Regulations and Related Reporting and Recording Requirements - Packers and Stockyards Programs-Business

Regulations and Related Reporting and Recording Requirements - Packers and Stockyards Programs

P&SP4100-i

Regulations and Related Reporting and Recording Requirements - Packers and Stockyards Programs-Business

OMB: 0580-0015

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Instructions to Complete

Weigher’s Acknowledgement and Agreement

for Weighing Live Poultry or Feed

Form P&SP-4100


Mail the completed form to the appropriate regional office of the Packers and Stockyards Program as listed below. The states covered by each regional office are listed below its address.


Regional Offices of the Packers and Stockyards Program

Grain Inspection, Packers and Stockyards Administration

Eastern Regional Office

Suite 230

75 Spring Street

Atlanta, GA 30303-3308

Telephone: (404) 562-5840

FAX: (404) 562-5848

e-mail: [email protected]

Western Regional Office

3950 Lewiston St., Suite 200

Aurora, CO 80011-1556

Telephone: (303) 375-4240

FAX: (303) 371-4609

e-mail: [email protected]

Midwestern Regional Office

Room 317

210 Walnut Street

Des Moines, IA 50309-2110

Telephone: (515) 323-2579

FAX: (515) 323-2590

e-mail: [email protected]

States Covered

States Covered

States Covered

AL, AR, CT, DC, DE, FL, GA, LA, MA, MD, ME, MS, NC, NH, NJ, NY, PA, RI, SC, TN, VA, VT, WV

AK, AZ, CA, CO, HI, ID, KS, MT, NM, NV, OK, OR, TX, UT, WA, WY

IA, IL, IN, KY, OH, MI, MO, MN, ND, NE, SD, WI


If you have any questions regarding this form, please contact the appropriate regional office of the Packers and Stockyards Program listed above.


Line No.

Subject

Instruction

1

Name

Enter name of person signing Weigher’s Acknowledgement and Agreement.

2

Employer

Enter name of company weigher is employed by.

3

City

Enter city where weigher will be weighing poultry.

4

State

Enter state where weigher will be weighing poultry.

5

Weigher Signature

The weigher must sign the form in front of a witness.

6

Witness Signature

A witness must sign the form after witnessing the weigher’s signature.

7

Date

Enter date that Weigher’s Acknowledgement and Agreement was signed and witnessed.


P&SP-4100-i August 2007 Page 1 of 1

File Typeapplication/msword
File TitleINSTRUCTIONS FOR COMPLETING FORM PSP-216
AuthorGipsaITS
Last Modified Bycmgrasso
File Modified2008-09-09
File Created2007-07-25

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