Form PPQ 518 PPQ 518 Report of Violation

Domestic Quarantine Regulations

PPQ 518 (SEP 2011) Secure

Private Sector

OMB: 0579-0088

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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 is 0579-0088. The time required
to complete these information collections is estimated to average 1.00 hour 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.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

OMB Approved
0579-0088
EXP XX/XXXX

SERIAL NO.
1. DATE VIOLATION DISCOVERED

REPORT OF VIOLATION

2. VIOLATED - REG/COMPL. AGREEMENT

3. WHERE INTERCEPTED (City or Port, and State; also county if domestic)

4. ORIGIN OF ARTICLE (Include county, if domestic)

5. ARTICLE MOVED IN VIOLATION OF REGULATIONS

6. IDENTITY OF ARTICLE (Serial No., Waybill No., Description, etc.)

7. NAME AND BUSINESS ADDRESS OF VIOLATOR (Shipper, caterer, cleaner, garbage
handler,
servicing agent, broker, ship's agent, etc. Identify which)

8. VIOLATOR HAD
COMPLIANCE
AGREEMENT?

YES

Permit?

NO

YES

NO

9. IF NO, WAS VIOLATOR AWARE OF REGULATION?

YES

NO

UNKNOWN

IF "YES,"HOW INFORMED AND WHEN?

10. NAME AND BUSINESS ADDRESS OF CARRIER

11. WAS CARRIER AWARE OF REGULATION?

YES

NO

UNKNOWN

IF "YES," HOW INFORMED AND WHEN?

12. IDENTITY OF CARRIER

13. NAME AND BUSINESS ADDRESS OF CONSIGNEE

PLANE AIRCRAFT NUMBER

FLIGHT NUMBER

SHIP FLAG

NAME

ROAD VEHICLE License No.
14. DISPOSITION OF PEST RISK (i.e., articles named in Item 5 were fumigated, destroyed, etc.)

15. REMARKS (Attach additional sheet, if needed)

16. VIOLATOR OR CARRIER'S STATEMENT OF VIOLATION (Attach additional sheet, if needed. Identify who gave statement.)

17. OFFICER'S STATEMENT: Must attach a detailed, signed, and dated statement. State how the action violated the regulations or compliance agreement cited in
Item 2. Describe fully the facts of the violation from discovery through disposition of pest risk including when, who, what, and where.
18. SIGNATURE OF INITIATING OFFICER

19. PRINTED NAME OF OFFICER AND WORK UNIT

20. DATE REPORT COMPLETED

21. OFFICER IN CHARGE COMMENTS (Attach additional sheet, if needed)
LIST PREVIOUS VIOLATIONS
RECOMMENDATIONS

22. SIGNATURE OF OFFICER IN CHARGE

PPQ FORM 518
SEP 2011

23. PRINTED NAME OF OFFICER IN CHARGE AND WORK UNIT

Previous editions are obsolete

24. DATE SIGNED


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