If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Recall Return Response Form For Destruction or Return of Product Name * Tel# * Title * Email * SWT Customer # * Firm Name: * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ****Documentation is required for all destruction. Send photographs when available.***** Please Check Appropriate Boxes if Applied To You: I have read and understand the recall instructions provided in the Recall Notice Letter.I labeled, re-packed, reprocessed, or made new products that receive a thermal kill step that eliminates pathogens from my food. I will or have contacted the FDA Recall Coordinator in my state to verify whether or not my kill step is adequate.I labeled, re-packed, reprocessed, or made new products that did NOT receive a thermal kill step that eliminate pathogens from my food. I will or have contacted the FDA Recall Coordinator in my state as I may have to initiate my own recall.I have checked my stock and I have no more remaining inventory subject to the Recall Notice.I have checked my stock and I have inventory still Please Select The Products and Qty's Effected By This Recall * 6611 - Strawberry Sort Outs 20/Lb Case4689 - Strawberries IQF Bulk 30 Lb Case20524 - IQF Diced Strawberries 2/5 Lb Case Enter Qty for 6611 Enter Qty for 4689 Enter Qty for 20524 (http://www.fda.gov/safety/recalls/industryguidance/ucm129334.htm) Indicate disposition of recalled product: * Returned (specify qty, date and method) or held for return;Destroyed (specify qty, date and method);Quarantined for return or correction (specify qty); Specify Quantity Date How was the product returned or disposed of? Any adverse events associated with recalled product? * YesNo Please explain: Please check the appropriate box(es) to describe you business: * Wholesaler/DistributorRetailerManufacturerPrivate ConsumerOther Please describe your business: If you have any questions regarding this form please call CH Belt 949-859-0700.
