N.Y. Comp. Codes R. & Regs. tit. 1, § 41.5 – Certification form.

A certification in the following form shall be deemed to satisfy the requirement of this Part:

DISTRIBUTOR'S CERTIFICATION

I hereby certify that the vehicle transporting packaged milk for resale in the same container is capable of maintaining such milk at a temperature of not more than 45 degrees Fahrenheit and the packaged milk is stored and shipped in a compartment which contains no toxic and hazardous chemicals or solid waste as defined in section 257-a of the Agriculture and Markets Law. ^* These requirements are being met with regard to milk purchased by me from

(Name & Address of Milk Dealer)


(Name of Distributor)	(Address of Distributor)

(Vehicle License Plate Number)	(Telephone Number of Distributor)

(Date Signed)	(Signature of Distributor or Distributor's Representative)

	(Name and Title of Signer)