶弹性体乳胶体材料的自我声明IOS-MAT-0010_SD_polymerics.docx

Self-declaration formPolymerics materialsSpec. nr: Date: Version nrIOS-MAT-00102013-05-10AA-10911-11Self declaration for polymerics including plastics, silicone and rubber/ elastomers/ latex, according to IOS-MAT-0010针对IOS-MAT-0010聚合物包括塑料、硅胶、和橡胶/弹性体/乳胶体材料的自我声明This form shall be used to certify compliance with requirements according to specification IOS-MAT-0010(AA-10911-11). This form-or an equivalent form with the same information- is to be signed by the final formulator(material producer) of the final polymeric material, i.e. the moulder or extruder(or the supplier of granules if they are pre-coloured and the moulder/ extruder does not add any additives when forming the plastic component ). This can be either the IKEA supplier or a sub-supplier(or a sub-sub-supplier, etc).此文件是针对IOS-MAT-0010(AA-10911-11)的符合性声明。此文件或具备同等信息的声明文件由聚合物完结材料的最终成型方（材料生产商）签署，即成型或挤出供应商（或进行预着色的粒子供应商，如果成型或挤出方在制作塑料部件时未添加任何化学助剂）。该签署人可以是宜家供应商或其下级供应商（或下-下级供应商，等）。The self declaration shall be in English addition of information in local language is voluntary.自我声明必须是英文的，以当地语言陈述的附加信息仅作参考。Supporting documents, verifying fulfillment of the requirements, shall be listed inTable 4, such as: Test reports, Self declarations or certificates from sub-suppliers of raw material and chemicals used to make the polymeric material.支持文件，即证实可以满足要求的文件，须列在表4中，比如： 测试报告 来自于生产该聚合材料所需的原材料和化学产品的下级供应商的自我声明或证书。Table 1. List of polymeric material materials表1. 聚合物材料清单Material identification(trade name, article code, quality and/or other identification) 1材料识别信息（商品名，产品编码，质量和/或其它识别信息）1Material description (type of material such as material base content, physical characteristics, colour ect)材料描述（材料类别例如材料基本内容，物理特性，颜色等）Contains only virgin polymeric material仅含未经使用的聚合材料Contains external recycled polymeric(state range of percentage of external recycled material)含有来自于外部的回收聚合材料（具体说明所含外部回收材料的比例） Table 2. Confirmation of fulfillment of chemical requirements表格2，对化学品要求的确认Requirements Type of polymeric material Fulfils NotSee IOS-MAT-0010 for specific applicableinformation on each requirement 聚合材料的类型 满足 不适用要求：参见 IOS-MAT-0010各具体要求Authorisation substances according All to EU REACH Annex XIV1 所有授权物质（依据欧盟REACH法规附录 XIV） Cadmium and its compounds All 镉及镉的化合物 所有CMR substances 1A or1B1 All 1A或1B类CMR物质 所有 Hazardous waste Material that contains any 有害废料 proportion of recycled material 材料中包含任何比例的回收材料Lead and its compounds All 铅及铅的化合物 所有Other SVHC1 All 其他 SVHC 所有PBT-substances and vPvB-substances1 All PBT-物质（持久的，生物累积的和有毒的物质） 所有和vPvB-物质（高持久的和高生物累积的物质）1Azodyes that may release Materials where colouring carcinogenic arylamines agents have been added可能释放致癌芳香胺的偶氮染料 材料中添加有着色粒子Bisphenol A Plastic material 双酚A 塑料材料CFCs(Chlorofluorocarbons) and Foamed plastic HCFCs(hydrochloro-fluorocarbons) 泡沫塑料 CFCs（氟氯烷烃）和HCFCs（氢氯氟烷烃）Heavy metal(extractable) All 重金属（可析出） 所有1 When referring to chemical substances that are included in lists established by government authorities, this SD applies to chemical substances that are included in such list at the time of signing. 