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FORM TL $43 Certificate <br /> (REV. 3/85) No. <br /> VENDOR'S CERTIFICATE OF OMPLIANCE <br /> G (PRECAST CONCRETE PRODUCTS) OR (READY MIXED CONCRETE <br /> To <br /> State Highway Engineer: <br /> We certify that the portlond cement,chemical and ninr:ral udn.iaurr�contained in tm: <br /> material described below are brands slated and ccmph with spnc.ficcl nni 1Lr, <br /> CONTRACT NUMBER --♦ <br /> Cement Brand: 4 Mill Location! <br /> TYP <br /> CHEMfCAL AbMfKTURf <br /> I. BRAND: MANUFACTURER. <br /> TYPE; <br /> 2. BRAND; MANUFACTURER. <br /> TYPE: <br /> OJECX BOX IF A CHEMICAI ADMIXTURE WAS NOT USED (s—_ <br /> MINERAL ADMIXTURE <br /> MANUFACTURER: <br /> CLASS: ~ <br /> CHECK BOX IF A MINERAL ADMIXTURE WAS NOT USED 1-7 <br /> Deli D?�odYM;�S) <br /> Dates of Fobri.ofion(P P1 — <br /> List prodocls to •which this certificalt applies. (Show site and lin. it. of pipe, etc <br /> defirery slip number_for ready-mii.) <br /> MA <br /> O G0;;�EPIRODI)CTS <br /> Orifi,to Rs$.*"Dr. <br /> Retain Dsrplkate. s �� <br /> BY, <br /> AUTHORI2ED REPRESE; rAnvE <br /> S�o�673 9 <br />