DA-244 Sanitary Certificate Request - Chile

Form
U. S DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

SANITARY CERT!FICATE REqUEST

OMB No.0581-0283

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 0581-0283. 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.

0 Additional copiesFaxed certificateChile
I acknowledge that by checking this box that the information provided is factual and accurate.
MAILING INFORMAT!ON
CONTACT INFORMATION

'additional chargesapprv

TYPE

1. CONTACT NAME

7. COMPANY

2. AMS BILLING ACCT.

8. CONTACT

3. BILLING REFERENCE

9. STREET

4. E-MAIL

10. CITY

ADDRESS

5. CONTACT PHONE

11. STATE

6. FAX

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CONSIGNOR

13. NAME
14. ADDRESS
15. CITY/STATE
CONSIGNEE

16. NAME
17. ADDRESS
CL
18. COUNTRY CODE
IDENTIFICATION OF DAIRY PRODUCTS

19. DESCRIPTION OF COMMODITY
20. KIND OF HEAT TREATMENT (HTST; PASTEURIZED)
21. TYPE OF PACKAGING

22. NUMBER OF PACKAGING UNITS
23. NET WEIGHT

tb

24. REQUIRED TEMPERATURE DURING STORAGE AND
TRANSPORTATION

25. EXPIRATION DATE
MANUFACTURER

26. PLANT NUMBER
SHIPMENT INFORMATION
27. TRANSPORT TYPE

28. PLACE OF ORIGIN

29. CONTAINER NUMBER
31. SEAL NUMBER
SIGNATURE (for foxed or mailed copies)

30. TRANSPORT NAME

32. DATE

**For fastest processing, please attach this form and a
DA-244

PDF

shipping label in an emailto [email protected].

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prograrnoractivityconductedorfundedbyUSDA(notall basesapplytoall programs) Remediesmdcomplaintfilingdeadlinesvarybyprogramorincident

may be made available in languages other than English

9410;(2)fax:(202)690-7442,or(3)email:[email protected]

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