FGIS 965 Scale Test Report (Hopper)

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Overview

SCALE FORM
INSTRUCTIONS
DISTRIBUTION
CONTACT

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Sheet 1: SCALE FORM

OMB Approved: 0580-0013

U.S. DEPARTMENT OF AGRICULTURE

LAST DATE TESTED

TEST DATE

PAGE

GRAIN INSPECTION, PACKERS AND STOCKYARDS ADMINISTRATION

FEDERAL GRAIN INSPECTION SERVICE

OF

FIELD MANAGEMENT DIVISION

MANUFACTURER

MODEL OF SCALE

SCALE CODE NO.

SCALE TEST REPORT - GRAIN HOPPER

TESTING AGENCY (Inspector's Name, Address)

SCALE CAPACITY

MINIMUM DIVISION

SERIAL NO.

SCALE TYPE

SCALE NO.

FIELD OFFICE LOCATION

Test Weight Information

Contact:

WEIGHTS

ELEVATOR WTS.

STATE WEIGHTS

Fax Number:

SCALE OWNER

TYPE AND MFG.

NUMBER OF WEIGHTS

SCALE LOCATION (ADDRESS)

LAST REVERIFICATION DATE

TOTAL WEIGHT

TEST RESULTS

SENSITIVITY

DISCRIMINATION

SCALE CONDITION AS FOUND

ZERO BALANCE AS FOUND

ZERO

CAP.

ZERO

CAP.

CORNER TEST

INCREASING LOAD TEST (CONT'D)

TEST

WEIGHT

ERROR

BAL

TEST

WEIGHT

ERROR

BALANCE

WEIGHT

INDICATION

WTS. lbs

ERROR

GRAIN

WTS.

WEIGHTS

INDICATION

WTS. lbs

ERROR

Corner 1

Corner 2

Corner 3

Corner 4

INCREASING LOAD TEST

BAL

TEST

WEIGHT

ERROR

GRAIN

WTS.

WEIGHTS

INDICATION

WTS lbs

ERROR

ZERO BALANCE CHANGE DURING TEST:

lbs.

THE ERRORS IN THIS SCALE AS INDICATED ABOVE

PRESCRIBED BY THE FEDERAL GRAIN INSPECTION SERVICE

REPAIRS, ADJUSTMENTS, MODIFICATIONS OR RECOMMENDATIONS MADE AT THIS TIME:

Return completed form to the above Field Office.

NEXT TEST IN:

APPLICABLE TOLERANCE ( "x" one)

APPROVAL SEAL APPLIED BY:

DATE:

REJECTION TAG NO.

ACCEPTANCE

MAINTENANCE

RECEIPT OF REPORT ACKNOWLEDGED (Signature)

FGIS WITNESS (Signature)

FORM FGIS-965 FEBRUARY 02

FORM APPROVED OMB NO. 0580-0013: 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 OMB control number for this information collection is 0580-0013. The time required to complete this information collection is estimated to average 2 hours per response and 1 minute of recordkeeping, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Edition dated (5/95) may be used.

