LP-210S Shell Egg Grading Certificate

(See reverse side of form for OMB and EEO Statement)

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
Livestock and Poultry Program

SHELL EGG
GRADING CERTIFICATE
APPLICANT (Name and address, including ZIP)

LOT
NO.

NO.
CONTAINERS
PER LOT 1/

LOT
NO.

EGGS

NO.
CONTAINERS
EXAMINED

This certificate 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 any of the
laws and regulations enforced by the United States
Department of Agriculture.

NAME AND ADDRESS OF SHIPPER OR SELLER 1/

NET WT.
2/

AA

A

B

B*

Dirties

CASE QUALITY
RANGE

TYPE OF PACKAGING

Product represented by this certificate meets specification requirements for:

PLACE EXAMINED
PLANT NUMBER

NAME AND ADDRESS OF RECEIVER OR BUYER 1/

____________________________________ Dated ___________________
SALES ORDER #

Checks

CHARACTER
OF LOSS

Loss

Under Wt.
3/

WHERE HELD AND
TEMPERATURE

OFFICIAL U.S. GRADE AND SIZE

CASES STAMPED WITH

ADDITIONAL CERTIFICATION

___________________________________________________________
PURCHASE ORDER #

SEA-

PERCENTAGES

DESCRIPTION
TYPE OF PACKING

OMB APPROVED: NO. 0581-0128
CERTIFICATE NO.

ITEM #

Product represented on this certificate meets the requirements for the stated grade

and size as determined by online sampling on ____________________

______________________________________________

Disease Free Certification Statements attached.

REMARKS:

CERTIFICATION STATEMENT

In compliance with the Regulations of the Secretary of Agriculture Governing the Grading of Shell Eggs issued pursuant to the Agricultural Marketing Act of 1946, as amended, and any other Act of Congress
conferring like authority, it is certified that the product(s) listed hereon were examined and that the class, quality, quantity, and/ or condition of the product(s) at the time and on the date shown, were as stated above.

___________________________________________________________________________________________
OFFICIAL GRADER (Printed Name & Signature)

1/ As stated by applicant or contractor.

2/ Weights based on 30-dozen equivalent.

LP-210S (XX/20XX) (Previous LPS-210S editions may be used.)

_________________________________________
DATE

3/ Eggs reported as undersized are also reported under other headings according to their quality.

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 0581-0128. The time required to complete this information collection is estimated to
average 3 minutes 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of
race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status,
religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape,
etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination,
write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call
(800) 795-3272 (voice) or (202) 720-6382 (TDD).
USDA is an equal opportunity provider, employer, and lender.

LP-210S (XX/20XX) Reverse