Form 571 District of Columbia Plant Health Certificate

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FORM APPROVED - OMB NO. 0579-0166
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

1. CERTIFICATE DATE

2. LOCATION

3. INSPECTION DATE

4. SERIAL NO.

DISTRICT OF COLUMBIA PLANT HEALTH CERTIFICATE

This is to certify that the plants or plant products described below have been inspected according to appropriate procedures and are
apparently free from quarantine pests, and practically free from other injurious pests; and that they are considered to conform with the current
phytosanitary regulations of the importing State or territory of the United States.
DISINFESTATION AND/OR DISINFECTION TREATMENT
5. DATE

6. TREATMENT

7. CHEMICAL (active ingredient)

8. CONCENTRATION

9. DURATION AND TEMPERATURE

10. ADDITIONAL INFORMATION

DESCRIPTION OF THE CONSIGNMENT
11. NAME AND ADDRESS OF THE SHIPPER

12. DECLARED NAME AND ADDRESS OF THE CONSIGNEE

13. NAME OF PRODUCE, QUANTITY DECLARED, AND BOTANICAL NAME

14. NUMBER AND DESCRIPTION OF PACKAGES

15. DISTINGUISHING MARKS

16. PLACE OF ORIGIN

17. ADDITIONAL DECLARATION

18. PRINTED NAME OF AUTHORIZED OFFICER

19. AUTHORIZED SIGNATURE

No liability shall attach to the United States Department of Agriculture or to any officer or representative of the Department with respect to this
certificate.
PPQ FORM 571
JAN 20001

Previous editions are obsolete.