VS 17-136 Refusal of Entry and Order to Dispose of Fish

According to the Paperwork Reduction Act of 1995, no persons are required to re spond to a collection of information unless it displays a valid OMB control num ber. The valid OMB control
number for this information collection is 0579 0301 The time required to compl ete this information collection is estimated to average .083 hours per response , including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information .

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

FORM APPROVED
OMB NO.
0579-0301

REFUSAL OF ENTRY AND ORDER TO
DISPOSE OF FISH

Owner/Responsible Party (Importer,Shipper/Broker, or other designee):
Address:
Phone Number:

Fax Number or E-mail Address:

The fish belonging to the following species (Latin name, common name):
that are known to be susceptible to Spring viremia of carp, and which were imported to the United States in the following consignment:
at the following Port of Entry:
Shipment Identification (consignment or waybill number, carrier, others)
have been inspected by or referred to USDA, APHIS, VS, and are refused entry into United States for the following reason(s) (check all that apply):

Non-Designated Port of Entry

Other (trade embargo; leaking containers; etc. Please specify)

Missing or incomplete USDA, APHIS, VS Import Permit

Missing or incomplete Export Health Certificate

Misrepresented, mislabeled or concealed

These fish must be removed from the United States within 48 hours or be destroyed due to the potential to introduce or further spread Spring viremia of carp i n farmed fish and other
fish populations. Under the authority of 9 CFR 93.905, you are hereby ordered as the owner (or designated agent of the owner) to remove the above described fish through
re-exportation to the country of origin or another country; or at your option, to destroy the consignment, including shipping containers under APHIS VS supervision, or release it to
APHIS VS for destruction. If destruction under APHIS VS supervision is elected, fish may not leave the port premises and must be humanely slaughtered under the provisions of VS
Memo 591.67
No compensation for the destroyed fish will be paid by USDA APHIS VS. You (the owner of the consignment) will be responsible for all costs associated with the removal or
destruction of the fish. No liability shall be attached to the USDA or to any inspector or representative of that Department with respect to the destruction and disposal of the above
described fish and shipping materials that did not meet entry requirements.
I hereby acknowledge receipt of the foregoing order and understand that if I elect to provide the required documentation, the consignment will be held withou t guarantee
of survival until proper documentation is provided. Alternatively, I elect the Removal option checked below:

I will re-export this consignment to the country of origin or another country within 48 hours of this notice.
I will destroy the fish in the consignment under USDA APHIS VS supervision and adhere to the guidelines in VS Memo 591.67 for disposal of all materials.
I release the fish in this consignment to USDA APHIS VS for immediate destruction and disposal.
Consignee Name (print):
Signature:

Date:

Relationship to owner:
The foregoing order is served at ______________________________________________ _____________(port) by:
Name (print):
Time and Date:

Signature:
Title: (Designated Official for USDA, APHIS, VS)

ACTION TAKEN:
Shipment documentation provided: shipment released
Name:

Time and Date

Shipment re-exported to:
Name:

Time and Date

(Exported Shipment Identification Information _________________________________ _________________________________________
Shipment destroyed:
Name:

VS FORM 17-136
(FEB 2006)

Time and Date