FGIS-915 Official Stowage Examination Certificate

FORM FGIS-915
JAN 07

Approved OMB No. 0580-0013

UNITED STATES DEPARTMENT OF AGRICULTURE
FEDERAL GRAIN INSPECTION SERVICE

CORRECTED
ORIGINAL

OFFICIAL STOWAGE EXAMINATION CERTIFICATE

US-NOFO-1-03934
NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

ISSUED AT:

Original

DATE OF SERVICE:

DESTREHAN, LA

IDENTIFICATION:

August 04, 2007

LOCATION:

M/V TENSHOU MARU

Belle Chasse Anchorage
Belle Chasse, LA

FINISH TIME:

11:00

REMARKS:

TYPE OF INSPECTION: USGSA
STOWAGE AREA EXAMINED: Hold Nos. 1,2,3,4,5.
RESULTS: Stowage area examined on the above date and found to be
substantially clean, dry, free of insect infestation, and suitable to store
or carry grain or commodity.
This certificate is corrected as to Identification and supersedes certificate
no. US-NOFO-1-03927 dated 08/04/07.

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

APPLICANT NAME: Southport Agencies Inc.
ISSUING OFFICE:

NAME OR SIGNATURE: Kerry F. Petit

FGIS - New Orleans Field Office

This certificate is issued under the authority of the United States Grain Standards Act, as amended (7 U.S.C. 71 et seq.), and the regulations thereunder (7 CFR 800.0 et seq.) or the Agricultural Marketing Act of 1946, as amended (7 U.S.C.
1621 et seq.), and regulations thereunder (7 CFR 868.1 et seq.), as appropriate. It is issued to show the condition of a carrier or container for the storage or transportation of grain or commodity. The statements on the certificate are considered
true at the time and place the inspection service was performed. If this certificate is not canceled by a superseding certificate, it is receivable by all officers and all courts of the United States as prima facie evidence of the truth of the facts stated
therein. This certificate does not excuse failure to comply with the provisions of the Federal Food, Drug, and Cosmetic Act, or other Federal Law.
WARNING: Any person who shall knowingly falsely make, issue, alter, forge, or counterfeit this certificate, or participate in any such actions, or otherwise violate provisions in the U.S. Grain Standards Act, the Agricultural
Marketing Act of 1946, or related Federal laws is subject to criminal, civil, and administrative penalties. 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, 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 0580-0013. The time required to complete this information collection is estimated to average 55.189 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.

EXAMPLE ONLY – NOT FOR OFFICIAL USE