C04 Attachment 6 - Certificate of Compliance.pdf
PDF 120 KB Posted
- Solicitation number
- 1240LT26Q0073
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Certificate of Compliance template used for Forest Service projects to verify product shipment specifications.
The certificate serves as a compliance verification document for chemical de-icing products being delivered to Forest Service projects. It requires documentation of shipment details including the consignee, destination, transportation identification, and delivery date. The form captures product composition specifications by weight percentage for three active ingredients: Magnesium Chloride, Calcium Chloride, and Liginsulfonate. Additional technical specifications include the net weight of the total shipment, net gallons measured at 15°C, and product specific gravity at 15°C. The certificate requires identification of the MSDS code and the manufacturer/source location. A producer's representative must sign the document, certifying that the identified shipment complies with all Forest Service specifications applicable to the specific project. This template ensures quality control and traceability for chemical products used in Forest Service operations.
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Other files
| File | Type | Posted |
|---|---|---|
| C05 Attach 2 - Amended SOI Greys Rv.xlsx | XLSX spreadsheet | |
| C05 Amendment 02 Greys River.pdf | ||
| C05 Amendment 01 Greys Rr Rd Dust Abatement.pdf | ||
| C04 Attachment 2 - SOI_GreysDustAbatement.xlsx | XLSX spreadsheet | |
| C04 Attachment 1 - Solicitation Greys River.pdf | ||
| C04 Attachment 4 - SCA WD2015-5409 051326.pdf | ||
| C04 Attachment 3 - FS Project Specifications.pdf | ||
| C04 Attachment 2 - SOI_GreysDustAbatement.xlsx | XLSX spreadsheet | |
| C04 Attachment 5 - QASP.pdf |
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Text version
Attachment 6
Certificate of Compliance
Consignee______________________________________________________ Destination______________________________
Transportation ID(Truck No.,etc.) ____________________________________ Date___________________________________
Product Concentration by Weight____________________________________ Magnesium Chloride:_____________________%
Calcium Chloride:________________________%
Ligninsulfonate:_________________________%
Net Weight Total Shipment_________________________________________
Net Gallons @ 15°C _____________________________________________
Product Specific Gravity @ 15°C ___________________________________
The shipment identified above and covered by this Certificate of Compliance complies with Forest Service specifications applicable to this project.
MSDS Identification Code __________________
Source_________________________________________________________ Signed By:_______________________________________ (Mfg. & Location) (Producers Representative)
Sample Certificate of Compliance
| Attachment 2 |
| Certificate of Compliance |
| Net Weight Total Shipment_________________________________________ |
| Net Gallons @ 15C _____________________________________________ |
| Product Specific Gravity @ 15C ___________________________________ |
| The shipment identified above and covered by this Certificate of Compliance complies with Forest Service specifications applicable to this project. |
| MSDS Identification Code __________________ |
| Sample Certificate of Compliance |
File details come from the government source that posted it. Updated .