DA-245 Sanitary Certificate Request - China

Form Approved OMB No.0581-0283
According to the paperwork 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 it displays a valid OMB control number. This
valid OMB control number for this collection is 0581-0283. The time required to complete this information
collection is estimated to average 12 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection information.

U. S DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REqUEST

TYPE

'aoortronar cnar8es apprv

Faxed Certificate'
0 Additional CopiesChina
I acknowledge that by checking this box that the information provided is factual and accurate.
MAILING INFORMATION
CONTACT INFORMATION
7. COMPANY
1. CONTACT NAME
2. AMS BILLING ACCT.
8. CONTACT

3. BILLING REFERENCE

9. STREET

4. E-MAIL

10. ctTY

ADDRESS

5. CONTACT PHONE

11. STATE

6. FAX

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CONSIGNOR

13. NAME
14. ADDRESS
15. CITY/STATE
CONSIGNEE

16. NAME
17. ADDRESS
18. COUNTRY CODE

CN

IDENT!FICATION OF DAIRY PRODUCTS

19. DESCRIPTION OF COMMODITY
20. KIND OF HEAT TREATMENT (HTST; PASTEURIZED)
21. TYPE OF PACKAGING

22. NUMBER OF PACKAGING UNITS
23. NET WEIGHT
24. REQUIRED TEMPERATURE DURING STORAGE AND

tb

TRANSPORTATION

25. DATE PRODUCED
26.EXPIRATION DATE
MANUFACTURER

27. PLANT NUMBER
SHIPMENT INFORMATTON

28. DEPARTURE PORT

29. ENTRY PORT

30. TRANSPORT WPE
32. CONTAINER NUMBER

31. TRANSPORT NAME

33. SEAL NUMBER
SIGNATURE (for foxed or maitted copies)
kFor fastest processing,
please attach

34. DATE

t

DA-24s (0Ll2O76l
ln accordance with Federal
participating in or administ

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Persons with disabil

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orientation,lisability,

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offices, md employees, and institutions
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apply t
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ve means ofcommunication for progr-am infomation (e.g Braille, large print,
audiotape, American Sign Language, etc.) should contact the
,
"F.a",ur'n.ruf
720-2600 (voice ard
or contaci usbi ihrough the
s!*tce at (800) r7r-s::! iaaiti",rriy, program inrormation

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//ww.ascr.usda. gov/complaint_fi ling cust.hrml and at
py ofthe complaint form, call (866) 632-9992. Submir
0 lndependence Avenue, SW Washington, D.C.20250_