FGIS-994 Commodity Inspection Certificate - Submitted Sample

Reporting and Recordkeeping Requirements (US Grain Standards Act and Agricultural Marketing Act of 1946)

fgis-994

Reporting and Recordkeeping Requirements - State, Local, Tribal

OMB: 0581-0309

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FORM FGIS-994
JAN 07

UNITED STATES DEPARTMENT OF AGRICULTURE

Approved OMB No. 0580-0013

FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
ORIGINAL

COMMODITY SUBMITTED SAMPLE INSPECTION

US-NOFO-1-03110

OFFICIAL PINK CERTIFICATE

NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

Original

ISSUED AT:

DATE OF SERVICE:

DESTREHAN, LA

July 20, 2007

IDENTIFICATION:

M/V ZAIRA

NOT OFFICIALLY SAMPLED
COMMODITY:

Corn Gluten Feed Pellets

RESULTS:

Moisture 11.0 %
REMARKS:

This sample of Corn Gluten Feed conforms to a maximum 28 percent starch, 4.5 percent fat, and 40 percent protein
on a dry matter basis.
END OF REMARKS

The sample identification and inspection results shown on this certificate are assigned only to the quantity in the sample and not to any identified carrier, container, or lot from which the sample may have been taken.
I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: Archer Daniels Midland Co.
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 83.206 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

FORM FGIS-994
JAN 07

UNITED STATES DEPARTMENT OF AGRICULTURE

Approved OMB No. 0580-0013

FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
COPY

COMMODITY SUBMITTED SAMPLE INSPECTION

US-NOFO-1-03110

OFFICIAL PINK CERTIFICATE

NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

Original

ISSUED AT:

DATE OF SERVICE:

DESTREHAN, LA

July 20, 2007

IDENTIFICATION:

M/V ZAIRA

NOT OFFICIALLY SAMPLED
COMMODITY:

Corn Gluten Feed Pellets

RESULTS:

Moisture 11.0 %
REMARKS:

This sample of Corn Gluten Feed conforms to a maximum 28 percent starch, 4.5 percent fat, and 40 percent protein
on a dry matter basis.
END OF REMARKS

The sample identification and inspection results shown on this certificate are assigned only to the quantity in the sample and not to any identified carrier, container, or lot from which the sample may have been taken.
I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: Archer Daniels Midland Co.
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 83.206 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

FORM FGIS-994
JAN 07

UNITED STATES DEPARTMENT OF AGRICULTURE

Approved OMB No. 0580-0013

FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
COPY

COMMODITY SUBMITTED SAMPLE INSPECTION

US-NOFO-1-03110

OFFICIAL PINK CERTIFICATE

NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

Original

ISSUED AT:

DATE OF SERVICE:

DESTREHAN, LA

July 20, 2007

IDENTIFICATION:

M/V ZAIRA

NOT OFFICIALLY SAMPLED
COMMODITY:

Corn Gluten Feed Pellets

RESULTS:

Moisture 11.0 %
REMARKS:

This sample of Corn Gluten Feed conforms to a maximum 28 percent starch, 4.5 percent fat, and 40 percent protein
on a dry matter basis.
END OF REMARKS

The sample identification and inspection results shown on this certificate are assigned only to the quantity in the sample and not to any identified carrier, container, or lot from which the sample may have been taken.
I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: Archer Daniels Midland Co.
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 83.206 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

FORM FGIS-994
JAN 07

UNITED STATES DEPARTMENT OF AGRICULTURE

Approved OMB No. 0580-0013

FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
COPY

COMMODITY SUBMITTED SAMPLE INSPECTION

US-NOFO-1-03110

OFFICIAL PINK CERTIFICATE

NOT NEGOTIABLE

EXAMPLE ONLY – NOT FOR OFFICIAL USE
LEVEL OF INSPECTION:

Original

ISSUED AT:

DATE OF SERVICE:

DESTREHAN, LA

July 20, 2007

IDENTIFICATION:

M/V ZAIRA

NOT OFFICIALLY SAMPLED
COMMODITY:

Corn Gluten Feed Pellets

RESULTS:

Moisture 11.0 %
REMARKS:

This sample of Corn Gluten Feed conforms to a maximum 28 percent starch, 4.5 percent fat, and 40 percent protein
on a dry matter basis.
END OF REMARKS

The sample identification and inspection results shown on this certificate are assigned only to the quantity in the sample and not to any identified carrier, container, or lot from which the sample may have been taken.
I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: Archer Daniels Midland Co.
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 83.206 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


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File Modified2011-04-22
File Created2011-04-22

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