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pdfOMB No. 0581-0274
Supplement - Multiple Plants Reporting Screening Table
Note: This supplement is required for all operations answering "YES" to Question 1 in Section 1 of the Annual validation.
1. Please list your company's headquarters location, all dairy plant locations, any firm with an exclusive marketing agreement:
Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.
Office
Use
Company Name
Physical Address
Contact Name
Plant
Id
Plant Name
Mailing Address
Telephone Number
Products
Produced
Question Answer Log
Q-2
Q-3
Q-4
HQ
(
)____________
(
)____________
(
)____________
(
)____________
P1
P2
P3
2. Does your office have full access to (insert Plant Name of each entry) weekly sales data (i.e. all ledgers, contracts,
invoices, and cash receipts)?
YES
NO
DNK
3. Does (insert Plant Name of each entry) produce and/or market products outside of the information you can provide to AMS (i.e. cheese is
reported through your office but the plant listed above sells dry whey using a different office)?
YES
NO
DNK
4. Does (insert Plant Name of each entry) market products of the same type outside of information you can provide to AMS (i.e. the plant
listed above may have walk-in cash sales you cannot access)?
YES
NO
DNK
[After completion of the supplement return to the Annual Validation Worksheet in Section 1, Question 2.]
DA-230-S (Supplement sheet to DA-230)
Page 1 of 3
Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.
Office
Use
Company Name
Physical Address
Contact Name
Plant
Id
Plant Name
Mailing Address
Telephone Number
Products
Produced
Question Answer Log
Q-2
Q-3
Q-4
P4
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
P5
P6
P7
P8
P9
P10
P11
P12
P13
DA-230-S (Supplement sheet to DA-230)
Page 2 of 3
Interviewer Note: List Company Name, Plant Name, Physical Address, Mailing Address, Contact, Telephone, and Dairy
Products Produced for each location.
Office
Use
Company Name
Physical Address
Contact Name
Plant
Id
Plant Name
Mailing Address
Telephone Number
Products
Produced
Question Answer Log
Q-2
Q-3
Q-4
P14
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
(
)____________
P15
P16
P17
P18
P19
P20
P21
P22
P23
DA-230-S (Supplement sheet to DA-230)
Page 3 of 3
| File Type | application/pdf |
| File Modified | 2014-10-08 |
| File Created | 2011-04-21 |