MA-100A Producer Weight Record

MA 100A

PRODUCER WEIGHT R ECORD
BULK FARM TANK
FEDERAL ORDER 30

PRODUCER
NUMBER

CONVERTED
POUNDS

GAUGE
ROD

TEMP.

MlLK PICKED UP
DATE

TIME

HAULER’S INITIAL_____________________________________

PLANT

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MA-1OOA PRODUCER WEIGHT RECORD
BULK FARM TANK TICKET
The following changes will be made when the lab orders new MA-100
Pink Tickets.
1) The words: "Form Approved, OMB 0581-0032" in the upper right
hand corner of the front page of the form; and
2) The Burden and Non-discrimination Statements will appear on the
reverse side of the form. These paragraphs will be in no smaller than
font size 8. The following are the current Burden and Nondiscrimination Statements:
According to the Paperwork Reduction Act of 1995, an
agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMS
control number for this information collection is 05810032. The time required to complete this information
collection is estimated to average . 2 5 hours per
response, including the time for reviewing instructions,
searching existing data sources, gathering and
maintaining the data needed, and completing and
reviewing the collection of information.
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.