Da Form 7539 - Request For Veterinary Laboratory Testiong & Food Sample Record

ADVERTISEMENT

REQUEST FOR VETERINARY LABORATORY TESTING & FOOD SAMPLE RECORD
For use of this form, see AR 40-657; the proponent agency is OTSG.
1. FROM:
2. POINT OF CONTACT:
3. CONTROL NUMBER:
Name:
4. TO:
VETCOM FADL
Phone:
Station Identification Number:
VLE
BAHRAIN
-
HAWAII
KOREA
(Name, Address and Phone):
5. PRODUCER/MANUFACTURER
ESTABLISHMENT # / PLANT CODE (IMSL, USDA, etc.)
VC #
Sanitation Audits
6. REASON FOR SUBMISSION:
Suspected foodborne illness
Destination monitoring program
Initial
(contact laboratory prior to submission)
Suspected foreign material/object
Special
Contract compliance
Customer return/complaint
Directed routine
Proximate analysis
(provide synopsis of incident/problem and local
inspection results in the Remarks section below).
Routine
OTHER
(Specify):
7. SAMPLES SELECTED FROM:
8. DATE SAMPLE(S) SELECTED:
thru
DECA
MWR
PLANT
9. SHIPMENT TEMPERATURE CONDITIONS:
Exchange
Exchange vendor
Prime vendor
Room temperature
Commercial establishment
Frozen
Chilled - include 1 temperature pilot per shipping container
OTHER:
10. INSPECTOR'S SIGNATURE
11. ACCOUNTABLE OFFICER'S SIGNATURE
12. REMARKS
(use additional paper if necessary):
FOR LABORATORY USE ONLY
SHIPPING CARRIER TRACKING NUMBER:
LABORATORY REPORT NUMBER:
RECEIVED:
SAMPLE(S) FOR ANALYSIS BY:
RECEIPT TEMPERATURE:
CHEMISTRY
MICROBIOLOGY
APD 9V1.000
DA FORM 7539, FEB 2005
PAGE 1 OF 2

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2