LPS-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
LIVESTOCK, POULTRY, AND SEED PROGRAM

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 laws and regulations enforced by the United
States Department of Agriculture.

SHELL EGG
GRADING CERTIFICATE

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

SEA-

PLACE EXAMINED

PLANT NUMBER

APPLICANT (Name and address, including ZIP)

LOT NO.

CERTIFICATE NO.

NAME AND ADDRESS OF SHIPPER OR SELLER 1/

NET WT.
2/

NAME AND ADDRESS OF RECEIVER OR BUYER 1/

PERCENTAGES
AA

A

B

B*

Dirties

Checks

Loss

Under Wt.
3/

U.S. OFFICIAL GRADE AND SIZE

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 (Printed Name & Signature)
1/ As stated by applicant or contractor.
2/ Weights based on 30-dozen equivalent.

_____________________________________________
DATE

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

LPS-210S (05/2017) (Previous PY-210S editions may be used.)

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 0581-0128. The time required to complete this information
collection is estimated to average 3 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.
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, employer, and lender.

LPS-210S (05/2017) Reverse