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Sampling Procedure Acknowledgement Receipt
FPA sample acknowledgement receipt
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
OFFICE OF THE PRESIDENT
FERTILIZER AND PESTICIDE AUTHORITY
FPA Bldg., BAI Compound, Visayas Avenue, Diliman , Quezon City 1101
Tel. No.: 441-1601
Telefax : 441-1601
E-mail Address: fpacentral77@gmail.com Website Address: http://fpa.da.gov.ph
P.O. Box 2582, Q.C.
ACKNOWLEDGEMENT RECEIPT
This is to certify that I, __________________________________ has taken the
(FPA Personnel/Name)
following products/materials for quality monitoring:
1.
Name of Product
___________________________
Packing/Volume
_____________________________________
2.
___________________________
_____________________________________
3.
___________________________
_____________________________________
at ________________________________________on ______________________ in the
(Name of store/company & location)
(Date)
presence of : _____________________________________________
(Manufacturer/Storekeeper/Owner’s name
or designated representative)
Please note that the cost of analysis will be borne by the owner/manufacturer/importer.
Sampled by:
_________________________________
(Signature of FPA Personnel)
Conforme:
________________________________
(Signature of Manufacturer/Importer
or Storeowner/Keeper
Accomplish in triplicate:
1.
Owner/Manufacturer/Importer
2.
FPA-Quezon City
3.
FPA-PDO IV/PDO II
171
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