Document rxz8xYnZXXxao28em7G8Njkwq

Use # Customer Section Description of Use (for client to complete) 1 Lubricants: threads, o-rings, plungers, hammer shaft (assembly and maintenance) Covered by Submissions (Y/N) Y 2 surfactant in circuit board cleaner Y 3 release agents (undeclared but very common) and pulling lubricants; including foams Y 4 PTFE parts including tape Y 5 heat shrink Y 6 anti-drip in polycarbonate housings Y 7 dielectric (including sil pads and circuit board flame retardant Y 8 PTFE and ePTFE wires for heat and harsh environments Y 9 oil used as hydraulic fluid Y 10 Label release paper Y 11 fluoroelastomers including viton Y 12 1. for electrical insulation purposes except wiring. Y 0000001 Claigan Derogation # c36, c38, c39, c10 Claigan Section Notes c44 c2, c24 c4a, c21 c3a c3b, c3a c7a, c6b c22 c20 c12a, c12b c4a 0000002 Notes The Desctiption of Use section are for company's to complete. To the best of your company's ability, please list each PFAS substance and a description of how that PFAS 1 is used. Claigan does not expect a deep expertise, we just need to know what uses you believe you have and ensure that it is being included in the derogation. Claigan will determine what specific derogation text should be produced to cover your uses. We will ask questions if we need clarification. 2 Claigan will review uses and identify if they are being covered under the submission (to be completed by Claigan). 3 If covered, the expected Claigan derogation number (to be completed by Claigan). 0000003