Attachment 2-Sample Certificate of Compliance.pdf

This document is a Certificate of Compliance template for Forest Service road treatment product shipments. The certificate serves as a verification document that shipped materials meet Forest Service specifications for the applicable project. The form requires the producer's representative to certify compliance by signature.

The certificate documents product identification and shipment details, including consignee information, destination, transportation ID, shipment date, and net weight and volume measurements. It specifies chemical composition by weight percentage for three active ingredients: Magnesium Chloride, Calcium Chloride, and Liginsulfonate. Additional technical specifications required include product specific gravity measured at 15°C, net gallons at 15°C, and MSDS Identification Code. The form also captures source information identifying the manufacturer and location, and requires certification from a producer's representative that the identified shipment complies with all applicable Forest Service specifications for the project.