Transcription of (TYPE ON SHIPPER’S LETTERHEAD) - R. E. Rogers
1 (TYPE ON shipper S letterhead ) TSCA STATEMENT I CERTIFY THAT ALL CHEMICAL SUBSTANCES IN THIS SHIPMENT (CHECK ONE): DOES COMPLY WITH ALL APPLICABLE RULES OR ORDERS UNDER THE TOXIC SUBSTANCES CONTROL ACT (TSCA) AND THAT I AM NOT OFFERING A CHEMICAL SUBSTANCE FOR ENTRY INTO THE UNITED STATES IN VIOLATION OF TSCA OR ANY APPLICABLE RULE OR ORDER UNDER TSCA. ARE NOT SUBJECT TO THE TOXIC SUBSTANCES CONTROL ACT (TSCA). PLEASE CONTACT THE UNDERSIGNED IF FURTHER INFORMATION IS REQUIRED. SIGNATURE: _____ NAME: _____ TITLE: _____ COMPANY: _____ DATE: _____
