Form VS 13-17 VS 13-17 Swine Health Protection Act

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OMB Approved
0579-0065
EXP. Date
XX/XXXX

SWINE HEALTH PROTECTION ACT
COMPLETE THIS FORM IF YOU BELIEVE FOOD SCRAPS ARE BEING TAKEN FROM FOOD SERVICE FACILITIES TO BE FED TO LIVESTOCK AND POULTRY IN
VIOLATION OF ORS 600.010 TO 600.110. PLEASE PROVIDE ACCURATE INFORMATION AND RETURN THE SECOND COPY (POST CARD) OF THIS FORM.

FOOD SCRAPS FROM ___________________________________________________________ARE BEING TAKEN BY PERSONS OTHER THAN
(FACILITY NAME)
A LICENSED GARBAGE COLLECTION SERVICE. IT IS POSSIBLE THAT THESE FOOD SCRAPS ARE BEING FED TO LIVESTOCK AND POULTRY.

__________________________________________
(FACILITY CONTACT PERSON)

PERSONS PICKING UP GARBAGE
______________________
1.__________________________________________
____________________
(DATE)
(NAME)
(TELEPHONE)

__________________________________________
(TELEPHONE NUMBER)

USDA, APHIS, VETERINARY SERVICES
530 CENTER ST., NE, SUITE 335
SALEM, OREGON 97301
(503) 399-5871

(TEAR OFF TOP COPY FOR YOUR RECORDS)
VS FORM 13-17
JUN 2011

____________________________________________________________________
(ADDRESS)
(CITY)
(STATE)

2.__________________________________________
(NAME)

____________________
(TELEPHONE)

____________________________________________________________________
(ADDRESS)
(CITY)
(STATE)

UNITED STATES DEPARTMENT OF AGRICULTURE
Animal and Plant Health Inspection Service
VETERINARY SERVICES
SUITE 335 EQUITABLE BUILDING
530 CENTER STREET, N.E.
SALEM, OREGON 97301
___________

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UNITED STATES

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PENALTY FOR PRIVATE USE, $300

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PERMIT NO. 4377

RIVERDALE, MD

USDA, APHIS, VETERINARY SERVICES
530 CENTER STREET, N.E., SUITE 335
SALEM, OREGON 97301