VS 13-16 Garbage Treatment Facility Inspection

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 is 0579-0065. The time required to complete this information collection is estimated to average 1 hour 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.

OMB Approved 0579-0065 EXP. Date XX/XXXX

A license cannot (1) be issued, or (2) remain in effect, unless an inspection is made of the treatment (PL 96-468 and 9 CFR 166).

U.S, DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT Health INSPECTION SERVICE GARBAGE TREATMENT FACILITY INSPECTION

1. LICENSE NUMBER (If relicensing inspection, so state)

2. COUNTY

3. state

INSTRUCTIONS – After inspection, distribute copies of this form as shown below. All items are to be completed.

4. NAME OF OPERATOR (First Name, MI, Last Name) PHONE NUMBER ( ______) ________________________

5. NAME AND MAILING ADDRESS OF FACILITY

6. ADDRESS WHERE YOU MAY BE CONTACTED IN PERSON

7. SOURCE(S) OF GARBAGE

For each item, “X” one column only indicating satisfactory, unsatisfactory, or not applicable. Explain deficiencies AND not applicable notation in item 27.

Satis.

Un- satits.

Not Appl.

For each item, “X” one column only indicating satisfactory, unsatisfactory, or not applicable. Explain deficiencies AND not applicable notation in item 27.

Satis.

Un- satits.

Not Appl.

8. General sanitation of treatment area . . . . . . . . . . . . . . . .

18. Containers for untreated garbage? a. Covered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Garbage cooked to time/temperature specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Leak-proof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. Disposal of excess garbage . . . . . . . . . . . . . . . . . . . . . .

10. Untreated garbage not accessible to swine . . . . . . . . . . .

20. Health of all animal species . . . . . . . . . . . . . . . . . . . . . .

11. Material associated with untreated garbage not accessible to swine . . . . . . . . . . . . . . . . . . . . . . . . . .

21. Cleaning and disinfection of vehicles. . . . . . . . . . . . . . . .

12. Drainage from untreated garbage not accessible to swine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22. Maintenance of records. . . . . . . . . . . . . . . . . . . . . . . . . .

13. Garbage cooking area not accessible to swine to swine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Pest control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23. Feeding untreated garbage: UNKNOWN YES NO (If unknown or yes, explain in item 27)

15. Separate equipment for untreated/treated garbage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24. Type of cooking equipment: STEAM DIRECT FIRE

16. Cooking equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25. Date of last temperature check:

17. Separate containers for untreated/treated garbage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26. Means of agitation available YES NO (If required in steam equipment)

27. explanation of deficiency(ies) and not applicable notation(s) (Cite item numbers, explain corrective measures necessary, and give due date(s) for correction.) If more space is needed, “X” and continue on reverse.

28. SIGNATURE OF INSPECTOR

29. DATE OF INSPECTION

30. SIGNATURE OF Licensee (Signature indicates a copy of the completed inspection report has been received)

31. DATE

VS FORM 13-16 Previous edition may be used

JUN 2011