Certificate Of Compliance Form - Reduction Of Toxics In Packaging printable pdf download

Certificate Of Compliance Form - Reduction Of Toxics In Packaging

Rev. 08-06-09

SAMPLE

[COMPANY LETTERHEAD]

Certificate of Compliance

Reduction of Toxics in Packaging

We certify that all packaging and packaging components sold to [Company Name] or its

subsidiaries in the State(s) of [State Name(s)] comply with the requirements of the toxics

in packaging law(s). Specifically:

1) We certify that the regulated metals – lead, mercury, cadmium, and hexavalent

chromium -- were not intentionally added to any package or packaging component

during the manufacturing process.

2) We further certify that the sum of the incidental concentration levels of lead,

mercury, cadmium and hexavalent chromium present in any package or package

component does not exceed 100 parts per million by weight.

3) We will maintain adequate documentation of this certification for inspection upon

request.

COMPANY NAME:________________________________________________

ADDRESS:______________________________________________________

_______________________________________________________________

CERTIFIED BY:

_______________________________

______________________________

(Name)

(Signature)

_______________________________

______________________________

(Title)

(Date)

****Addendum: The State of Iowa (IAC 455D.19) also requires the following certification:

We further certify that no materials used to replace the heavy metals are present in a quantity or

manner that creates a hazard as great or greater than the hazard created by the regulated

metals.

Certificate Of Compliance Form - Reduction Of Toxics In Packaging