Form PPQ-203 Foreign Site Certificate of Inspection and/or Treatment

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 numbers for this information collection are 0579-0190 and 017 3. The time required to complete this information collection is estimated to a verage .5
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.

U.S DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

FOREIGN SITE CERTIFICATE OF INSPECTION
AND/OR TREATMENT

OMB APPROVED
0579-0190 and
0579-0173

1. CERTIFICATE NO.

2. COUNTRY OF ORIGIN

3. DATE LOADED

4. FOREIGN PORT OF EXPORT

5. CARRIER IDENTIFICATION

6. U.S. PORT OF ENTRY

7. SHIPPER (Name and Address)

8. CONSIGNEE (Name and Address - Include Zip Code)

9. COMMODITY

12. LOCATION OF INSPECTION AND/OR TREATMENT

10. NO. CONTAINERS
(Identify as box, sack,
1/2 Bruce box, flat,
cardboard box, etc.)

11. CONTAINER
IDENTIFICATION MARKS

13. DATE

This certifies that the shipment described above has been inspected and/or treated in accordance with agricultural
requirements for entry into the United States.
14. SIGNATURE OF PLANT PROTECTION AND QUARANTINE OFFICER

PPQ FORM 203
(APR 2007)

15. DATE ISSUED