Spreadsheet: 5d111786-ccfa-4a44-a469-b9f294ff7ab3
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Agricultural | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Country of | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 |  | Unnamed: 18 | 1400 Independence Avenue, SW. | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | COOL | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37 | Unnamed: 38 | Unnamed: 39 | Unnamed: 40 | Unnamed: 41 | Unnamed: 42 | Unnamed: 43
 |  |  | Marketing |  |  |  | Origin Labeling |  |  |  |  |  |  |  |  |  |  |  | Room 2620-S, STOP 0216 |  |  |  |  |  |  |  |  | Worksheet
 |  |  | Service |  |  |  | Division |  |  |  |  |  |  |  |  |  |  |  | Washington, DC 20250-0216 |  |  |  |  |  |  |  | 2012-01-23 00:00:00 |  |  |  |  | 1
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 2
COOL Retail Surveillance Worksheet |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 3
Date of Review |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 |  | Mr. | Pre-labeled Package-Consumer Ready
File Name |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] E-mail |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 5 |  | Ms. | Master [NAME]
Store Name |  |  |  |  |  |  |  |  |  |  |  |  | Reviewer's Phone Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 6 |  |  | [NAME]
Store Address |  |  |  |  |  |  |  |  |  |  |  |  | Store Phone Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 7 |  |  | [NAME] of Lading
City, State ZIP |  |  |  |  |  |  |  |  |  |  |  |  | Store Representative's Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 8 |  |  | Invoice
Store ID Number |  |  |  |  |  |  |  |  |  |  |  |  | Responsible Authority's Name (Title/First Name/Last Name) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 9 |  |  | [NAME]
Corporate Representative |  |  |  |  |  |  |  |  |  |  |  |  | Responsible Authority's Position |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 10 | Yes |  | Shipping Manifest
Corporate Name |  |  |  |  |  |  |  |  |  |  |  |  | Mailing Address |  |  |  |  |  |  |  |  |  |  | Retailer Address |  |  |  |  |  |  |  | 11 | No |  | Store Log
Corporate Address |  |  |  |  |  |  |  |  |  |  |  |  | (Choose only one option) |  |  |  |  |  |  |  |  |  |  | Corporate Address |  |  |  |  |  |  |  | 12 | Not PACA Licensed
City, State ZIP |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 13 | Store Closed
Non-Compliance (NC) Codes |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 14
Code |  | Non-Compliance Findings |  |  |  |  |  |  |  |  |  |  |  | Code |  | Non-Compliance Findings |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 15 |  |  |  |  |  |  |  |  |  |  | 1
1 |  | Covered commodity is not identified with the country of origin. |  |  |  |  |  |  |  |  |  |  |  | 9 |  | The method of production is not stated in an acceptable form.  (i.e. wild, wild caught, farmed, farm-raised, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ü | Farm Raised |  | 0 |  |  |  |  |  |  |  | 2
2 |  | The country of origin declaration is not legible and /or is not placed in a conspicuous location. |  |  |  |  |  |  |  |  |  |  |  | 10 |  | Records were not provided within 5 business days. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Wild Caught |  |  |  |  |  |  |  |  |  | 3
3 |  | The country of origin declaration is not accurate at point of sale. |  |  |  |  |  |  |  |  |  |  |  | 11 |  | Records do not provide the country of origin information. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NA-Not Identified |  |  |  |  |  |  |  |  |  | 4
4 |  | The country of origin is not stated in an acceptable form.  (The use of "or" and "and/or" is not acceptable; unacceptable regional designation.) |  |  |  |  |  |  |  |  |  |  |  | 12 |  | Records do not provide the method of production information. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other-See below |  |  |  |  |  |  |  |  |  | 5
5 |  | Abbreviations and variant spellings do not unmistakably indicate the country of origin. |  |  |  |  |  |  |  |  |  |  |  | 13 |  | Records do not provide the [NAME] information.  (Supplier records are required for all Traceback Items) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 6
6 |  | Covered commodity is not identified with the method of production. |  |  |  |  |  |  |  |  |  |  |  | 14 |  | Records information for country of origin as provided by supplier is not accurately conveyed to point of sale label. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 7
7 |  | The method of production declaration is not legible and/or is not placed in a conspicuous location. |  |  |  |  |  |  |  |  |  |  |  | 15 |  | Records information for method of production as provided by supplier is not accurately conveyed to point of sale label. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 8
8 |  | The method of production declaration is not accurate at point of sale. |  |  |  |  |  |  |  |  |  |  |  | 16 |  | Records that identify the chain of custody for the pre-labeled item were not provided within 5 business days. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 9
Fruits (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 10
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 11
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 12
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 13
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 14
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 15
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 16
6
7
Nuts (Peanuts, Pecans and Macadamia) and [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 10
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 11
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 12
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 13
