SHELLSTOCK & SHUCKED SHELLFISH FOR RETAIL

Lisa Esparza – Corporate QA ManagerOcean Beauty SeafoodsTags, Traceability and Records

The dealers' tags shall: Be durable, waterproof Be at least 13.8 square inches (89.03 cm2 ) in size.

(2) The dealer's tag shall contain the following indelible, legible information in the order specified below: (a) The dealer's name and address. (b) The dealer's certification number as

assigned by the Authority. (c) The original shellstock shipper's

certification number.(d) The harvest date; or if wet stored, the

original harvest date, and the final harvest date which is the date removed from wet storage.

(g) The type and quantity of shellstock. (h) The following statement in bold capitalized type on each tag:

(i) All shellstock intended for raw consumption shall include a consumer advisory.

(j) The statement "Keep Refrigerated" or an equivalent statement.

Dealer Tags from Vendor: Ballard

Relevant records for adequate trace back.

Purchase Order – from who did we procure the Shellfish (Vendor)

B.O.L. – Proof of shipment to us from the Vendor

Original Shellstock tag or label for Shucked*

HACCP Record – Incoming Receiving Form verifying the critical limits have been met and not exceeded.

Sales Invoice – payment to Vendor for specific type & quantity of Shellfish

Customer Invoice – receipt or bill for payment of type & quantity of Shellfish sold to customer from us.

To: Date:

Product Recalled (product description, code dates, etc):

Please read each question, and check the appropriate answer to each. Please check with anyone else who may have received this notification or may have information before giving your response.

1. Did your firm receive information that Ocean Beauty Seafoods was recalling the above product?

Yes_____ No______

2. Did your firm receive shipments of the recalled product?

Yes_____

No______

If no to #2, then please sign this form and return the form to OBS contact given in cover letter.

3. Do you now have any of the recalled product(s) on hand?

Yes_____

No______

If yes to #3, then please verify the quantity and report the quantity you have on inventory.

Quantity on Hand: _______________ (cases and/or packages).

4. If yes to #3, do you intend to return the product to OBS as requested?

Yes_____

No______

5. If no to #4, please explain your intentions with the product:

6. Have you received any reports of injury or illness related to the recalled product?

Yes____

No_____

If yes to #6, then please provide all the details that you can.

Name of person completing this questionnaire:

Title:

Recall Effectiveness Check – Return Questionnaire

Name of Facility or Company:

Facility or Company Address:

Facility or Company Representative:

Phone Number: Fax Number:

Item/Product to be destroyed (full description):

Reason for Destruction:

Quantity destroyed (please report how many lbs or containers):

Product/Package Codes:

Date Destroyed:

Name of responsible individual (Name of the person who dumped or destroyed the product):

Signature: Date:

Name of witness (Name of the person who witnessed the destruction of the item or product):

Signature: Date:

Certification of Destruction: I certify that the item and quantity listed above was destroyed by placing said product into a garbage dumpster or rendering bucket which represents, to the best of my knowledge the destruction of all products listed.

Signature of Representative:

Date:

The completed & signed, original form should be kept on file at the facility.

Certificate of Destruction