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<title>Notification Form</title>
<style>
body {
font-family: Arial, sans-serif;
line-height: 1.6;
margin: 0;
padding: 20px;
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.container {
max-width: 800px;
margin: 0 auto;
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h1 {
font-size: 16px;
margin-bottom: 20px;
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.header {
font-weight: bold;
margin-bottom: 10px;
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.header textarea {
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height: 60px;
resize: vertical;
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p {
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ul {
margin-bottom: 20px;
padding-left: 20px;
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.form-group {
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label {
display: block;
margin-bottom: 5px;
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input[type="text"], input[type="number"] {
width: 100%;
padding: 5px;
border: 1px solid #ccc;
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.signature-box {
border: 1px solid #ccc;
height: 100px;
margin-top: 5px;
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</style>
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<body>
<div class="container">
<h1>Date: 29, August, 2024</h1>
<div class="header">
<textarea id="service-public">Service Public Fédéral Santé publique, Sécurité de la chaîne alimentaire et Environnement / Federale overheidsdienst, Volksgezondheid, Veiligheid van de voedselketen en Leefmilieu</textarea>
</div>
<p>To Whom It May Concern:</p>
<p>As a downstream user of a product that has been granted an authorisation for continued use of 4-tert-OPnEO, it is required to complete a notification to the local authorities and wastewater treatment plant.</p>
<p>The Authorisation indicates that those discharging wastewater contaminated with 4-tert-OPnEO shall submit a notification to the following bodies, in accordance with the legislation transposing Directives 91/271/EEC and 2000/60/EC, as well as with national provisions of the Member States where the uses take place:</p>
<ul>
<li>the competent authorities responsible under Directive 2000/60/EC;</li>
<li>the competent authorities responsible under Directive 91/271/EEC;</li>
<li>the wastewater treatment plant connected to the sewage system into which they are discharging that wastewater.</li>
</ul>
<p>To fulfill this requirement, please find the annual amount of 4-tert-OPnEO released and annual volume of wastewater discharged.</p>
<div class="form-group">
<label for="reporting-year">Reporting Year</label>
<input type="number" id="reporting-year">
</div>
<div class="form-group">
<label for="amount-released">Annual amount of 4-tert-OPnEO released (Kg)</label>
<input type="number" id="amount-released" step="0.0001">
</div>
<div class="form-group">
<label for="volume-discharged">Annual volume of wastewater discharged</label>
<input type="text" id="volume-discharged">
</div>
<div class="form-group">
<label for="name-stamp">Name and stamp</label>
<div class="signature-box"></div>
</div>
</div>
<script>
// Set default values
document.getElementById('reporting-year').value = new Date().getFullYear();
document.getElementById('amount-released').value = '0.0658';
</script>
</body>
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