Form PPQ 519 PPQ 519 Compliance Agreement

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 numbers for this information collection are 0579-0054, 0088, 0129, 0155, 0257, 0310, 0312,
0317, 0322, 0337, 0346, 0363, and 0383. The time required to complete this information collection is estimated to average 1.25 hours 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE
1. NAME AND MAILING ADDRESS OF PERSON OR FIRM

OMB APPROVED:
0579-0054/0088/0129/
0155/0257/0310/0312/
0317/0322/0337/0346/
0363/0383

COMPLIANCE AGREEMENT
2. LOCATION

3. REGULATED ARTICLE(S)

4. APPLICABLE FEDERAL QUARANTINE(S) OR REGULATIONS

5. I / WE AGREE TO THE FOLLOWING:

The United States Department of Agriculture, Animal and Plant Health Inspection Service, Plant Protection and
Quarantine will permit your Establishment to execute the regulatory requirements outlined in 7 Code of Federal
Regulations (CFR) Part 301.40-6. This agreement becomes effective upon signing and shall remain in effect
until canceled by either party after 30 days notice to the other at the address of either appearing above.
However, the Department may accelerate the notice to ‘immediate for cause’ including but not limited to the
Establishment’s abandonment of the prescribed procedures. The Establishment assumes liability, if any, arising
from the manner in which the Establishment sells, handles, or distributes any regulated host material.
NOTICE: Any signatory, or employee of any signatory, who violates the terms of this compliance agreement
may be subject to civil penalties pursuant to 7 CFR Part 301.46, and the Plant Protection Act of 2000.

6. SIGNATURE

7. TITLE

8. DATE SIGNED

9. AGREEMENT NO.

The affixing of the signatures below will validate this agreement which shall remain in
effect until canceled, but may be revised as necessary or revoked for noncompliance.

11. PPQ/CBP OFFICIAL (NAME AND TITLE)

12. ADDRESS

13. SIGNATURE

14. U.S. GOVERNMENT/STATE AGENCY OFFICIAL (NAME AND TITLE)

16. SIGNATURE

PPQ FORM 519 (OCT 2010)

Previous editions are obsolete

15. ADDRESS

10. DATE OF AGREEMENT