Dairy Producer Affidavit Training - Sterling Solutions

STERLING
Solutions, LLC
An Affiliate of Sterling Marketing, Inc.
STATE OF ______________)
County of _______________)
P R O D U C E R A F F I D A V I T
Dairy Beef
Sterling Ranch Code _________
USAIP Premise ID__________
Date ___________________
Lot/Load # ______________
I
, am the present owner, or the responsible person (circle one)
for the animals identified below and have directly controlled or take full responsibility for relevant
practices applied in their raising. If animals represented by this affidavit have been owned by others
since their birth, I am attaching affidavits like this for each such previous owner.
I do swear and affirm that the animals covered by this affidavit were born in the United States of
America. I authorize Sterling Solutions, LLC or an agent appointed by Sterling Solutions, LLC to
make random, unannounced audits of all properties and records in my control, as necessary to ensure
that the relevant conditions of the USDA approved Sterling Solutions Source Verification Protocol
have been met. I also understand that the premises of previous owners upon which these animals
were born and/or raised are subject to the same auditing procedure.
Identification
Tattoo, Marks
Number in Lot /
Head Count on
this Truck
Sex of Animal Breed Age of
oldest
In
months
Date of First Calf Born
and last Calf Born
“Actual” complete
date of first calf and
last calf born in a
group.
Place of Dispatch: Name of Dairy Calf Ranch/Farm Location Town and State of Dairy Operation
Transfer to:
Establishment Number_______________________________________________
Calf Farm_________________________________________________________
Feedlot___________________________________________________________
Signature of Owner (or responsible person):
Note for the Cattle Producer signing this Affidavit: Please retain a copy for your records per program requirements.
Note for the group receiving this Affidavit: Please verify on the company web site that this
producer or feedlot is an approved and active supplier (http://www.sterlingtraceback.com).
Sterling Solutions, LLC
Process Verified, Age Verified and Identification
Training Dairy Beef Producer Affidavit Ver 3.1
Revised: January 26, 2012

Notes for completion of the Dairy Producer Affidavit:
1. The completed affidavit must be signed by the responsible person to meet Age
and Source Verification requirements.
2. Sterling Ranch Code is 2 letter State and 3-5 letter ranch code assigned to cattle
based on their ranch of origin and follows cattle through the supply chain and from
owner to owner.
Note to Sterling Feedlots: If third party program cattle are included in
shipment then enter the third party program name and ranch name on this
line. If multiple ranches included in shipment then enter all included Sterling
Ranch Codes and/or Third Party Program Names and Ranch Names.
3. The lot number should describe the lot # at the feedlot assigned to the specific
livestock being shipped. In many cases the ranch to feedlot affidavit will leave the
“Lot #” blank.
4. Date of first calf born is the oldest and therefore the default for the group unless
animals are individually identified and can be sorted. The youngest date should
also be entered. The range must indicate a complete date: 1-3-10 to 4-25-10 ( for
ex.)
Please include a Load Report with Individual Animal details for Calf
Ranch shipments (individual number, actual birth date, dairy of
origin)
5. The person signing the document shall circle the appropriate designator in
paragraph one, “present owner,” “responsible person,” or “agent.”
6. Under the box indicating “Identifying Marks” please enter the Sterling Ranch
Code listed on the ear tag (or third party program name if indicated on ear tags). If
using sequential tags, please indicate the range of numbers. If feedlots use a lot
tag, then the Lot Number can also be indicated as an “Identifying Mark.”
7. A copy of the document shall be retained on the premise for five years and a
copy shall be mailed, faxed or scanned and emailed to Sterling Solutions at the
time the affidavit is completed. The original may accompany the shipment or be
faxed directly to the buyer. A copy of the completed affidavit must be on file at the
feedlot prior to harvest.
8. Copies mailed or faxed should be sent to the attention of Susan Morse, P.O.
Box 4047, Irvine, CA 92616 or smorse@sterlingtraceback.com. For additional
program questions contact Susan Morse at Cell#714-742-4801.
Sterling Solutions, LLC
Process Verified, Age Verified and Identification
Training Dairy Beef Producer Affidavit Ver 3.1
Revised: January 26, 2012