FGIS 993 Commodity Inpection Certificate

FORM FGIS-993
JAN 07

Approved OMB No. 0580-0013

UNITED STATES DEPARTMENT OF AGRICULTURE
FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
ORIGINAL

COMMODITY INSPECTION CERTIFICATE

US-MWFO-1-00233

OFFICIAL WHITE CERTIFICATE

NOT NEGOTIABLE

LEVEL OF INSPECTION:
Original

ISSUED AT:
MOSCOW, ID

DATE OF SERVICE:
May 07, 2007

IDENTIFICATION:
VEP 776688

LOCATION:

QUANTITY: (this is NOT a weight certificate)
174,864 Pounds

Moscow, ID
TYPE OF MOVEMENT:
Out

COMMODITY:

DATE SAMPLED:
May 07, 2007

METHOD OF SAMPLING:
Bag Trier

U. S. No. 2 Pinto Beans

RESULTS:
Foreign Material Total 0.1 %
Splits 3.1 %
Moisture 11.9 %

Contrasting Classes 0.2 %
Defects 3.9 %
Damaged Kernels 0.2 %

REMARKS:
1400 - Kg poly bags.
Lot code 203.
Average net weight per container 109.29 lbs.
Quantity is estimated.
Checkloaded 1400, carrier VEP 776688, on May 7, 2007, seals applied BNSF 72541-42.
This lot meets U. S. Standards for Condition for Food Containers.
END OF REMARKS

I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: ABC Bean Company
ISSUING OFFICE:

NAME OR SIGNATURE: Diane K Palecek

FGIS - Moscow Suboffice

This certificate is issued under the authority of the Agricultural Marketing Act of 1946, as amended (7 U.S.C. 1621 et seq.), and the regulations thereunder (7 CFR 868.1 et seq.), and 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 the provisions of the Federal Food, Drug, and Cosmetic Act, or other Federal Laws.
WARNING: Sec. 203(h) of the Agricultural Marketing Act of 1946 provides that anyone who shall knowingly falsely make, issue, alter, forge, or counterfeit any official certificate, or aid, assist, or be party to such actions, is
subject to a fine of not more than $1000 or imprisonment for not more than 1 year, or both. The conduct of all services and the licensing of personnel under the regulations governing such services shall be accomplished without
discrimination as to race, color, religion, sex, national origin, age, or handicap.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information is 0580-0013. The time
required to disclose this recordkeeping requirement is to average 17 hours per recordkeeper annually, including the time to retain such records, and to notify, disclose, and report to third parties such recordkeeping requirements.