Chapter 5 - Sampling and Testing

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Annex A: Submission Form - Cost Recovered Antibiotic Confirmation

Submission Form - Cost Recovered Antibiotic Confirmation
(this completed form and CFIA/ACIA 5258 must accompany submission for cost recovered laboratory confirmation of antibiotic residues)

I. Sample Identification No. -

II. Result of In-plant Testing of Kidney Tissue (mark with a)

Test	Test result
	Positive	Negative	Not done
STOP

Comments:

Inspector's Signature:

Date:

I understand that, should the laboratory testing result in the detection of violative levels of antibiotic residues, the costs of the laboratory testing will be charged to the Establishment . These costs can range from minimum of $55 to a maximum of $340 depending on the amount of laboratory testing required to confirm the presence or absence of violative antibiotic residues in the tissue sample(s) submitted.

Signature of plant representative:

Date:

I do not wish to pay for antibiotic confirmation tests and I therefore request that the carcass and parts of the carcass from which the above identified sample ha been taken be treated as condemned meat products in accordance with Section 88 of the Meat Inspection Regulations, 1990.

Authorized by:

Signature of inspector:

Date:

Signature of plant operator:

Date:

Rev Jan 2008

Note: This form is available from CFIA inspectors. Do not photocopy this page.

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