MONTANA DEPARTMENT OF LIVESTOCK USE ONLY Cooperative Interstate Shipment Program Application checklist – completed by MPI staff

Regulatory Compliance

Last FSA Completed Date:
Completed By:
9 CFR 416: SPS and SSOP
9 CFR 417: HACCP
9 CFR 418: Recall Plan
Food Defense (Voluntary)

Verified: 9 CFR 416: SPS and SSOP 9 CFR 418: Recall Plan 9 CFR 332.13: Written plant to address separation by time & space Water and sewage approval Labels for Cooperative Interstate Shipment (CIS) in compliance

9 CFR 332.13: Written plant to address separation by time & space
Water and sewage approval

Source Material Verified source materials are from which USDA establishment:

Labels for Cooperative Interstate Shipment (CIS) in compliance
Verified source materials are from which USDA establishment:

Slaughter Last Review Date for Humane Handling/Good Commercial Practices review: Controls for SRM Controls for Listeria Monocytogenes

Last Review Date for Humane Handling/Good Commercial Practices review:
Controls for SRM Controls for Listeria Monocytogenes
Handling/Good

List of Products for CIS

Administrative

List Products
List Products (continued)

Has the establishment ever been under USDA inspection? Yes No

Yes
No
Yes
No
Date to meet 90 days under Inspection

Authorization I acknowledge establishment is in good standing with Montana MPI and is recommended for selection. Bureau Chief Signature Print Name of Signer:

Date:
Bureau Chief Signature
Print Name of Signer:

Bureau Chief’s Recommendation for Selection

CIS Assigned Establishment Number:

MI-1CIS 4-2022