I Importer of Record (IOR)
Company NamePacific Rim Imports LLC
Contact PersonJane Smith, Compliance Manager
Phone+1 555-123-4567
Street Address4550 Distribution Drive, Suite 200
City / State / ZIPLong Beach, CA 90805
Issuer of CertificateSame as Importer of Record
II Product Identification
Product Name (English)Adult Cotton T-Shirt, Short Sleeve
Model No.MDL-2026-A1
SKUSKU-2026-A1-BLK
GTIN / UPC06901234567890
Color / SizeBlack / L
Material Specification100% cotton jersey, 180 gsm
Production DateJan 2026 - Mar 2026
Place of ManufactureHangzhou, China
Batch / Lot(s)Lots 2026A-001 through 2026A-050
III Category & Applicable U.S. Consumer Product Safety Rules
Product CategoryAdult wearing apparel (general flammability)
Age Groupadult
Other StandardsNone
Exemption NotesNone
- 16 CFR Part 1610 — Adult wearing apparel flammability. Applies to most textile clothing; exemptions exist for certain fabrics/garments.
IV Manufacturer
Legal NameHangzhou Textile Manufacturing Co., Ltd.
AddressNo.88 Yuhang Zone, Hangzhou, China
V Test Report Reference
Report NumberTR-2026-0117
Date of Test2026-02-10
Report Date2026-02-15
Testing LaboratorySGS North America, Inc.
Testing LocationFairfield, NJ, United States
Laboratory Phone+1 770-123-4567
Laboratory Address2950 Peachtree Rd NW, Suite 300, Atlanta, GA 30305, United States
Standards Tested16 CFR Part 1610
Model / Batch CoverageApplies to MDL-2026-A1, lots 2026A-001 through 2026A-050
Records Custodian Address4550 Distribution Drive, Suite 200, Long Beach, CA 90805, United States
VI Declarations & Signature
I, the undersigned, certify that the product(s) identified above are in compliance with all applicable consumer product safety rules and regulations of the United States Consumer Product Safety Commission (CPSC) as cited in Section III of this certificate, based on the test evidence identified in Section V.
- ✓The information provided in this certificate is accurate and complete to the best of my knowledge and belief.
- ✓This certificate is issued by the importer of record, or by an agent authorized to act on behalf of the importer of record.
- ✓No substitute materials, components, or manufacturing changes affecting conformance have been made without re-evaluation against the applicable rules.
- ✓Issuance of this certificate does not constitute a guarantee or warranty of product safety beyond the applicable rules cited herein.
- ✓I confirm that the product is designed and intended for the "adult" age group and is not a children's product subject to 16 CFR Part 1107.
Name (Printed)Jane Smith
TitleCompliance Manager
Signature
Date of Issue2026-09-02
CompanyPacific Rim Imports LLC