9060-5EP Egg Products Export Certificate

OMB Control Number 0583-0153
Expiration Date:
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 0583-0153. The time required to complete this information collection
is estimated to average 25 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.

U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE
FIELD OPERATIONS
EGG PRODUCTS EXPORT CERTIFICATE OF
WHOLESOMENESS
1. DISTRICT OFFICE

2. COUNTRY OF DESTINATION

A knowingly false entry or alteration of any entry on the certificate may
result in a fine of not more than $10,000 or imprisonment for not more
than five years or both (18 USC 1001). Additional Prohibited Acts and
Penalties exist under the Egg Product Inspection Act [21 USC 1037 (e)
(2), (3), and (6), 21 USC 1041] for an unauthorized or false alteration or
misuse of this certificate.

EPB-

3. EXPORTED BY(Applicant's Name and Address including ZIP Code)

PRODUCT EXPORTED FROM
7. EST. / PLANT NUMBER (if applicable)
8. CITY

4. CONSIGNED TO 1 (Name and Address including ZIP Code)

9.

WAREHOUSE
PROCESSING PLANT
OTHER (Please Specify)

5. TOTAL MARKED NET WEIGHT

6. TOTAL CONTAINERS

10.
PRODUCT AS LABELED

11.
MARKED WEIGHT
OF LOT¹

12.
NUMBER OF
PACKAGES
IN LOT¹

13.
SHIPPING MARKS / LOT NUMBER ¹

14.
EST. / PLANT NUMBER
ON
PRODUCT

¹As stated by the applicant or contractor
15. REMARKS

16. I CERTIFY that the egg products specified on this form have been inspected and passed in accordance with the applicable laws and regulations
of the United States Department of Agriculture and are wholesome and fit for human consumption.
NOT VALID UNLESS SIGNED BY A FSIS INSPECTOR
By order of the
Secretary of Agriculture

17. INSPECTOR AND DISTRICT

18. Date Signed (MM/DD/YYYY)

This certificate is receivable in all courts of the United States as prima facie evidence of the truth of the statement herein contained.
This certificate does not excuse failure to comply with any of the regulatory laws enforced by the United States Department of Agriculture.
FSIS FORM 9060-5EP (Edition date - 03/09/2020)

ORIGINAL

DISTRIBUTION:

ORIGINAL
DUPLICATE
TRIPLICATE
QUADRUPLICATE