PY-156 Shell Egg Regulatory Inspection Report

TOTAL

5

4

3

2

1

NO.

QUANTITY
(dz.)

GRADE
CODE

SHELL EGG
REGULATORY
INSPECTION REPORT

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
POULTRY PROGRAMS

QUANTITY

SIZE
CODE

10.

CHECKS LEAKERS DIRTIES
(%)
(%)
(%)

7. ADDRESS

1. NAME OF EGG HANDLER

LOSS 1

LOSS 2

TYPE

(%)

MISLABELED
Temp
(°F)

Restricted

RELEASE OF RETAINED PRODUCT

TAG NUMBER

(%)

DESCRIPTION OF RETAINED PRODUCT
TYPE

(Check one)

3. COUNTY CODE
6. PAGE
_____

(See reverse of form for Privacy Act Statement)

REMARKS

9. NATURE OF BUSINESS (Mark appropriate box)

4. HANDLER CODE 5. DATE

AVERAGE AMBIENT AIR TEMP:

TAG OR LOT
NUMBER

11. Is record keeping satisfactory?

2. STATE CODE

FORM APPROVED - OMB NO. 0581-0113

AA
A
B
C
D
CD
NR
R
S
U

SIZE CODES
Jumbo
Extra Large
Large
Medium
Small
Pee Wee
Unsized/Mixed

LOSS TYPE CODES
Black Rot
Blood Ring
Bloody White
Cooked Egg
Frozen
Green White
Large Spot, Blood or Meat
Mixed Rot
Moldy
Sour Rot
Stuck Yolk

DISPOSITION CODES

BLRT
BR
BW
CE
FZ
GW
LS
MR
MLDY
SR
SY

HQ Headquarters Representative

RO Regional Office Representative

FS Federal Supervisor Performing Supervision Visit

SS State Supervisor Performing Supervision Visit

RG Resident Grader

FI Federal SES Inspector/Supervisor Performing Inspection Visit

SI State SES Inspector/Supervisor Performing Inspection Visit

DUTY CODES
CI County SES Inspector/Supervisor Performing Inspection Visit

Labeled, Denatured, and Released - Labeled and adequately decharacterized shell eggs and/or inedible product and
released based on verification.

Placed into Inedible and Released - Disposed of shell eggs by placing into inedible product and released based on
verification.

Reworked and Regraded at Destination Location - Reworked and regraded shell eggs and/or inedible product at
destination location (another egg handler or at an egg products plant), and released based on the verification by the
destination surveillance inspector.

Process for Industrial Use or Animal Food - Processed shell eggs and/or inedible product for industrial use or animal food
under official supervision and released based on the verification by the destination surveillance inspector.

LD

IR

RD

PA

Destroyed - Destroyed shell eggs and/or inedible product on site with verification.

Denatured and Released - Denatured to identify proper decharacterization of shell eggs and/or inedible products and
released based on verification.

DR

DY

Labeled/Relabeled and Released - Relabeled to identify proper category of shell eggs and/or inedible product and released
based on verification.

Reworked, Regraded, and Released - Reworked and regraded shell eggs based on full sample size, and released.

J
XL
L
M
S
PW
U

LR

RR

GRADE CODES
AA
A
B
Checks
Dirties
Checks & Dirties
Nest Run
Restricted
Spots
Unwashed & Ungraded

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W.,
Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital
status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individuals income is derived from any public assistance
program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should
contact USDAs TARGET Center at (202) 720-2600 (voice and TDD).

NOTE: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0581-0113. The time required to complete this information collection is estimated to average .20 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.