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 14
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 15
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 16
6
7
Vegetables (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 10
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 11
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 12
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 13
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 14
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 15
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 16
6
7
Fish and Shellfish (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes |  |  |  | Category Assigned
1
2
3
4
5
6
7
Beef and Veal ([NAME]) |  |  |  |  |  |  |  |  |  | Enter the COOL info provided by the records.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice, PO,  Record Number or Date; Lot or Item Numbers; Dates from Item, Packaging, or [NAME]. |  | Number of Items Reviewed |  |  |  |  |  |  |  |  |  | B-Frozen Fruits
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes
1
2
3
4
5
6
7
Pork (Muscle Cuts and Ground) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes
1
2
3
4
5
6
7
[NAME] ([NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes
1
2
3
4
5
6
7
Lamb and Goat (Muscle Cuts and Ground) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number of Items Reviewed
Non-Complying Items |  |  |  |  |  |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes
1
2
3
4
5
6
7
Record Items
Records - Fruits (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | A-Fresh Fruits
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | B-Frozen Fruits
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #.
Item Name
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Nuts (Peanuts, Pecans, and [NAME]) and [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | C-Peanuts
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | D-Pecans
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #. |  |  |  |  |  |  |  |  |  |  |  | E-Macadamia Nuts
Item Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | F-Ginseng
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Vegetables (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | G-Fresh Vegetables
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | H-Frozen Vegetables
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #.
Item Name |  | Type of Commodity
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Fish and Shellfish (Fresh and [NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | I-Fresh Fish
Store Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | J-Frozen Fish
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #. |  |  |  |  |  |  |  |  |  |  |  | K-Fresh Shellfish
Item Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | L-Frozen Shellfish
Country of Origin
Method of Production
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Beef and Veal ([NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | M-Beef Muscle Cuts
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | N-Ground Beef
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #. |  |  |  |  |  |  |  |  |  |  |  | O-Veal Muscle Cuts or Ground Veal
Item Name
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Pork (Muscle Cuts and Ground) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | P-Pork Muscle Cuts
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | Q-Ground Pork
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #.
Item Name
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Chicken ([NAME]) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | R-Chicken Muscle Cuts
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | S-Ground Chicken
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #.
Item Name
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
Records - Lamb and Goat (Muscle Cuts and Ground) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Category Assigned |  |  |  |  |  |  |  |  | T-Goat Muscle Cuts or Ground Goat
Store's Labeling Information |  |  |  |  |  |  |  |  |  | Record Information |  |  |  |  |  |  | Records Reviewed |  |  | Record Transaction ID |  |  |  |  |  |  |  |  |  |  |  | U-Lamb/Mutton Muscle Cuts or [NAME]
 |  |  |  | Enter information provided at POINT OF SALE.  Enter NA if not provided. |  |  |  |  |  | Enter information provided by the RECORDS.   Enter NA if not provided. |  |  |  |  |  |  | List all records that were reviewed. |  |  | Invoice #, PO #,  Lot #, Item #, Record Date, Best by Date, Product size, PLU, UPC, FSIS Inspection #, & Est #.
Item Name
Country of Origin
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Provided by [NAME]
Supplier Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Records - Due from Corporate
Additional Supplier Information (e.g., phone #, fax #, web site, etc.) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Due:
If questions arise during the review, contact the COOL Division Manager (202) 720-4486
Additional Comments and Information
Additional Items
 |  | Type of Commodity |  | Non-Complying Items |  |  |  |  |  |  |  | NC Code |  |  |  |  |  | Notes
1 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Fruits
2 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Nuts (Peanuts, Pecans, & Macadamia) & Ginseng
3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vegetables
4 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Fish & Shellfish
5 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Beef & Veal
6 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Pork
7 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Chicken
8 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Lamb & Goat
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Reviewer's Signature