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ADDRESS (Street, City, State and Zip Code) 7. CONTRACTOR DATA 8. PLANT DATA a. NAME b. ADDRESS (Street, a. NAME b. ADDRESS (Street, City, State and Zip Code) City, State and Zip Code) City, State and Zip Code) c. ESTABLISHMENT NUMBER 9. PRODUCT DESCRIPTION a. NSN e. PACK PER CASE 10. CONVEYANCE NUMBER 14. TEMPERATURES a. OPENING b. GRADE f. LOT SIZE (DZ) c. WEIGHT CLASS g. DATE OF PACK h. USDA CERTIFICATE NUMBER(S) 11. SEAL NUMBERS b. CLOSING 12. STAMP NUMBER c. STORAGE 19. QU.

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