Recommendation for a documentation leaflet for the WGK-Classification according to Annex 4 of the Administrative Regulation on the Classification of Substances Hazardous to Waters into Water Hazard Classes (VwVwS) of 17 May, 1999 
	Date 	
1. Manufacturer/distributor details 		

Company			
Department 			
Contact person 		e-mail-address 	
Street / P.O. Box 		Tel. 	
Post Code City 		Fax 	
State 			

2. Mixture/preparation specifications 
Name 		
Commercial name 		
R-phrase-classification according to 
§ 4b of the Ordinance on Hazardous Substances 		
3. WGK Classification 
a) according to Annex 4 No. 3 (computation rule) 
			Yes 	No	
Percentage of carcinogenic substances (R45) 	WGK 2 	≥ 0,1 %* 			
	WGK 3 	≥ Ý0,1%* 			
Percentage of carcinogenic substances (R45) 		> 0 - <0,1%* 			
Does the mixture contain dispersing agents? 			

Components 	Mass fraction based on total amount [%] 	
WGK 3 		
WGK 2 		
WGK 1 		
nwg 		
unknown identity 		
resulting WGK 		

* Other limits for R45-classifications specified according to GefStoffV are effective 

b) according to Annex 4 No. 4 (test data obtained with the mixture) 
	result Evaluation point/ 	default value 	
Acute oral or dermal toxicity for mammals 			
Aquatic toxicity (at min. 2 species) 
Fish (96h) LC50 			
Daphnia (48h) EC50 			
Algae (72h) IC50 			
Other hazardous characteristics (according to. Annex. 4, No. 4.4) 		
Total number of points 		
resulting WGK 			
c) according to Annex 4 No. 5 (special mixtures) 
The following WGK was determined differing from Annex 4 No. 3 und 4: …………………

Decision of the Commission for the Evaluation of Substances Hazardous to Waters (KBwS) from: ………………………..

Comments of the applicant 		

Please note: This leaflet is regarded as a recommendation for the documentation of a WGK-classification according to Annex 4 of the Administrative Regulation on the Classification of Substances Hazardous to Waters into Water Hazard Classes for manufacturers and distributors of substance mixtures/preparations. The Office of Documentation and Information on Substances Hazardous to Waters (Dokumentations- und Auskunftsstelle wassergefährdende Stoffe) is not in charge of processing these classifications. It is recommended to provide customers and the regional authorities at least the above-mentioned specifications for a WGK classification of substance mixtures/preparations. 

Signature of applicant, stamp