I, ____, designated by the Director of the U.S. Fish and Wildlife Service on ____ (date), as a certifying official for ____ (country), as required by Title 50, CFR 16.13, do hereby certify that the fish lot(s) of origin for this shipment of ____ (weight in kilograms) dead uneviscerated salmonid fish, live salmonid fish, live salmonid fish eggs disinfected as described in §16.13, or live salmonid gametes to be shipped under ____ (bill of lading number or airway bill number), were sampled at ____ (location of fish facility) on ____ (sampling date) and the required viral assays were completed on ____ (date assays were completed) at ____ (location where assays were conducted) using the methodology described in §16.13. I further certify that Oncorhynchus masou virus and the viruses causing viral hemorrhagic septicemia, infectious hematopoietic necrosis, and infectious pancreatic necrosis have not been detected in viral assays of the fish lot(s) of origin.
The shipment is scheduled to depart ____ (city and country) on ____ (date), via ____ (name of carrier) with anticipated arrival at the port of ____ (city), U.S.A., on ____ (date).
________________________
(Signature in ink of certifying official)
________________________
(Printed name of certifying official)
Date:________________________
Organization employing certifying official:________________________
Mailing address:________________________
City:________________________
State/Province:________________________
Zip Code/Mail Code:________________________
Country:________________________
Office telephone number: International code________________________
Telephone number________________________
Fax number________________________
50 C.F.R. § 16.13