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Local Assistance Procedures Manual <br />EXHIBIT 17-G <br />Materials Certificate <br />EXHIBIT 17-G MATERIALS CERTIFICATE <br />Materials Certificate <br />CITY/COUNTY LETTERHEAD <br />(Sample) <br />Date: <br />Federal -Aid Project No.: <br />Caltrans File Category 61: <br />Job Stamp <br />Subject: Materials Certification <br />This is to certify that: <br />The results of the tests on acceptance samples indicate that the materials incorporated in the construction work <br />and the construction operations controlled by sampling and testing were in conformity with the approved plans <br />and specifications. <br />Exceptions to the plans and specifications are explained on the back of this memorandum (or on <br />attached sheet). <br />❑ No exceptions to the plans and specifications were found. <br />Signature of local agency engineer in responsible charge of project and title <br />Distribution: ( For all projects) 1) Local agency Project Files (original) <br />2) DLAE (1 copy in Report of Expenditures) <br />(For projects on the NHS) 3) FHWA (1 copy) <br />Page 17-23 <br />LPP 09-01 April 30, 2009 <br />