Annex I: Notice of shipment of refused entry product (FSIS form 9135-1)

The Notice of shipment of refused entry product, issued by the United States Department of Agriculture, contains the following information:

Canadian Food Inspection Agency wordmark

Title: United States Department of Agriculture Food Safety and Inspection Service Notice of shipment of refused entry product

Inspector must provide address, at bottom, for Canadian Official.

A. Present location of product (To be completed by Inspector)

1. Establishment number

2. Date

3. Method of shipment

4. Container or vehicle number

5. Location (include city and state)

B. Destination (To be completed by Inspector)

6. Canadian establishment number

7. Location (include city and province)

C. Refused product information (To be completed by Inspector)

8. Name of product

9. Quantity

10. Weight

11. Producer's establishment number

12. Automated Import Information System lot identification number

13. Reason for rejection

14. Health certificate number

15. Custom entry number

16. Signature of inspector

D. Confirmation (To be completed by Canadian inspection official)

18. Establishment number

19. Signature of Canadian inspection official

20. Date

E. Return form to: (To be completed by Inspector)

Or fax to:

Food Safety and Inspection Service form 9135-1 (11/29/2002)

Previous editions are obsolete

Copy - retain for case file.