Meat & Poultry - Inspection Specimen Request Form Submitted by medlst on Fri, 10/20/2023 - 13:31 REQUESTER INFORMATION Indicates required field First Name Last Name Title Organization Date Phone Email Address Fax Number Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code ESTABLISHMENT INFORMATION(Permission from the establishment management must be obtained prior to submitting this form.) Plant Name City Kind of Material Desired Amount of Material Desired Species of Animal(s) Indicate Purpose of Collecting Specimens Education Research Retrieving from own animals Other (specify) Enter other… Describe Purpose of Collecting Specimens This question is for testing whether or not you are a human
