FGIS 956 Rice Inspection Services Certificate

FORM FGIS-956
JAN 07

Approved OMB No. 0580-0013

UNITED STATES DEPARTMENT OF AGRICULTURE
FEDERAL GRAIN INSPECTION SERVICE

AGRICULTURAL MARKETING ACT OF 1946
ORIGINAL

RICE INSPECTION SERVICES CERTIFICATE

US-STFO-1-00217

OFFICIAL WHITE CERTIFICATE

NOT NEGOTIABLE

LEVEL OF INSPECTION:
Original

ISSUED AT:
STUTTGART, AR

DATE OF SERVICE:
May 07, 2007

IDENTIFICATION:
UCCL-57689

LOCATION:

QUANTITY: (this is NOT a weight certificate)
1 Containerlot

Stuttgart, AR
TYPE OF MOVEMENT:
Export

COMMODITY:

DATE SAMPLED:
May 07, 2007

METHOD OF SAMPLING:
Bag Trier

U. S. No. 2 or better Long Grain Milled Rice

RESULTS:
Chalky Kernels 0.0 %
Heat-Damaged Kernels And Objectionable Seeds 1
Milling Degree Well Milled
Red Rice And Damaged Kernels 0.4 %
Total Seeds, Heat-Damaged Kernels And Paddy Kernels 1

Objectionable Seeds 1
Moisture 12.7 %
Other Types 0.2 %
Total Broken Kernels 4.3 %

REMARKS:
Quantity and Container: 70 - 12/5 lb. poly ELG bags; 70 - 6/10 lb. poly ELG bags; 35 - 30/2 Lb. poly ELG bags.
Container examination meets all requirements of U.S. Standards for Condition of Food Containers.
175 balers checkloaded 5/7/07; Carrier UCCL-57689; Seal 003421.
Applicant states this rice is enriched.
This rice does not contain live or dead weevils or other insects, insect webbing or insect refuse.

I CERTIFY THAT THE SERVICES SPECIFIED ABOVE WERE PERFORMED WITH THE RESULTS STATED.

APPLICANT NAME: ABC Rice Milling Company
ISSUING OFFICE:

NAME OR SIGNATURE: Diane K Palecek

FGIS - Stuttgart Field Office

This certificate is issued under the authority of the Agricultural Marketing Act of 1946, as amended (7 U.S.C. 1621 et seq.), and the regulations thereunder (7 CFR 868.1 et seq.), and is receivable in all courts of the United States as prima facie
evidence of the truth of the statements therein contained. This certificate does not excuse failure to comply with the provisions of the Federal Food, Drug, and Cosmetic Act, or other Federal Laws.
WARNING: Sec. 203(h) of the Agricultural Marketing Act of 1946 provides that anyone who shall knowingly falsely make, issue, alter, forge, or counterfeit any official certificate, or aid, assist, or be party to such actions, is
subject to a fine of not more than $1000 or imprisonment for not more than 1 year, or both. The conduct of all services and the licensing of personnel under the regulations governing such services shall be accomplished without
discrimination as to race, color, religion, sex, national origin, age, or handicap.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information is 0580-0013. The time
required to disclose this recordkeeping requirement is to average 17 hours per recordkeeper annually, including the time to retain such records, and to notify, disclose, and report to third parties such recordkeeping requirements.