FGIS-993 Commodity Inspection 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-NOFO-1-03756

OFFICIAL WHITE CERTIFICATE

NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

ISSUED AT:

Original

DATE OF SERVICE:

DESTREHAN, LA

IDENTIFICATION:

August 01, 2007

LOCATION:

4962-8351/3832-11

QUANTITY: (this is NOT a weight certificate)

FOFO Import
Hialeah, FL

TYPE OF MOVEMENT:

76,670 Pounds

DATE SAMPLED:

METHOD OF SAMPLING:

Export

COMMODITY:

U. S. No. 3 Small Red Beans

RESULTS:

Contrasting Classes 0.0 %
Damaged Kernels Total 1.0 %
Moisture 12.5 %
Stones 0 %

Classes That Blend 0.2 %
Foreign Material Total 0.0 %
Splits 3.2 %
Total Defects 4.2 %

REMARKS:

Vendor's Count - Net Estimated 697 - 110 lb. bags loaded into the following
2 containers:
CMCU 209961-8
CMCU 209635-2
END OF REMARKS

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

APPLICANT NAME: Anderson Commodities, Inc.
ISSUING OFFICE:

NAME OR SIGNATURE: Kerry F. Petit

FGIS - New Orleans Field Office

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, 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 17 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