Compliance Agreement Form PPQ 519

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control FORM APPROVED
number. The valid OMB control number for this information collection is 0579-0054 & 0292. The time required to complete this information collection is estimated OMB NUMBER
to average 1.25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and 0579-0054 & 0292
completing and reviewing the collection of information.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

COMPLIANCE AGREEMENT
2. LOCATION

1. NAME AND MAILING ADDRESS OF PERSON OR FIRM

,
,
3. REGULATED ARTICLE(S)

4. APPLICABLE FEDERAL QUARANTINE(S) OR REGULATIONS

5. I/We agree to the following:

6. SIGNATURE

7. TITLE

8. DATE SIGNED

9. AGREEMENT NO.

The affixing of the signatures below will validate this agreement which shall remain in
effect until canceled, but may be revised as necessary or revoked for noncompliance.

11. PPQ OFFICIAL (Name and Title)

12. ADDRESS

13. SIGNATURE

14. STATE AGENCY OFFICIAL (Name and Title)

16. SIGNATURE

PPQ FORM 519
(AUG 2006)

15. ADDRESS

10. DATE OF AGREEMENT