Sanitary Certificate Request - China

Export Health Certificate Request Forms

Sanitary-China 100112

Export Certificates

OMB: 0581-0283

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Form approved OMB No. 0581-NEW


U. S DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REQUEST-CHINA


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. This valid OMB control number for this collection is 0581-NEW. The time required to complete this information collection is estimated to average 12 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 information.


  1. CONTACT NAME

     

MAIL CERTIFICATE TO:

  1. CUSTOMER NUMBER

     

7. COMPANY

     

  1. BILLING REFERENCE

     

8. CONTACT

     

  1. E-MAIL ADDRESS

     

9. STREET

     

  1. CONTACT PHONE

     

10. CITY

     

  1. FAX

     

11. STATE

     

12. ZIP

     

CONSIGNOR

13. NAME

     

14. ADDRESS

     

CONSIGNEE

15. NAME

     

16. ADDRESS

     

MANUFACTURER

17. NAME

     

18. CITY, STATE

     

19. PLANT NUMBER

     

SHIPMENT INFORMATION

20. DEPARTURE PORT

     

21. ENTRY PORT

     

22. TRANSPORT

     

23. SHIP NAME

     

24. CONTAINER NUMBER

     

25. SEAL NUMBER

     

IDENTIFICATION OF DAIRY PRODUCTS

26. DESCRIPTION OF COMMODITY

     

27. KIND OF HEAT TREATMENT (HTST; PAST.)

     

28. TYPE OF PACKAGING

     

29. NUMBER OF PACKAGING UNITS

     

30. NET WEIGHT

     

31. REQUIRED TEMPERATURE DURING STORAGE AND TRANSPORTATION

     

32. DATE PRODUCED

     

33. EXPIRATION DATE

     

24. SIGNATURE OF AGENT FOR APPLICANT



25. DATE

     

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.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKen Vorgert Chief, Dairy Grading BranchUSDA
File Modified0000-00-00
File Created2021-01-24

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