PY-210S Shell Egg Grading Certificate

(See reverse side of form for OMB and EEO Statement)

FORM OMB APPROVED - NO. 0581-0128

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
POULTRY PROGRAMS

CERTIFICATE NO.

This certificate is receivable in all courts of the United States as
prima facie evidence of the truth of the statements therein
contained. This certificate does not excuse failure to comply
with any of the regulatory laws enforced by the United States
Department of Agriculture.

SHELL EGG
GRADING CERTIFICATE

SEAPLACE EXAMINED

PLANT NUMBER

TO: APPLICANT (Name and address, including ZIP)

LOT NO.

NO. OF
NO. OF
CONTAINERS CONTAINERS
EXAMINED
PER LOT 1/

NAME AND ADDRESS OF SHIPPER OR SELLER 1/

NAME AND ADDRESS OF RECEIVER OR BUYER 1/

PERCENTAGES
NET WT.
2/

U.S. OFFICIAL GRADE AND SIZE
AA

A

B

B*

Dirties

Checks

Loss

Under Wt.
3/

DESCRIPTION
LOT NO.
EGGS

TYPE OF PACKING

TYPE OF PACKAGING

CASE QUALITY CHARACTER
RANGE
OF LOSS

WHERE HELD AND
TEMPERATURE

CASES STAMPED WITH
Sample
All
Sample
All
Sample
All
Sample
All

ADDITIONAL CERTIFICATION

Product represented by this certificate meets specification requirements for:

Check each applicable box:

_______________________________________________________________________________________

Product represented on this certificate meets the requirements for the stated
grade and size as determined by online sampling on ____________________.

_______________________________________________________________________________________

Disease Free Certification Statements attached.

REMARKS

CERTIFICATION STATEMENT

In compliance with the Regulations of the Secretary of Agriculture Governing the Grading of Shell Eggs issued pursuant to the Agricultural Marketing Act of 1946, as amended, and any
other Act of Congress conferring like authority, it is certified that the product(s) listed hereon were examined and that the class, quality, quantity, and/ or condition of the product(s) at the
time and on the date shown, were as stated above.

__________________________________________________________________________________________________
OFFICIAL GRADER (Signature)
1/ As stated by applicant or contractor.
2/ Weights based on 30-dozen equivalent.
PY-210S (03-14) (Previous edition dated 03-10 may be used.)

_____________________________________________
DATE

3/ Eggs reported as undersized are also reported under other headings according to their quality.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
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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, age, disability, and where applicable, sex, marital status, familial status, parental
status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an
individual’s income is derived from any public assistance program. (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue,
S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.

PY-210S (03-14) (REVERSE)