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Golden Nematode Program Manual - Phytosanitary Resources

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Appendix A: Forms and Worksheets<br />

PPQ Form 519, Compliance Agreement<br />

Purpose<br />

PPQ Form 519, Compliance Agreement, is completed by the PPQ Office/<br />

Plant Health Safeguarding Specialist for the area of coverage.<br />

Instructions<br />

Complete PPQ Form 519 as shown in Table A-1-25.<br />

TABLE A-1-25 Instructions for Completing PPQ Form 519, Compliance Agreement<br />

Block<br />

1 NAME AND ADDRESS OF PERSON OR FIRM LIST the name and address of the person or firm with whom<br />

the agreement is made<br />

2 LOCATION LIST the location of the land <br />

3 REGULATED ARTICLES LIST the name of the regulated article<br />

EXAMPLE<br />

Soil samples for analysis.<br />

4 APPLICABLE FEDERAL QUARANTINE(S) OR LIST “<strong>Golden</strong> <strong>Nematode</strong> 7CFR§301.85”<br />

REGULATIONS<br />

5 I/we agree to the following LIST the terms of the agreement<br />

6 SIGNATURE Person authorizing agreement SIGNS<br />

7 TITLE LIST your title <br />

8 DATE SIGNED LIST the date signed <br />

9 AGREEMENT NO. LIST the agreement number<br />

10 DATE OF AGREEMENT LIST the date the agreement is signed<br />

11 PPQ/CBP OFFICIAL LIST the name and title of the PPQ Official authorized to<br />

execute the agreement<br />

12 ADDRESS If the agreement is made in with the USDA in New York, then<br />

ENTER the following information:<br />

<br />

U.S. Department of Agriculture, APHIS<br />

Plant Protection and Quarantine<br />

8237 Kanona Road<br />

Avoca, NY 14809<br />

607/566-2212<br />

13 SIGNATURE PPQ Official SIGNS <br />

14 U.S. GOVERNMENT/STATE AGENCY OFFICIAL LIST the name and title of the agency official entering the<br />

agreement<br />

A-1-34 <strong>Golden</strong> <strong>Nematode</strong> <strong>Program</strong> <strong>Manual</strong> 07/2008-01<br />

PPQ

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