This form is completed by an inspector designated by the USDA. The form is split up into 3 main sections. The top part of the form is to provide information on the applicant/shipper and receiver, the issuance date of the form, the inspection site, the carrier ID, and the Certificate/worksheet number. The middle part of the form is to describe the product including the number and type of containers, and the origin, size, brand, variety, and grade of the product. The bottom part of the form is for additional remarks, the inspector to detail the fees associated with the issuance of the form (including the estimated total cost) and to sign the form.