Form 7350-1 Request and notice of Shipment of Sealed Meat and Poultr

U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION
SERVICE
FIELD OPERATIONS

REQUEST AND NOTICE OF
SHIPMENT OF
SEALED MEAT/POULTRY

DISTRIBUTION:
1 copy:
Food Inspector at
Destination
1 copy:

Inside Sealed Car

1 copy:

Origin Est.

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 0583-0094. The
time required to complete this
information collection is estimated to average
5 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.

SECTION A-REQUEST (To be completed by the Packer)
ORIGIN
1. ESTABLISHMENT NO.

3. DATE (Mo., day & year)

2. TIME TO BE SEALED
AM/
PM

4. METHOD OF SHIPMENT
AIR

RAIL

5. CAR OR TRUCK NO.

TRUCK

6. LOCATION (City & State)

DESTINATION
7. ESTABLISHMENT NO.

8. LOCATION (City & State)

9. PRODUCT
MARKED PRODUCT
NUMBER
PIECES

DESCRIPTION
GREEN WT.
CURED PRODUCT
B

POUNDS
A

UNMARKED MEAT/POULTRY
GREEN WT.
CURED PROPOUNDS
DUCT
H
I

CLASS

CUT OR PART

CURE

NUMBER
PIECES

C

D

E

F

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

10. TOTALS
CERTIFICATION
I certify that the above description is correct.
11. REASON FOR SHIPPING PRODUCTS UNDER SEAL

12. SIGNATURE OF ESTABLISHMENT EMPLOYEE

13. TITLE

14. DATE OF REQUEST

SECTION B - NOTIFICATION (To be completed by the Food Inspector)
15. TO: FOOD INSPECTOR AT DESTINATION ESTABLISHMENT

16. GOVT. SEALS (NUMBERS)

17. TIME REQUEST
TO SEAL WAS
REC'D

18. TIME
SEALED
AM/
PM

19. DATE AFFIXED ON
ABOVE CAR/TRUCK

20. SIGNATURE OF FOOD INSPECTOR

AM/
PM

NOTE: IF UPON ARRIVAL AT DESTINATION, BOTH OF THE SEALS MENTIONED ARE NOT INTACT, OR IF ONE OR BOTH OF THEM ARE MISSING, THE EXACT
FACTS, INCLUDING KIND AND AMOUNT OF MEAT/POULTRY IN THE CAR AND ITS DISPOSITION, SHOULD BE REPORTED OVER THE SIGNATURE OF THE
INSPECTOR IN CHARGE, ON THE BACK OF THIS SLIP, TO THE REGIONAL DIRECTOR WITHIN THE RECEIVING REGION.

FSIS FORM 7350-1 (09/09/2003)

REPLACES FSIS FORM 7350-1 (11/90), WHICH MAY BE USED
UNTIL EXHAUSTED.