FGIS-9601 Repair/Modification Notice

Reporting and Recordkeeping Requirements (US Grain Standards Act and Agricultural Marketing Act of 1946)

fgis-9601

Reporting and Recordkeeping Requirements - State, Local, Tribal

OMB: 0580-0013

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FORM APPROVED OMB NO. 0580-0013 (FGIS-9601)

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 0580-0013. The time required to complete this information collection is estimated to average 2 minutes per response and 2 minutes of recordkeeping, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Expires January 2015.








U.S. DEPARTMENT OF AGRICULTURE

GRAIN INSPECTION, PACKERS AND

STOCKYARDS ADMINISTRATION

FEDERAL GRAIN INSPECTION SERVICE

FIELD MANAGEMENT DIVISION


REPAIR/MODIFICATION NOTICE

SERIAL NUMBER (Optional)


NAME AND LOCATION OF FACILITY

DATE

TIME AM

PM


EMERGENCY BREAKDOWN


NON-EMERGENCY BREAKDOWN

REQUESTED BY

PERSON NOTIFIED

MALFUNCTION NOTED


HANDLING/DELIVERY SYSTEM



SCALE(S) SYSTEM



GRAIN SPILLS(S)


REMARKS:






ACTION TO BE TAKEN BY FGIS

UNTIL REPAIR OR MODIFICATION IS COMPLETED, WEIGHT CERTIFICATION:


WILL BE DISCONTINUED


WILL CONTINUE


WILL CONTINUE UNDER THE FOLLOWING CONDTIONS:



REPAIR/MODIFICATION COMPLETED

DATE


TIME AM

PM



_____________________________________________

(Name of Official Personnel)


FGIS-9601 (6/04) (Replaces Form FGIS-9601 which may be used)


Instructions for Use. To complete the Repair/Modification Notice, enter the following information:


1. Enter the scale serial number (optional).


2. Enter the name and location of facility.


3. Enter the date the form was prepared.


4. Enter the time the form was prepared.


5. Check block ‑ emergency breakdown or non-emergency breakdown.


6. Enter the name of official personnel (Supervisor or Scales Specialist) requesting repair or modification.


7. Enter the name of elevator person notified.


8. Check appropriate block to fit malfunction and explain in remarks what the malfunction is and its location.


9. Check appropriate block and explain the conditions under which weighing will continue.


10. Enter the date of the completion of repair/modification.


11. Enter the time the repair/modification was completed.


12. Enter the name of the official inspection personnel who observed the completion of the repair/modification.


Distribution. Complete the notice up to, and including, the "Action To Be Taken By FGIS" section. Give the person notified of the necessary repairs or modifications a copy of the notice. After the repairs or changes are made, complete the "Repair/Modification Completed" section of the notice and send a copy to the field office.



CONTACT INFORMATION:



Contact the field office responsible for the geographic area in which the service is provided. Details for these locations can be found at:


http://www.gipsa.usda.gov/GIPSA/webapp?area=forms&subject=landing&topic=fgis


For further information on the Repair/Modification Notice:

William Bates

Policies and Procedures Branch

Field Management Division

1400 Independence Avenue, SW, Room 2409 N

Washington, DC 20250-3630

Telephone 202-690-0961

Fax 202-720-1015

[email protected]

File Typeapplication/msword
File TitleFORM APPROVED OMB NO
AuthorGipsaITS
Last Modified ByASGreenfield
File Modified2011-04-22
File Created2011-04-22

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