Form PPQ 519 PPQ 519 Compliance Agreement

Pine Shoot Beetle Host Material from Canada

ppq519

Business/Private Industry

OMB: 0579-0257

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

FORM APPROVED
OMB NUMBER 05790054/0088/0129/0198/
0238/0257/0306/0310

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 cancelled, but may be revised as necessary or revoked for noncompliance.

12. ADDRESS

11. PPQ/CBP OFFICIAL (NAME AND TITLE)

13. SIGNATURE

14. U.S. GOVERNMENT/STATE AGENCY OFFICIAL (NAME AND TITLE)

15. ADDRESS

16. SIGNATURE

PPQ FORM 519 (MAY 2007)

Previous editions are obsolete.

10. DATE OF AGREEMENT


File Typeapplication/pdf
File TitleInForms - ppq519.wpf
Authorkastratchko
File Modified2007-07-05
File Created2007-07-05

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