FGIS 909-2 U.S. Grain Standard Act Official Export Grain Inspection

UNITED STATES DEPARTMENT OF AGRICULTURE

FORM FGIS 909-2

APPROVED OMB NO. 0580-0013

FEDERAL GRAIN INSPECTION SERVICE

MAR 05

ORIGINAL

U.S. GRAIN STANDARDS ACT

NOT NEGOTIABLE

OFFICIAL EXPORT GRAIN INSPECTION CERTIFICATE

ISSUED AT

USDATE OF SERVICE

I certify that I am licensed or authorized under the United States Grain Standards Act (7 U.S.C. 71 et seq.) to inspect the kind of grain covered by this
certificate and that on the above date the following identified grain was inspected under the Act, with the following results:

Level of Inspection

DATE Sampled

Location

Method of Sampling

Identification of Carrier

QUANTITY (This is not a weight certificate)

GRADE AND KIND

TEST WEIGHT
per bushel

REMARKS

S

MOISTURE

1

APPEAL NO. (If applicable)

Damaged
Kernels
(TOTAL)

Foreign
material

1

Broken corn
and foreign
material

%

APPLICANT

NAME AND SIGNATURE

This certificate is issued under the authority of the United States Grain Standards Act, as amended (7 U.S.C 71 et seq.), and the regulations thereunder (7 CFR 800.0 et seq.). It is issued to show the kind, class, grade, quality,
condition, or quantity of grain, or the condition of a carrier or container for the storage or transportation of grain, or other facts relating to grain as determined by official personnel. The statements on the certificate are considered
true at the time and place the inspection or weighing service was performed. The certificate is not considered representative of the lot if the grain is transshipped or is otherwise transferred from the identified carrier or container or
if grain or other material is added to or removed from the total lot. If this certificate is not canceled by a superseding certificate, it is receivable by all officers and all courts of the United States as prima facie evidence of the truth
of the facts stated therein. This certificate does not excuse failure to comply with the provisions of the Federal Food, Drug, and Cosmetic Act, of other Federal law. The conduct of all services and the licensing of the (inspecting/
grading/sampling) personnel under the regulations governing such services shall be accomplished without discrimination as to race, color, religion, sex, national origin, age, or handicap.
WARNING: Any person who shall knowingly falsely make, issue, alter, forge, or counterfeit this certificate,or participate in any such actions, or otherwise violate provisions in the U.S. Grain Standards Act, the U.S. Warehouse Act, or
related Federal laws is subject to criminal, civil, and administrative penalties.
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 number. The valid OMB control number for this information is 0580-0013. The time required to disclose
this recordkeeping requirement is to average .67 hours per recordkeeper annually, including the time to retain such records, and to notify, disclose, and report to third parties such recordkeeping requirements.