Ppq Form 525 - Application And Permit To Move Soil 1979
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1U.S. DEPARTMENT OF AGRICULTURE
INSTRUCTIONS TO APPLICANT: Complete Items
DO NOT USE
ANIMAL AND PLANT HEALTH INSPECTOR SERVICE
1 thru 21. Use reverse for continuation if needed.
APPLICATION AND PERMIT TO MOVE SOIL
FORWARD THIS APPLICATION TO:
1. NAME AND ADDRESS OF APPLICANT (Include ZIP Code)
U.S. Department of Agriculture
Animal and Plant Health Inspection Service
Plant Protection and Quarantine Programs (PPQ)
Federal Building
Hyattsville, Maryland 20782
2. TYPE OF SOIL
3. COUNTRY
4. DEPTH
5. NUMBER
6. APPROX.
7. WILL HEAT STERILIZATION OF SOIL
OF ORIGIN
TAKEN FROM
OF SAMPLES
WEIGHT OF
(before its release to you) INTERFERE
SURFACE
EACH
WITH ITS INTENDED USE?
NO (if NO, check preferred treatment)
A.
Dry Heat
Steam Heat
B.
YES, (if YES, item 19 must be signed
by the Head of the Laboratory
C.
receiving the soil.)
8. NUMBER OF SHIPPING CONTAINERS
9. METHOD OF PACKAGING SOIL
10. METHOD OF SHIPMENT
11. SHIPPED BY
12. PORT OF ARRIVAL
13. DATE OF ARRIVAL
Mail
Cargo
Baggage
Air
Surface
14. destination where soil will be used (City & State)
15. ARE OTHER IMPORTATIONS CONTEMPLATED WITHIN THE
NEXT TWO YEARS?
Yes
No
16. IS SOIL TO BE USED AS GROWING MEDIUM?
Yes
No (if NO, state intended use)
17. PRECAUTIONS TO BE USED TO PREVENT PLANT PEST DISSEMINATION
18. METHOD OF FINAL DISPOSITION (Autoclaving, incineration, or other)
19. SIGNATURE OF APPLICANT OR AGENT (Laboratory Head sign
20. TELEPHONE NUMBER
21. DATE
if you checked YES in item 7.)
TO BE COMPLETED BY STATE REGULATORY OFFICIAL
COMMENTS
SIGNATURE (Or verbal approval
)
TITLE
DATE
TO BE COMPLETED BY PLANT PROTECTION AND QUARANTINE PROGRAMS
FEDERAL PERMIT: Under authority of the Federal Plant Pest Act of May 23, 1957, permission is hereby granted to the applicant named above to
move the soil described, subject to the following ocnditions (Items 1-21 above are conditions of this permit, exept as indicated below):
1.
Valid for shipments of soil not heat treated at port of entry, only if a Compliance Agreement (PPQ Form 519) has been completed and
Signed, and if this permit is countersigned by a field Plant Protection and Quarantine Officer.
PERMIT NO.
VALID
NO. LABELS ISSUED
SIGNATURE OF PPQ OFFICIAL – PERMIT UNIT
DATE
SIGNATURE OF PPQ OFFICIAL – FIELD
DATE
PPQ Form 525
Previous editions may be used
(JUL 79)
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