U.S. Department of Agriculture 1.

Name and Address of Shipper

Grain Inspection, Packers and Interstate Commodities, Inc.
Stockyards Administration 7 Madison Street
Animal and Plant Health Inspection Service Troy, New York 12181

INSPECTION REPORT - INSECTS IN GRAIN

Page 1 of 1
2. Location of Elevator 3. Grain/Commodity 4. Quantity
5. Grain Inspection Certificate Number 6. Status of Report Lockbourne, Ohio Distillers Dried Grains Containers- 8
Original With Solubles
7. Country of Destination 8. Name of Carrier/Vessel 9. Loading Date Start/Date Finished
Indonesia 038CHI1412980 12/5/2016
10. Sublot Number/ 11. Date 12. Stowage 13. Quantity 14. No. of 15. Lot 16. Name of Insect
Carrier Identification Inspected (Hold Nos.) Live Insects Infested
BMOU6772071 12/5/2016 Container 0
BMOU6772301 12/5/2016 Container 0
FSCU6901094 12/5/2016 Container 0
GLDU7287824 12/5/2016 Container 0
GLDU7447250 12/5/2016 Container 0
TCLU5851932 12/5/2016 Container 0
MSCU9523457 12/5/2016 Container 0
TCNU7227497 12/5/2016 Container 0

17. Remarks (Use reverse for additional space) 18. Name of Inspector and name of official service provider

Michael Adams
Fumigation Information
19. Date of Fumigation 20. Treatment 21. Hold Nos.

22. Type of Chemical 23. Concentration Level

24. Duration of Exposure 25. Commodity Temperature at Time of Fumigation

degrees Fahrenheit
26. Quantity (metric tons) 27. Name of Inspector

Form FGIS-921-2 (03-15) Edition 07-10 may be used. Expires January 2018
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minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
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