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WYDOT <br />Bid kern Number <br />Product Descriptton <br />or Use <br />Quantity <br />Unit <br />LF YD', m, <br />m', etc. <br />Manutactuter <br />Applicable Specification <br />(AASHTO, ASTM WYDOT, YDOT, etc.) <br />TYPE I FERTILIZER <br />b 4 0 5 <br />{ 1,.)6. 11 1 ,. <br />JIRDON <br />27- 13.5 -13.5 <br />,airy <br />n <br />Diatiunuiuum Ph osphate <br />2.9.30 <br />% (fir umark <br />18 -46 -0 <br />Ammonium Sultate <br />u na <br />— <br />.3 % <br />:.3.7 � fo <br />LHS <br />CHS <br />21 -0 -0 <br />46 -0 -0 <br />Potassium Uthlonde <br />21.6 Vo <br />tiromark <br />0-U -60 <br />Total <br />lhs <br />F•OttM f16B <br />CERTIFICATTON OF M <br />WYDOT Project No. <br />Location: <br />The <br />WESTCO dba JIRDON, 70727 Highway 26, Morrill, NE 69358 <br />Rocky' ouri ain Reclamation :1754 N 2nd, Larainir WY 82073 <br />has furnished to <br />(Name of Contractor) <br />(Name Typed or Printed) <br />(Stpnature) <br />Distribution: <br />White : Materials Laboratory <br />Yellow: Resident Engineer <br />Pink: Contractor <br />Gold: Manufacturer /Supplier <br />(Add <br />the following materials for use in the construction of the above referenced project. <br />(Mill Test Reports, Heat Numbers, Chemical Analysis Reports, Coating Thickness Reports, Seed Analysis Reports, <br />Transit Certificates, etc. must accompany this form where applicable.) <br />Statement of Certification <br />I hereby certify that the above listed items of materials do meet the requirements as set forth in the plans and/or specifications. <br />By: Merlin Anderson Title: Sales <br />Date: <br />KRIAT4S1 <br />WYDOT Field Identification <br />(Date - Sequence Re'd - hIspectoes kids) <br />(City, State) <br />Note: This certification and attachments must be furnished in triplicate to the contractor who, in turn, must submit two copies <br />to the engineer before the material can be incorporated into this project. <br />Copies of this form are available from: <br />WYDOT Purchasing Program <br />Attn: Storeroom Manager <br />5300 Bishop Bivd <br />Cheyenne, WY 82009 -3340 <br />