SWAGELOK COMPANY

29500 Solon Road, Solon, Ohio 44139-3492 U.S.A.

DISTRIBUTOR: CUSTOMER:

DATE: LOG#: CUSTOMER PO#:

QUANTITY PART NUMBER QUANTITY PART NUMBER

Certificate of Compliance/Typical Material Certification

Swagelok gaskets shipped to you for the above referenced products are manufactured from material purchased in
accordance with the specification(s) listed.

MATERIAL / STANDARDS
Material Type Standards
Poly Tetrafluoroethylene, PTFE 21CFR 177.1550,
3-A Sanitary Standard 20-19 *
* For multiple use plastic materials used as product contact surfaces
for Dairy Equipment.

The Swagelok product specified above was manufactured in accordance with Swagelok Company’s Quality
Assurance Manual (latest revision, revision B, dated March 25, 2002). Swagelok Company’s Quality System is
approved to ISO 9001 (BSI Certificate # FM01729).

____________________________
Carl Meece
Vice President of Engineering
SMCM-00038
DIST. D02

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