1. W.R. GRACE & CO.
GRACE CONSTRUCTION PRODUCTS
GLOBAL REGULATORY INFORMATION REQUEST
Product Name: CENSPERSE RT 02 Date: 05.08.2014
Manufacturer Name:
Distributor Name: temcon solutions GmbH Shelf Life: 12 month
Manufacturing Site(s):
Packaging Types: bag 20 kg
1) COMPOSITION:
Please list all components including any monomers in your product. Include component amount by percentage or
range, CAS# and chemical name. Amount listed must total 100%.
CAS NUMBER(s):
XXXXXX-XX-X
Amount (%) or
Range (%) Chemical Name
68-04-3 100-80 2-hydroxy-1,2,3-propane tricarboxylic acid, sodium salt
7631-86-9 0-20 Silicon dioxide
TOTAL 100% Insert more rows if needed
2) CHEMICAL INVENTORY STATUS:
Please indicate if your product complies with the following Chemical Inventory Regulations.
Y= Yes (includes pre-registered, registered and/or exempt substances), N= No, U= Unknown:
USA
TSCA
Canada
DSL
Canada
NDSL
EU
REACH*
Swiss
Chemical
Inventory
Australia
AICS
New
Zealand
ERMA
NZloC
China
IESCS
MEP
Japan
ENCS
MITI
Korea
(K)ECTL
Philippines
PICCS
*Is the product currently sold in EU?
Please circle your answer
Yes – complete Section
5) EU REACH
No
*Is the product intended to be sold in EU?
Please circle your answer
Yes – complete Section
5) EU REACH
No
3) TRANSPORTATION:
Complete for products regulated as Dangerous Goods or Hazardous Materials when transported:
Proper Shipping Name:
Hazard Class:
UN Number:
Packing Group:
Label Requirement:
HMIS Rating (Hx,Fx,Rx)
Harmonized Tariff
Schedule # HTS/CCE/BTN):
Please identify chapter, heading, subheading, country subdivision and statistical subdivision e.g. 2804.61.0000
Does your product contain any Marine Pollutants as identified in 49 CFR 172.101?
If yes, please provide the substance name and its percentage composition in the product.
Marine Pollutants? Yes No Unknown If yes: Substance %
X
Insert more rows if needed
Version 17 (English) Page 1 of 3
Revised: 28 February 2014

2. W.R. GRACE & CO.
GRACE CONSTRUCTION PRODUCTS
GLOBAL REGULATORY INFORMATION REQUEST
4) ADDITIVES, CONTAMINANTS and IMPURITIES:
List all additives, contaminants, or impurities, which can migrate or give problems in construction products.
PRESENT ? YES NO AMOUNT wt % UNKNOWN
METALS
Antimony
Arsenic
Barium
Beryllium
Cadmium
Chromium
Copper
Lead
Mercury
Nickel
Selenium
Silver
Thallium
Zinc
MINERALS
Asbestos
Crystalline Silica (Total)
Crystalline Silica
(Respirable-less than 10μm)
Talc
Titanium dioxide
OTHERS
Nanomaterials (particles in sizes
1nm-100nm)*
Free Formaldehyde
OESTROGEN MIMICS (possible)
Bisphenol A
Nonylphenol
Nonylphenol ethoxylate
Octylphenol
Octylphenol ethoxylate
Trisnonylphenyl phosphite
* http://ec.europa.eu/environment/chemicals/nanotech/#definition
NOTE: In addition to completing this form, please also supply the following documents for this product:
· Current product specification. Safety Data Sheet (SDS) in both the local language and English
· Typical Certificate of Analysis (COA)
· NAFTA Certificate of Origin (for North America manufacturers only)
If the chemical composition of this product changes at any time, you are required to notify GRACE
CONSTRUCTION PRODUCTS. By signing this document, you certify that all information provided is
accurate to the best of your knowledge.
SIGNATURE: DATE: 08/0502914
NAME: Michael Kassautzki
TITLE: Dipl.-Min. TELEPHONE:+49 6631 9110888
COMPANY: Temcon solutions GmbH FAX: +49 6631 9110889
EMAIL: info@temcon-solutions.de
Version 17 (English) Page 2 of 3
Revised: 28 February 2014

3. W.R. GRACE & CO.
GRACE CONSTRUCTION PRODUCTS
GLOBAL REGULATORY INFORMATION REQUEST
Product Name: CENSPERSE RT 02 Date:
08/05/2014
Distributor: temcon solutions GmbH
5) EU REACH:
A) EU REACH COMPLIANCE STATUS:
Does your product contain any substances or any
monomers that: Yes/No CAS# or Registration number if
available
- have already been registered to date?
- will have to be registered before 01/June/2018?
- are exempt according to ANNEX V of REACH Regulations?
B) PRESENCE OF SVHC (Substances of Very High Concern): Please give details in table below for
SVHCs contained in your product formulation whether it is a mixture or an article.
Does your product contain SVHC included in Candidate
list published by ECHA? See list of current SVHCs via
link below.
http://echa.europa.eu/web/guest/candidate-list-table
Yes/No CAS NUMBER(s):
XXXXXX-XX-X
Concentration (%)
C) OR (Only Representative) ARRANGEMENT DETAILS:
If you are a non-EU based supplier or an EU supplier importing non-EU manufactured substance(s) to EU
by relying on an OR, please provide details of your OR.
CAS Number(s): OR Details for non-EU manufactured substances
D) ANY OTHER RELEVANT INFORMATION OR COMMENTS:
If EU-REACH information for this product changes at any time, you are required to notify GRACE
CONSTRUCTION PRODUCTS. By signing this document, you certify that all information provided is
accurate to the best of your knowledge.
SIGNATURE: DATE: 08/05/2014
NAME: Michael Kassautzki
Version 17 (English) Page 3 of 3
Revised: 28 February 2014