Documentation of WGK-Classification according to Annex 3 of the Administrative Regulation on the Classification of Substances Hazardous to Waters into Water Hazard Classes (VwVwS) of 17 May, 1999 and Administrative Regulation on Amendment of the VwVwS of 27 July, 2005
Documentation Sheet 

Applicant data		For official use only	
		KN:		
Company		DB Aufnahme am:		
Department		Unterschrift:		
Contact Person				
Street / P.O. Box	Date		
Post Code City	e-mail-address		
State	Telephone/Fax		

Substance specifications

Chemical name 
□ EINECS name    □ CAS name	
	
synonyms 	
	
CAS-No	
	EG-No		
water solubility in mg/l at 20°C 	
	
physical state at 20° C 	
	
For polymers	average molecular weight 		
	range of molecular weight		
	identity and content of residual monomers, additives and pollutants > 0,2 % w/w 		
	identity and content of 
carcinogens > 0,1 % w/w		

R-phrases according to § 5 of the Ordinance on Hazardous Substances

R-phrases for toxicity to mammals	 	
R-phrases for environmental hazards  		□ Not classified based on data1
□ Not classified lack of data1	

Experimental data (if presently no legally binding classification had been set)

acute oral/ dermal mammalian toxicity	  species	duration/LDx/ application procedure	result in mg/kg b.w.	reference
E    L    S    U	
	
			□   □   □   □	
aquatic toxicity	  taxonomic name	duration/end point	result in mg/l		
fish				□   □   □   □	
daphnia				□   □   □   □	
algae				□   □   □   □	
other species				□   □   □   □	
biodegradability	  testing method	degradation rate
after 28 d in %	10 d-window
attained?		
 				□   □   □   □	
bioaccumulation potential	  log POW	                    □ measured1
                    □ calculated1	□   □   □   □	
	  BCF	                    □ measured1
                    □ calculated1	□   □   □   □	

Evaluation points according to VwVwS	mammalian toxicity	environmental hazard	
evaluation points based on R-phrases	
		
evaluation points based on experimental data	
		
default values (if no experimental data are available)	
		
total number of points	
	
WGK	

If the applicant is aware of any properties of the substance that may affect the hazard to waters and are not adequately covered by the R-phrases (e.g. mobility in soil), he should inform the Office of Documentation and Information on Substances Hazardous to Waters at the Federal Environmental Agency accordingly. 

comments of the applicant

	

Applicant must inform the Federal Environmental Agency, Office of Documentation and Information on Substances Hazardous to Waters (Dokumentations- und Auskunftsstelle wassergefährdende Stoffe im Umweltbundesamt, Schichauweg 58, 12307 Berlin) about any new information leading to a change in WGK. 

signature of the applicant , stamp