PPQ 571 District of Columbia Plant Health Certificate

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 0579-0088. The time required to
complete this information collection is estimated to average 15 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

DISTRICT OF COLUMBIA PLANT HEALTH CERTIFICATE

OMB Approved
0579-0088
Exp. XX/XXXX

1. CERTIFICATE

2. LOCATION

3. INSPECTION

4. SERIAL NUMBER

This is to certify that the plants or plant products described below have been inspected according to appropriate procedures and are
apparently free from quarantine pests, and practically free from other injurious pests; and that they are considered to conform with
the current phytosanitary regulations of the importing State or territory of the United States.
DISINFESTATIONS AND/OR DISINFECTION TREATMENT

5. Date

6. Treatment

8.

9. duration and temperature

11. NAME AND ADDRESS OF THE SHIPPER

7. chemical (active ingredient)

10. additional information

DESCRIPTION OF THE CONSIGNMENT

12. DECLARED NAME AND ADDRESS OF THE CONSIGNEE

13. name of produce, quantity declared, and botanical name

14. NUMBER AND DESCRIPTION OF PACKAGES

15. DISTINGUISHING MARKS

16. PLACE OF ORIGIN

17. ADDITIONAL DECLARATION

18. PRINTED NAME OF AUTHORIZED OFFICER

19. AUTHORIZED SIGNATURE

No liability shall attach to the United States Department of Agriculture or to any officer or representative of the Department with respect to
this certificate
PPQ FORM 571
Previous editions are obsolete.
JUNE 2010