P&SP 4400 Vehicle Scale Test Report - Poultry

OMB Control No. 0580‑0015

U.S. Department of Agriculture Grain Inspection, Packers and Stockyards Administration Packers and Stockyards Program

Vehicle Scale Test Report

1 Page No.

2 Date

3 Test Agency (Name, address, city, state, zip code, phone number, and e‑mail address)

4 Scale Owner (Name of firm)

5a Scale Location (Address)

5b (City)

5d (County)

5e (State)

6 Name and Address of Poultry Processor or Dealer Using Scale

7 Make of Scale

8 Scale Capacity Lbs.

9 Kind of Indicator

10 Serial Number

11 Minimum Division

12 Balance Indicator (Make)

13 Platform Size X Ft.

14 Balance Condition on Arrival Lbs.

15 Type of Levers

16 Pit Depth Ft.

17 Last Date Tested

18 Year Installed

Test Results

Increasing Load Test of Each Section

Test Weights

21 Scale Indication

22 Error

Test Weights

21 Scale Indication

22 Error

19 Position

20 Pounds

19 Position

20 Pounds

Balance

0

Strain-Load Test

Left to Right

Right to Left

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

23 Indicated Weight of Empty Truck

24 Amount of Test Weight Added

25 Scale Indication, Truck Plus Weights

26 Error on Test Weights Added

27 The errors indicated on this test report  ARE  ARE NOT within the accuracy requirements specified in National Institute of Standards and Technology (NIST) Handbook 44 as required by the Packers and Stockyards Program regulations (9 CFR 201.71). (For more information, contact the Business Practices Unit of the Packers and Stockyards Program Regional Office that covers your state.)

28 Repairs, Adjustments, or Changes Made at This Time (To be completed by State or scale agency):

29 Recommendations for Repair, Replacement, etc. (Continue on the reverse side if necessary)

30 Receipt of Report Acknowledged (Signature):

31 Scale Inspector (Signature):

Response is required in order to assure that tests have been made on scales to show their accuracy so that live poultry may be weighed (9 CFR 201.72). Information held confidential (9 CFR 201.96).

According to the Paperwork Reduction Act of 1995, no persons are 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 0580-0015. The time required to complete this information collection is estimated to average .25 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

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 individual’s 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 USDA’s TARGET Center at (202) 720-2600 (voice and TDD). 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.

Form P&SP-4400 August 2007 Page 2 of 2