DA-201C Cheese Graders Memorandum

OMB APPROVED – NO. 0581-0126 REPRODUCE LOCALLY Include form number and edition date on all reproductions

Page

of

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE CHEESE GRADERS MEMORANDUM

CERTIFICATE NO.

TO: APPLICANT (Name and address)

SHIPPER OR SELLER (Name and address)

RECEIVER OR BUYER (Name and address)

DATE INSPECTED

NO. SAMPLES TAKEN

INSPECTED AT (Name and address)1

INSPECTED BY:

CONDITION OF CONTAINERS

SAMPLE CONTAINERS STAMPED WITH USDA LOT NO.

applicable U.S. standards for condition of food containers

MANUFACTURED BY (Name and address)1

ANNOUNCEMENT NO.

CONTRACT NO.

SEED NO.

SIZE AND KIND OF CONTAINERS

STORAGE LOT

SERVICE DATE

MOISTURE TEST

VAT NUMBER

YR__MFG. DATE

NO. PKGS.

MARKED WEIGHT

TEST SHORTAGE

NET WEIGHT

DEFECT RATING

U.S. GRADE

COMMENTS (S-Slight, D-Definite, P-Pronounced)

FDB

% H2O

pH

FLA­VOR

BODY & TEX

COLOR

FINISH

SIGNATURE OF AGENT FOR APPLICANT

US GRADE

NO. OF PACKAGES

WEIGHT

FEES

GRADE

lbs

INSPECTION

$

GRADE

lbs

EXPENSE

GRADE

lbs

LABORATORY

GRADE

lbs

TOTAL

$

GRADE

BELOW

lbs

DA-201C (9-2015) (Destroy previous editions)

(See reverse of form for Burden Statement)

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