SHELLSTOCK SHIPPING RECORD

Firm Name:__________________________________________________________Cert #__________________ Firm Address:________________________________________________________

Date and Time Shipped

Sold To Quantity and Species

Product Iced or in <45°F conveyance

Yes or No

Internal Temp ___°F at Shipping

OriginalHarvest Date

Original Harvest Area

Original Harvester Cert #

Signature of person performing weekly records review: _________________________________________________________ Date___________________Signature of person performing weekly records review: _________________________________________________________ Date___________________

* Indicates new record keeping requirement.

Food Safety Program - Oregon.gov/ODA/FSD 05/2014 Page 1 of 1