Ppq Form 572 - Application For Inspection And Certification Of Domestic Plants 1981
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1FORM APPROVED
No Phytosanitary Export Certificate can be issued until an application is completed (7 CFR 353).
OMB No. 0579-0052
U.S. DEPARTMENT OF AGRICULTURE
INSTRUCTIONS: APPLICANT-Forward original to
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
Officer In Charge where inspection, treatment and
PLANT PROTECTION AND QUARANTINE
certification will be given (Item 4). Complete items 1 thru
APPLICATION FOR INSPECTION AND CERTIFICATION OF DOMESTIC PLANTS
11. OFFICER – Complete items 12 thru 17.
AND PLANT PRODUCTS FOR EXPORT
1. NAME AND ADDRESS OF EXPORTER
3. NAME AND ADDRESS OF APPLICANT (or exporters agent)
2. NAME AND ADDRESS OF FOREIGN CONSIGNEE
4. PLACE WHERE ARTICLES WILL BE MADE AVAILABLE FOR INSPEC-
TION AND/OR TREATMENT AND CERTIFCATION (Port and Location)
5.APPROXIMATE DATE OF DEPARTURE
6. PORT OF EXPORT
7. DESCRIPTION OF ARTICLES TO BE CERTIFIED
a.
QUANTITY AND NAME
OF PRODUCE AND
BOTANICAL NAME
b.
NUMBER AND
DESCRIPTION OF
PACKAGES
c.
DISTINGUISHING
MARKS
d.
CERTIFIED
ORIGIN
8. DECLARED MEANS OF CONVEYANCE
I certify that the origin (place where grown) of the articles listed is as
represented.
9. DELARED POINT OF ENTRY
)
10. SIGNATURE (applicant or exporters agent
11. DATE
EXPORT INSPECTION DATA – (To be filled in by Plant Protection and Quarantine Officer)
12. LOCATION OF ARTICLES
13. % OF MATERIALS EXAMINED
14. % OF MATERIALS INFESTED
(Use reverse if necessary
15. FINDINGS AND/OR TREATMENT GIVEN
)
16. SIGNATURE
17. DATE AND TIME INSPECTED
PPQ FORM 572
Replaces PPQ FORM 572 (AUG 74) which may be used
(FEB 81)
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