FV-237 Record of Request for Inspection/Reinspection of Food Pr

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS
FRESH PRODUCTS BRANCH

*REQUEST FOR:

INSPECTION

REINSPECTION

APPEAL INSPECTION

(This is the only acceptable form for fax or electronic submission to USDA for inspection requests)
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is 0581-0125. The time required to complete this information collection is estimated to average 2 minutes 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual
orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large
print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964
(voice and TDD). USDA is an equal opportunity provider and employer.

NOTE: Fill in all appropriate blocks; blocks with “*” must be completed. Inspection may be delayed
because of incomplete information. Type of Inspection must be selected above.
*Applicant’s (Company) Name:
*Street Address:
*City, State & Zip:
*Contact Person:
*Phone Number:
Enter when
different
from
Applicant:

*Date:
*Time:
Type of Carrier:
Car Number or
Type:
License Number:

*E-Mail Address:
*Shipper’s Name:
City and State:
Receiver’s Name:
City and State:
*Location of Product(s):

Car:
Trailer:
Lot Inspection
Applicant’s P.O. Number:

Lots Separated by (Optional):
PLI Numbers
Grower Numbers
Size
Other, Specify:
Digital Images Requested:
Yes
No

Inspection Requested For (Must select at least one):
Quality and Condition (including size when applicable)
Condition Only
Size
Net Weight
Other, Specify:
Products To Be Inspected

*PRODUCTS

BRANDS/MARKS

Remarks/Special Instructions;

FV-237 (10/03) (Previous editions may be used)

*QUANTITY

Type Container

*Size

Type/Variety