
Equipment Physical Design Standards ATT-TP-76200, Issue 19
AT&T Services, Inc. June 2014
PbF Form
Pb-Free Solder Declaration
Supplier: Equipment Name:
Equipment ID: Nomenclature (Acronym):
Does the product contain PWBs or Components that are assembled with Pb-free solder?
YES NO
If “Yes” is checked Please provide all test results along with the Checklist as per ATTIS
standards ATTIS 0600019 and ATTIS 0600020. Please refer back to Section 12 of ATT-TP-
76200 for more information.
Does the product contain a mixture of Pb and Pb-free soldered components?
YES NO
If “Yes” is checked provide a complete list of all components that are Pb-free.
Please provide all test results along with the Checklist as per ATTIS standards ATTIS 0600019
and ATTIS 0600020. Please refer back to Section 12 of TP76200 for more information.
(Company name) has caused this Letter of Declaration to be executed by its duly authorized
representative as of the date written below.
By:
Title:
Date:
NOTE: This affidavit must be signed in front of a notary and notarized _________________
.
Copyright ©2014, AT&T . All Rights Reserved.
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