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Sample

RoHS COMPLIANCE

CERTIFICATION

Friday, November 11, 2005 

Supplier Name: Goodwin Robbins Packaging Co.
Contact’s Name: David P. Robbins

Do any of the products manufactured for, and/or provided to the XYZ Co.                              contains any of the following materials:

MERCURY                                            YES______ NO __X__

CADNIUM                                             YES______ NO __X__

HEXAVALENT CHROMIUM                      YES______ NO __X__

POLYBROMINATED BIPHENYLS (PBB’S)   YES______ NO __X__

POLYBROMONIATED DIPHENYL(PBDE’S)YES______ NO __X__

 Supplier’s declaration on use of banned or restricted materials and chemical substances. 

I hereby certify that all information provided is accurate and true for the products and components listed above. 

Signature of Authorized Company Representative: David P. Robbins    Date: 11-10-05

Position: Operation and QC Manager - E-mail david@goodwinrobbins.com

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Email
 info@goodwinrobbins.com


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