Form 89-819 Specification and label submittal action request

OMB Control #0648-266
Expires 7/31/2015

NOAA FORM 89-819
(07-15)
Prescribed by NOAA Inspection Manual

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
SEAFOOD INSPECTION PROGRAM

SPECIFICATION AND LABEL SUBMITTAL ACTION REQUEST
INSTRUCTIONS – Please print or complete by typewriter. Submit a set of
5 specifications and/or labels with each product label indicated on form.
All copies except field copy to be submitted to the address below for
action. Field copy to be retained by requestor until specifications and/or
labels are returned by Approving Officer.

1. DATE SUBMITTED

2. PLANT CODE(S)

3. PROCESSOR OR PACKER (Name, address and Phone Number)

4. DISTRIBUTOR (Name and full address)

TO: DOCUMENTATION APPROVAL and SUPPLY SERVICES
3209 Frederic Street
PASCAGOULA, MISSISSIPPI 39567
USDC No. (Item 5) to be assigned by Approving Officer. Indicate USDC Number of approved specifications or labels in Remarks when submitting
replacements with minor changes, or when submitting for verification or cancellation. Indicate primary logo, packer or distributor name, or other identification
for item 6. Use numbers only or item 9: 1 - No. Shield 2 - Combination Grade A & PUFI., 3 - PUFI Mark, 4 - Grade A, 5 - Lot Inspected Mark
5. USDC NUMBER
6. PRODUCT IDENTIFICATION 7. COMMODITY (Use official terminology including type, style and size;
8. CONTENT
9. SHIELD
indicate in ounces or count/pounds. Enter 10 digit commodity code)
OR
CODE
(Brand and identifying number if any)
(See Above)
LABEL
SPEC.
PRODUCT
COMMODITY CODE
NET WEIGHT

10. USDC INSPECTOR (Signature)

Inspector Number

HACCP

COMPANY OFFICIAL (Signature)

11. HAVE SPECIFICATIONS AND/FOR LABELS BEEN
REVIEWED FOR COMPLIANCE WITH USDC AND FDA
REGULATIONS?
BY INSPECTOR?
BY FIELD INSPECTION OFFICER?
YES
NO
YES
NO

12. ACTION REQUESTED
LABEL/SPEC. REVIEW
NEW LABEL SKETCH/PROOF REVIEW
NEW SPEC. APPROVAL (FINAL)
REPLACEMENT SPEC. OR LABEL
USDA/FNS (CN) LABEL OR SPECS ACTION

NEW LABEL APPROVAL (FINAL)
CANCEL APPROVAL
OTHER (SPECIFY IN REMARKS)
EXTEND TEMPORARY APPROVAL (SPECIFY IN REMARKS)

APPROVAL BY THE USDC IS BASED ON THE INFORMATION SUPPLIED AND DOES NOT IMPLY CONCURRENCE FOR ACCEPTANCE BY OTHER
FEDERAL, STATE FOR LOCAL GOVERNMENTAL AGENCIES UNLESS SPECIFICALLY NOTED, NOR DOES IT RELIEVE THE COMPANY FROM
COMPLIANCE WITH OTHER APPLICABLE LAWS, REGULATIONS OR RULINGS. THIS APPROVAL BECOMES VOID IF CHANGES ARE MADE IN THE
SPECIFICATION OR LABEL WITHOUT THE CONCURRENCE OF THE USDC APPROVING OFFICER.
13. REMARKS (Please initial)

TO BE COMPLETED BY APPROVING OFFICE(S) ONLY
PROOF APPROVED FOR PRINTING
AS IS WITH CHANGES NOTED
Temporary Approval Expires
(Spec)
(Label)
Final Approval Label
Final approval Spec.
Disapproved label
Disapproved Spec.
Extends Approval
Cancelled
Reviewed

APPROVING OFFICER (Signature)
USDA/FNS USE ONLY
SKETCH/PROOF
LABEL
USDA APPROVAL (Signature)

DATE:

CONCURRENCE

NON-CONCURRENCE
DATE: