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["R"]
["TOXIC SUBSTANCES CONTROL ACT (TSCA) CERTIFICATION"]
[]
[]
["Date : "]
[]
["(Check one section only)"]
[]
["[      ] POSITIVE CERTIFICATION:"]
["    \"I certify that all chemical substances in this shipment comply with all applicable rules and orders under TSCA and that I am not offering a chemical substance for entry in violation of TSCA or and applicable rule or order hereunder.\""]
[]
["OR"]
[]
["[      ] NEGATIVE CERTIFICATION:"]
["    \"I certify that all chemicals in this shipment are not subject to TSCA.\""]
[]
[]
[]
["Company Name:"]
[]
["Company Address:"]
[]
["Authorized Name:"]
[]
[]
[]
["Authorized Signature: _________________________"]
[]
["Title:"]
[]
["AIR WAYBILL:"]
[]
["If the certifier is unsure if them chemical substance is subject to TSCA compliance, contact the environmental protection agency, TSCA Assistance Office, D. C. (202) 554-1404 between 8:30 a.m. - 5:00 p.m. E.T"]
[]
["Date :"]

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