Lacey Act Declaration Form

1. ESTIMATED DATE OF ARRIVAL:(MM/DD/YYYY)

2.ENTRY NUMBER: 3.CONTAINER NUMBER:

TEMU5962168

4.BILL OF LADING : 5.MID:

6.IMPORTER NAME: 8.CONSIGNEE NAME:

7. IMPORTER ADDRESS: 9.CONSIGNEE ADDRESS:

I certify under penalty of perjury that the information furnished is true and correct :

Signature : liuhong Type or print Name :Sales Assitant Date :06/25/2016

PPQ FORM 505

Version 12-08-2008-0856 Page 1

DECEMBER 2008

06/27/2016

NJZY025588

YOUR OTHER WAREHOUSE

2500 HWY 155 SOUTH LOCUST GROVE GA 30248