DA-230S Annual Validation (Supplement, if applicable)

OMB 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 plants/companies owned or partially owned producing or selling dairy
products, plants/companies with whom you have tolling agreements, or plants/companies with whom you have exclusive marketing agreements.
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

List ALL Dairy Products
Produced at Plant

Plant
Id

Plant Name

Mailing Address

Telephone Number

(Check the box ONLY if ALL PRODUCTS LISTED
are NOT REPORTABLE )

Question Answer Log
(For plants with reportable products, answer
questions in the boxes below)

Question 2

Question 3

Question 4

HQ

P1

P2

P3

[Interviewer Note: In the Question Answer Log - For each plant listed in the supplement with reportable products , answer questions 2, 3 and 4 listed below.]

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)? If "No" or "Unknown", please explain in the comment box.
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)? If "Yes" or "Unknown", please explain in the comment box.
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 cash sales you cannot access)? If "Yes" or "Unknown", please explain in the comment box.
5. Comment Box:

[After completion of the supplement return to the Annual Validation Worksheet in Section 1, Question 2.]
DA-230-S (Supplement sheet to DA-230)

Supplement 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

List ALL Dairy Products
Produced at Plant

Plant
Id

Plant Name

Mailing Address

Telephone Number

(Check the box ONLY if ALL PRODUCTS
LISTED are NOT REPORTABLE )

Question Answer Log
(For plants with reportable products, answer
questions in the boxes below)

Question 2

Question 3

Question 4

P4

P5

P6

P7

P8

P9

P10

P11

P12

P13

DA-230-S (Supplement sheet to DA-230)

Supplement 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

List ALL Dairy Products
Produced at Plant

Plant
Id

Plant Name

Mailing Address

Telephone Number

(Check the box ONLY if ALL PRODUCTS LISTED
are NOT REPORTABLE )

Question Answer Log
(For plants with reportable products, answer
questions in the boxes below)

Question 2

Question 3

Question 4

P14

P15

P16

P17

P18

P19

P20

P21

P22

P23

DA-230-S (Supplement sheet to DA-230)

Supplement Page 3 of 3