Meat & Poultry - Inspection Specimen Request Form

Submitted by medlst on Fri, 10/20/2023 - 13:31

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REQUESTER INFORMATION

First Name

Last Name

Title

Organization

Date

Phone

Email Address

Fax Number

Address

City/Town

State/Province

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)

Describe Purpose of Collecting Specimens