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Fsis 5200 15 2012 form

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NAME OF APPLICANT 2. DATE OF REQUEST 3. DISTRICT / IID-HEADQUARTER OFFICE 4. MAILING ADDRESS OF APPLICANT New Attach to application form Update or Revision HOURS OF OFFICIAL INSPECTION OPERATIONS REQUESTED - SHIFT I DAY OF WEEK SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Start Time Lunch Break Start Break End End Time 5. According to the Paperwork Reduction Act of 1995 an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless ...

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