Expires January 2015

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Sheet 2: INSTRUCTIONS

			Instructions for Completing Scale Test Reports	29	Scale Condition as Found. Indicate the condition of the scale as found. (i.e., water in pit, dirty platform, etc.)
		1	Testing Agency. The name of the organization, name of the person testing, address, and telephone number.	30	Zero Balance as Found. The weight indication on the primary indicating element with no load on the load receiving element at the time of starting the official inspection and test.
		2	Field Office Location. The city and state of the field office which has jurisdiction for the scale being tested.	31	Results. Check appropriate box; /x/ ARE‑for scales that are within tolerance or have been adjusted to be within tolerance, /x/ ARE NOT‑for a scale that cannot be used for official weight certification because it cannot be adjusted or fixed and is consequently REJECTED.
		3	Scale Owner. Facility name and designation; i.e., Mid-South Grain, House A.	32	Remarks. Indicate any repairs, adjustments, modifications, or recommendations. (i.e., scale serviced before test, load cell #2 replaced, A/D converter replaced.)
		4	Scale Location. The street address of the elevator.	33	Next Test In. Check the appropriate box to indicate approximately when the next test is due.
		5	Last Date Tested. Date of the last test.	34	Applicable Tolerance. ("X" one.) Indicate which tolerance is to be applied.
		6	Test Date. The month, day, and year of the test.	35	Approval Seal Applied. Indicate the name of the inspector who applied the FGIS Approved Label for Inspected Machinery. If the person is the same as the FGIS witness, just initial.
		7	Test No. Inspector’s assigned serial number, plus consecutive test number for the fiscal year. Cary Brown’s assigned serial (which is 1000), the first test of FY 2004, would be: "1001-04", the second would "1002-04", and so forth. In order of testing, regardless whether a hopper, vehicle, or railway track scale test.	36	Date. Indicate the date of approval.
		8	Manufacturer. The name of the company, corporation, person, etc., who manufactured the indicating element.	37	Rejection Tag No. Indicate the number of the rejection tag, if applicable.
		9	Model of scale. The model name, number, or designation which has been assigned by the manufacturer.	38	Receipt of Report Acknowledged. Signature of the scale owner's representative.
		10	Scale Code No. The code number of the scale which was assigned by the FGIS Policies and Procedures Branch for use in the ADP Scale Test Monitoring System.	39	FGIS Witness. FGIS or delegated official who observed the testing and approval of the scale.
		11	Scale Capacity. The maximum gross load that can be accepted for official weight certification as determined by an official scale inspector.	40	Test Procedures. See test procedures for hopper scales in Chapter 3 of the FGIS Weighing Handbook.
		12	Minimum Division. The value of the smallest unit that can be indicated on the primary indicating element during normal weighing.
		13	Serial No. The nonrepetitive number which was assigned by the manufacturer and affixed to the indicating element or beam.
		14	Scale Type. Check the appropriate box to indicate whether the scale is full electronic, levertronic, a full capacity beam (FCB) mechanical scale, or a counterpoise (CPB) mechanical scale.
		15	Scale No. The number assigned to the scale by the owner which usually includes S and/ or R designations to differentiate between shipping and receiving.
		16	Sectional Capacity. The maximum gross load that can be applied to any one section of the scale without causing structural deflections affecting the accuracy of the scale.
		17	Platform Size. The length and width of the vehicle scale platform.
		18	Scale Length. The length of the live track on a railroad track scale.
		19	Load Cell Capacity. The manufacturer's rated capacity of one of the load cells in the scale system.
		20	Sectional Test Load. The maximum amount of test standards applied to any one section of a railroad track or vehicle scale.
		21	Type and Mfg. For vehicle and hopper scales indicate the type of test weights; i.e., fab, basket, cast, etc., and the manufacturer. For railroad track scales check the appropriate box.
		22	Test Weight Owner. Indicate the test weight owner.
		23	Total Weight. The total amount of the test weights combined.
		24	Last Reverification Date. Indicate the month and year of the latest test weight reverification.
		25	I.D. No. The identification of the test car.
		26	Number of Weights. The total number of individual weights.
		27	Sensitivity. The results of the sensitivity check in number of divisions at zero and at capacity.
		28	Discrimination. The results of the discrimination check in number of divisions at ZERO and at CAPACITY.

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Sheet 3: DISTRIBUTION

Distribution of Scale Test Reports

"Scale Test Reports" are marked for distribution in the lower right‑hand corner of each copy. They shall be distributed as follows:

1 Original (white) shall be retained in a separate file at the office (FGIS or State) to which the responsibility for the scale is assigned. The hard copy printed record of the test indications shall be attached to the original.

2  First Copy (blue) shall be given or sent to the owner/operator of the scale for their information and records.

3 Second Copy (green) shall be sent to the FGIS, Policies and Procedures Branch by the FGIS scale specialist responsible for the scale.

4 Third Copy (pink) shall be sent to the FGIS field office, which is responsible for the area in which the scale is located.

5 Fourth Copy (yellow) is an extra copy available for an interested party (e.g., State Weights and Measures supervisor or scale service company).

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Sheet 4: CONTACT