Environmental Product Declaration Name of Product Product Description

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1 Environmental Product Declaration 2012 Disclaimer: It is not recommended to compare LCA studies or EPDs from another organization as there may be differences in methodology, assumptions and data quality. For additional information contact the product manufacturer.

2 Company Name Company Street Address City, State Zip Company Phone Company Website ENVIRONMENTAL PRODUCT DECLARATION VERIFICATION EPD Information Program Operator Declaration Holder Name of the Client Product Product Period of Validity Period of Validity Declaration Number Declaration Number This EPD was independently verified by NSF International in accordance with ISO 14025: [Signature of NSF Representative] Internal External Name of Representative Contact Information for Representative This life cycle assessment was independently verified by in accordance with ISO and the reference PCR: [Signature of LCA Representative] Name of Representative Contact Information for Representative LCA Information Basis LCA LCA Preparer This life cycle assessment was critically reviewed in accordance with ISO by: PCR Information Program Operator Reference PCR PCR review was conducted by: Title of LCA Name of Preparer Organization of Preparer Contact Information for Preparer Name of Critical Reviewer Organization of Reviewer Contact Information for Reviewer Reference PCR Name of Chair Organization of Chair Contact Information for Chair (through the program operator) Page

3 ENVIRONMENTAL PRODUCT DECLARATION: DETAILED VERSION Product Description Product classification and description Provide product name, product manufacturer, model number (if applicable), and a description of the product. Identify the product or range of products. Example: Functional Unit Provide information for the entire physical product and state the functional unit. Cut-off Rules If applicable, define cut-off rules. System Boundaries Identify the system boundary, including each life cycle stage: raw material acquisition and pre-processing, production, product distribution and storage, use and maintenance, and end of life management. Include a system boundary example. Page

4 Example: Material Acqusition & Pre-Processing Stage Production Stage Distribution, Storage, & Use Stage End-of-Life Stage [Scope] [Scope] [Scope] [Scope] Material acquisition and pre-processing stage Provide a description of the acquisition and primary/intermediate pre-processing of materials used (primary or secondary). Provide boundary details and include transportation of all stages. Example: Material Transport Distances, Material Acquisition, and Pre-Processing Stage to Production Stage Raw Material/ Classification grouping Distance (miles) Rail Truck Water Veneer 26 Wood Products 162 miles 332 miles 5982 Miles picking 5 ports for an average of all water transport (Asia, Australia, Africa, Europe & South America) Particle Board 26 Wood Products 162 miles 332 miles 0 miles (NA due to this mode of transport not being significant for this commodity, to our knowledge) MDF 26 Wood Products 162 miles 332 miles 0 miles (NA due to this mode of transport not being significant for this commodity, to our knowledge) Production Define the production process. Describe the production of the components or semi-finished product(s). Describe the transport of components or semi-finished products between processes and/or facilities. Describe the prodution of the final product by assembling of the components or semi-finished products. Describe the use of catalysts or other ancillary materials during production. Describe any additional preparing of the finished product including forming, surface treatment, machining and other processes, as appropriate. Include/describe packaging materials of the final product. Include/describe equipment support chemicals. Include/describe personnel support equipment. Distribution, storage, and use Define the distribution, storage, and use processes. Describe transportation to the use location and during use. Describe storage at the use location. Describe normal use. Describe repair and maintenance occurring during the usage time. Describe preparation of a product. Page

5 End-of-life stage Define and provide details of the end-of-life stage. Describe collection of end-of-life products and packages. Describe dismanting of components from end-of-life products. Describe shredding and sorting. Describe incineration and sorting of bottom ash. Describe landfilling, landfill maintenance, and decomposition emissions. Allocation Rules Provide clearly defined allocation procedures (if applicable). Define the allocation methods used. If there are deviations from the allocation rules, provide rationale with justified documented evidence. Example: Calculation Rules and Data Quality Requirements Types and sources of data Address primary data used for facilities and processes that fall under operational control of the reporting company. Address secondary data for facilities and processes outside of the control of the reporting company. Data quality assessment Data for manufacturing process, current technology, and current measurement capability as addressed in 7.2 of the PCR. Address the time-related coverage. Address the geographical coverage. Address the technology coverage. Address precision. Address completeness. Address representativeness. Address consistency. Address reproducibility. Address sources of the data. Address uncertainty of the information. Examples: USLCI ILCD Table 9-2: Criteria to Evaluate the Data Quality Indicators (Adapted from Weidema and Wesnaes, 1996) Optional: Include database information as representative data. Page

6 Data Source Identify the source of the input data. Electricity modeling Electricity is modeled on a regional basis. LCIA methodology Disclosure of environmental impact categories per functional unit. Global warming potential (GWP 100 years) [kg CO2-eq.] IPCC (most recent version) Acidification potential (AP) [kg SO2] TRACI 2.0 Photochemical ozone creation potential (POCP, or Smog ) [kg NOx eq.] TRACI 2.0 Eutrophication potential (EP) [kg phosphate-eq.] TRACI 2.0 Human Health Impact A human health impact assessment shall be performed in conformance with a documented standard methodology (e.g., USETox as implemented in TRACI 2.0) Sensitivity analysis Address the sensitivity analysis performed for any major assumptions in the LCA model. Provide a clear description of the environmental impact for each of the assumptions. Parameters to be Declared in the EPD Materials composition Indicate the material composition of the reference product (in kg per functional unit and in percentage of total weight. Disclose chemicals listed on the MSDS for all materials that make up 1% or more of the product weight by weight. 95% of product weight shall be accounted for. Example: Material Composition Table Material Weight (Kg) Percentage of Total Weight (%) Maple % Bio- Based Pre- Consumer Recycled Post- Consumer Recycled Biodegradable Recyclable Y/N Contains Hazardous Substance Y/N Hazardous Substance Name Wood % Steel Frame % Foam % Polyester % Nylon % Aluminum % Polypropylene % Total % Page

7 Life cycle inventory data Inventory assessment categories by life cycle stage and in total. Life Cycle Inventory Data Emissions to air SOx NOx CO 2 Methane N 2 O CO Water Phosphates Nitrates Dioxins Heavy Metals Consumption Energy Primary Energy Demand Fossil Fuel Based Energy Nuclear Renewable Waste Incineration with energy recovery Incineration without energy recovery Disposal Hazardous Waste Recycling Life Cycle Inventory Data {kg} {kg} {MJ} {kg} Impact assessment categories Report impact assessment categories by life cycle stage and in total. (See LCIA Methodology, section 7.5) Global warming potential Acidification potential Photochemical ozone creation potential Eutrophication potential Page

8 Other Environmental Information Provide any additional pertinent information (handling, noise, risk related issues, HSE). Include methodology that supports any additonal information provided, including Human Health Assessment Impacts. References List all references utilized in the EPD. Example: ANSI/BIFMA e3 Furniture Sustainability Standard ISO 14025: 2006 Environmental labels and declarations Type III environmental declarations Principles and procedures ISO 14040: Environmental management - Life cycle assessment Principles and framework ISO 14044: Environmental management - Life cycle assessment Requirements and guidelines EPA, Tool for the Reduction and Assessment of Chemical and Other Environmental Impacts (TRACI) Page

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