对引用来自政府制定的法规和标准里面的化学物质清单时，此声明适用于签署时清单里的物质。Table 2. Confirmation of fulfillment of chemical requirements表格2，对化学品要求的确认Requirements Type of polymeric material Fulfils NotSee IOS-MAT-0010 for specific applicableinformation on each requirement 聚合材料的类型 满足 不适用要求：参见 IOS-MAT-0010各具体要求Hexavalent chromium(Cr-VI) All compounds 所有六价铬化合物(Cr-VI)Lindane Materials consisting wholly or 林丹 partly of natural latex/rubber 材料由全部或部分天然乳胶/橡胶组成 Mercury(Hg) and its compounds All 汞(Hg)及汞的化合物 所有 Organotin compounds All 有机锡化合物 所有 Pentachlorophenol(PCP) including Materials consisting wholly or salts and esters of PCP partly of natural latex/rubber 五氯苯酚 (PCP) 包括PCP的盐类和酯类 材料由全部或部分天然乳胶/橡胶组成 Phthalates All 邻苯二甲酸酯 所有Polycyclic aromatic hydrocarbons All except rubber components that (PAH) contain carbon black, that are with-稠环芳烃(PAH) out skin-contact during usage, and where tensile and abrasion wear properties are needed 所有，除了橡胶组件如含有碳黑，非皮 肤接触用途，需具有可拉伸及磨损特性 Polycyclic aromatic hydrocarbons Rubber components that (PAH) （exception: higher CLVs） contain carbon black, that are with-稠环芳烃(PAH) (例外：高CLV物质) out skin-contact during usage, and where tensile and abrasion wear properties are needed 橡胶组件如含有碳黑，非皮肤接触用途， 需具有可拉伸及磨损特性Polyvinyl-chloride(PVC) All 聚氯乙烯（PVC） 所有Table 2. Confirmation of fulfillment of chemical requirements表格2，对化学品要求的确认Requirements Type of polymeric material Fulfils UsedSee IOS-MAT-0010 for specific (no use) (IKEA information on each requirement 聚合材料的类型 满足 approval) 要求：参见 IOS-MAT-0010各具体要求 (未使用) required)2 使用 （需宜家许 可）2Biocides of all kinds, added in order to All impart properties to the final product 所有用于赋予最终产品性能的各种生物杀灭剂 Fragrances All 香精 所有Flame retardants All 2 阻燃剂 所有 Does not Fulfils Not Fulfil4 符合 applicable 不符合 不适用 Alkylphenolethoxylates(APEO), AP, AP All phosphites and other AP derivatives 所有烷基苯酚聚氧乙烯醚，AP, AP磷酸盐和其它AP衍生物 Note:”Not applicable” shall only be ticked if the material being declared is not in the scope of the requirement according to IOS-MAT-0010.注：“不适用”仅在被声明材料不属于IOS-MAT-0010要求范围之内时可选。2 Documentation as required in the approval from IKEA shall be attached to this SD. 作为宜家许可的文件需要附在此声明内。3 “Fulfils(no use)”= No use of any flame retardant or only use of melamine, chalk, graphite, kaolin or modacrylic fibre. “满足（未使用）“=没有使用任何阻燃剂或仅使用了三聚氰胺，碳酸钙，石墨，高岭土或改性聚丙烯腈纤维。4 Allowed to be used before datestamp 1402 for final IKEA sales article 包装周数章为1402周之前的宜家产品中允许使用。Table 3. Additional required information on Flame retardant used表3. 阻燃剂使用的附加要求Trade name of flame retardant阻燃剂商品名称Manufacturer生产商名称Table 4. List of supporting documents表4. 支持文件清单Document文件Source(issuer of document)来源（文件签署人）Comments(optional)注释（可选）This is to certify that we have read and understood IKEA specification IOS-MAT-0010 and that the materials listed in Table 1comply with IKEA requirements according to specification IOS-MAT-0010 (AA-10911-11) .兹证明我们已阅读及理解宜家技术规范IOS-MAT-0010， 且列于表1的材料能够符合宜家技术规范MAT