P&SP 4500 Hopper Scale Test Report - Feed

OMB Control No. 0580-0015

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

Hopper Scale Test Report

1 Page No.

2 Testing Agency (Name, address, city, state, zip code, telephone number, and e-mail address):

3 Scale Owner

4 Address

5 City

6 County

7 State

8 Scale Location

9 Address

10 City

11 County

12 State

13 Date Test Weights Were Last Verified

14 Test Date (mm/dd/yyyy)

15 Last Test Date (mm/dd/yyyy)

16 List Times and Days When Scale Is Not In Use, and Available For Testing

17 Scale Capacity (lbs.)

18 Class of Scale:  Marked III  Not Marked

19 Model Number

20 Scale Division (lbs.)

21 Scale Manufacturer (Indicator)

22 Type of Indicator:  Beam  Dial  Digital  Printer

23 Is the Scale Connected to a Computer?  Yes  No

24 Serial Number

TEST RESULTS

25 SR (Sensitivity Response) Or Discrimination Test Zero Load = ______________ lb. Maximum Load = ______________ lb.

26 Scale Condition As Found

27 Zero Balance As Found

28 CORNER TEST

29 INCREASING LOAD TEST (continued)

Position

(a) Balance Weights

(b) Test Weight

(c) Weight Indication

(d) Error Weights (lbs.)

(e) Error

(a) Feed

(b) Balance Weights

(c) Test Weights

(d) Weight Indication

(e) Error Weights (lbs.)

(f) Error

Corner 1

Corner 2

Corner 3

Corner 4

29 INCREASING LOAD TEST

a Feed

b Balance Weights

c Test Weights

d Weight Indication

e Error Weights (lbs.)

f Error

30 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 regulations (9 CFR 201.71). (For more information, contact the Business Practices Unit of the Packers and Stockyards Program Regional Office.)

31 Repairs, adjustments, or changes made at this time:

32 Recommendations for repair, replacement, etc. (Continue on reverse side if necessary):

33 Receipt of Report Acknowledged (Signature):	34 Scale Inspector (Signature):
Response is required to assure that tests are made on feed scales, and to show accuracy of scales used to weigh feed when feed weight is a factor in determining payment or settlement for livestock or live poultry. ( 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-4500 August 2007 Page 2 of 2