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Meat & Poultry Inspection

REQUESTER INFORMATION
Name
(required)
Title:
Organization:
Date:
Phone:
(required)
Email Address or Fax Number:
Address:
(required)

ESTABLISHMENT INFORMATION
(Permission from the establishment management must be obtained prior to submitting this form.)
Plant Name:
(required)
City:
(required)
Kind and Amount of Material Desired: (include species of animal)
(required)
Indicate Purpose of Collecting Specimens: (required)
Education Research
Pharmaceutical Experimental
Other (specify)
Describe Purpose of Collecting Specimens:
(required)



 

NCDA&CS - Meat and Poultry Inspection Division, W. Alan Wade , Director
Mailing Address:1001 Mail Service Center Raleigh, NC 27699-1001
Physical Address: 2 West Edenton Street , Raleigh, NC 27601
Phone: (919) 707-3180; FAX: (919) 715-0246;TA Office: (919) 707-3195