PPQ 579 Phytosanitary Certificate for Reexport

See reverse for additional OMB information.

No phyt~anitary certificate can be Jssued unifi an application [s completed (7 CFR 353)

FORM APPROVED
OME) NO. 0579~3052 and 0094

FOROFRC~LUSEONLY

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT P ROTEC3]ON AND QUARAN]]NE

PLACEOFISSUE

PHYTOSANITARY CERTIFICATE
FOR REEXPORT

NO~:

TO: THE PLANT PROTECTION ORGANIZATION(S) OF

FPC

-R

CERTIFICATION
This is to certify that the plants or plant products described below were imported into the United States from (CountpJ of odgin)
covered by Phy[osanitary Certificate
[~ original
[] certified true copy
ofwhichisa[tachedtothis certfficate. That they are [] packed
~] repacked
[] in original [] in new containers, that
based on the [] odginal Phytosangary Certificate [] and additional inspection, they are considered to conform with the current phytosanitary
regulations of the importing country, and that dudng storage in the United States, the consignment has not been subjected to the risk of infestation or infection.
DISINFESTATION AND/OR DISINFECTION TREATMENr
1 DATE

2. TREATMENT
4 DURATION AND TEMPERATURE

5 CONCENTRATION

6. ADDITIONAL INFORMATION

DESCRIPTION OF THE CONSIGNMENT
7. NAMEANDADDRESS OFTHEEXPORTER

8 DECLARED NAME AND ADDRESS OF THE CONSIGNEE

9 NAM E OF PRODUCE AND QUANTITY DECLARED

10 BOTANICAL NAME OF PLANTS

tl NUMBERAND DESCRIPTION OF PACKAGES

12. DISTINGUISHING MARKS

13 PLACE OF ORIGIN

14 DECLARED MEANS OF CONVEYANCE

15. DECLARED POINT OF ENTRY

WARNING: Any alteration, forgery, or unauthorized use of this phytosanitary certificate is subject to civil penalties of up to $250,000 (7 US.C. Section 7734(b)) or punishable by a
fine of not more than $10,000, or imprisonment of not more than 5 years, or both (18 U.S.C. Section 1001),

ADDITIONAL DECLARATION

16. DATEISSUED

17 NAME OF AUTHORIZED OFFICER (Type orPtint)

I 48 SIGNATURE OF AUTHORIZED OFFICER

No liability shall attach to the United states Department of Agriculture or to any officer or representative of the Department with respect to this ceffificate.
PPQ FORM 579 FEB 2001

Previous editions are obsolete ~et6/30/01

EXPORT INSPECTION DATA (To be filled in by Authorized Officer)
2. % OF MATERIALS EXAMINED

5. SIGNATURE

PPQ FORM 579 (RevePse Part 4)

3. % OF MATERIALS INFESTED

6. DATE AND TIME INSPECteD

According to the Paperwork Reduction Act of 1995, no persons are requi~-ed to respond to a collection of information u~less it displays a valid
OMB control number. The valid OMI~ control number for this information is 0579-0052 and 0094. The time required to complete this informa~on collection is
estimated to average .033 to 1.20 hours per response, including the t~me for revie’wi;~g i~sb*uctions, searching e,~s~ng data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.