PPQ 579 Phytosanitary Certificate for Reexport

FORM APPROVED
OMS NO. 0519-0052
and 0510-0055
EXPDATEXX/XXJ/Y.

See reverse for additional 0MB information.

No phytosanitary certificate can be issued until an application is completed (7 CFR 353)

FOR OFFICIAL USE ONLY

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

PHYTOSANITARY CERTIFICATE
FOR REEXPORT

PLACE OF ISSUE

NO.:

FPC

TO: THE PLANT PROTECTION ORGANIZATION(Sl OF

-R

CERTIFICATION
This is to certify that the plants or plant products described below were imported into the United States from (Country of origin)
covered by Phytosanitary Certificate
certified true copy
original
of which is attached to this certificate. That they are
repacked
packed
in original
in new containers, that
based on the
original Phytosanitary Certificate
and additional inspection, they are considered to conform with the current phytosanitary
regulations of the importing country, and that during storage in the United States, the consignment has not been subjected to the risk of infestation or infection.

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0

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DISINFESTATION AND/OR DISINFECTION TREATMENT
1. DATE

2. TREATMENT

3. CHEMICAL (active ingredient)

4. DURATION AND TEMPERATURE

5. CONCENTRATION

6. ADDITIONAL INFORMATION

DESCRIPTION OF THE CONSIGNMENT
7. NAME AND ADDRESS OF THE EXPORTER

8. DECLARED NAME AND ADDRESS OF THE CONSIGNEE

9. NAME OF PRODUCE AND QUANTITY DECLARED

10. BOTANICAL NAME OF PLANTS

11. NUMBER AND DESCRIPTION OF PACKAGES

12. DISTINGUISHING MARKS

13. PLACE OF ORIGIN

14. DECLARED MEANS OF CONVEYANCE

15. DECLARED POINT OF ENTRY

WARNING: Any alteration, forgery, or unauthorized use of this phytosanitary certificate is subject to civil penalties of up to $250,000 (7 U.S.C. Section 7734(b)) or punishable by a
fine of not more than $10,000, or imprisonment of not more than 5 years, or both (18 U.S.C. Section 1001).

ADDITIONAL DECLARATION

16. DATE ISSUED

17. NAME OF ALJTHORIZED OFFICER

(Type or Print)

18. SIGNATURE OF AUTHORIZED OFFICER

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 579

FEB 2001

Previous editions are obsol'ete after 6130/01

According to the Pape,wo,k 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 ii displays a valid 0MB control
number. The valid 0MB control numbers for these information collections are 0579-0052 and 0579-0055. The time required to complete these information collectlons is estimated to average 0.5 hours
per response. including the lime for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

PPO FORM 579 (Reverse)