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WYDOT <br />Bid Item Number <br />Product Description <br />or Use <br />Quantity <br />Unit <br />LF' Y ' m <br />m etc. <br />Manufacturer <br />Applicable Specification <br />(AASHTO, ASTM, WYDOT, etc.) <br />TYPE I I FERTILIZER <br />13 6 <br />5.):46' <br />JIRDON <br />18 -46 -0 <br />9.3,6 <br />IN <br />Diammonium Phosphate <br />4000 <br />lb <br />Gromark <br />18 -46 -0 <br />Tntal <br />4000 <br />lhs <br />WYDOT rat T 168 <br />"Rev WO <br />c <br />FaTIFICATION OF MA ERIALS <br />WYDOT Project No. <br />Location: <br />WESTCO dba JIRDON, 70727 Highway 26, Morrill, NE 69358 <br />The <br />(Na ltZ7a r kli irer naintain Reclamation, 1254 N 2nd, I rat ie, WY 82073 <br />has furnished to <br />By: Merlin Anderson <br />(Name of Contractor) <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 />I hereby certify that the above listed items of materials do meet the requirements as set forth in the plans and/or specifications. <br />Note: This certification and attachments must be furnished in triplicate to the contractor who, in tum, must submit two copies <br />to the engineer before the material can be incorporated into this project. <br />Distribution: <br />White : Materials Laboratory <br />Yellow: Resident Engineer <br />Pink: Contractor <br />Gold: Manufacturer /Supplier <br />(Addres <br />Statement of Certification <br />WYDOT Field Identification <br />(Date • Seouence Reed - Inspector's initials) <br />Title: Sales <br />(City. State) <br />Date: — Z 7 — /& ---'" <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 />