"Permanent Preservative Treatment Certificate Form" - Australia

This fillable "Permanent Preservative Treatment Certificate Form" is a document issued by the Australian Department of Agriculture and Water Resources specifically for Australia residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

ADVERTISEMENT
ADVERTISEMENT

Download "Permanent Preservative Treatment Certificate Form" - Australia

355 times
Rate (4.4 / 5) 18 votes
______________________________ ______________________________
Company letterhead
(MUST be issued by the treatment provider, and MUST include the company’s name and
physical address)
PERMANENT PRESERVATIVE TREATMENT CERTIFICATE
Unique identifiable link to the consignment: ........................................................................
Description of goods/packaging treated: ……………………………………………………….
(such as pallets and crates if packaging is treated)
Quantity/volume of goods/packaging treated: …………………………………………………
Date of treatment: ………………………………..
Name of preservative formulation.....................................…………………………………….
Chemical class of preservative (active ingredients) .................................……………………..
Retention of active ingredient (loading of preservative) expressed as
................................................. % mass/mass based on the oven dried mass of the treated
wood; or mass per volume (net dry salt retention – Fenvalerate and Fenitrothion ONLY).
NOTE: %mass/mass = 100 x actual batch retention of active ingredient in penetration zone (mass/vol)
actual oven dried mass of the treated wood (mass/vol)
Plywood, LVL and veneers only:
Veneer only treatment
or glueline only treatment
or both
(please tick one)
Veneer thickness …………………………………………… mm or
inches
STATEMENT (tick one box):
This is to certify that the timber described below was treated in accordance with Department of
Agriculture and Water Resources biosecurity penetration and retention requirements with an
acceptable (listed) preservative formulation.
®
This is to certify that the timber described below was treated in accordance with Australian Standard
AS/NZS1604 to specific Department of Agriculture and Water Resources biosecurity penetration and
retention requirements.
Additional statements as required by the import conditions for the relevant goods/packaging (if applicable)
………………………………………………………………………………………………………………..
Printed name: ………………………..
Signature: ..........................................................
(Treatment provider company representative)
Date of issue: ..........................................
(DD/MM/YYYY)
______________________________ ______________________________
Company letterhead
(MUST be issued by the treatment provider, and MUST include the company’s name and
physical address)
PERMANENT PRESERVATIVE TREATMENT CERTIFICATE
Unique identifiable link to the consignment: ........................................................................
Description of goods/packaging treated: ……………………………………………………….
(such as pallets and crates if packaging is treated)
Quantity/volume of goods/packaging treated: …………………………………………………
Date of treatment: ………………………………..
Name of preservative formulation.....................................…………………………………….
Chemical class of preservative (active ingredients) .................................……………………..
Retention of active ingredient (loading of preservative) expressed as
................................................. % mass/mass based on the oven dried mass of the treated
wood; or mass per volume (net dry salt retention – Fenvalerate and Fenitrothion ONLY).
NOTE: %mass/mass = 100 x actual batch retention of active ingredient in penetration zone (mass/vol)
actual oven dried mass of the treated wood (mass/vol)
Plywood, LVL and veneers only:
Veneer only treatment
or glueline only treatment
or both
(please tick one)
Veneer thickness …………………………………………… mm or
inches
STATEMENT (tick one box):
This is to certify that the timber described below was treated in accordance with Department of
Agriculture and Water Resources biosecurity penetration and retention requirements with an
acceptable (listed) preservative formulation.
®
This is to certify that the timber described below was treated in accordance with Australian Standard
AS/NZS1604 to specific Department of Agriculture and Water Resources biosecurity penetration and
retention requirements.
Additional statements as required by the import conditions for the relevant goods/packaging (if applicable)
………………………………………………………………………………………………………………..
Printed name: ………………………..
Signature: ..........................................................
(Treatment provider company representative)
Date of issue: ..........................................
(DD/MM/YYYY)