Form LPS-156 Shell Egg Regulatory Inspection Report

U.S. DEPARTMENT OF AGRICULTURE
1. NAME OF EGG HANDLER
AGRICULTURAL MARKETING SERVICE
LIVESTOCK, POULTRY, AND SEED PROGRAM
7. ADDRESS (Include Street, City, State, and Zip Code)

SHELL EGG
REGULATORY
INSPECTION REPORT
NO.

QUANTITY
(dz.)

GRADE
CODE

SIZE
CODE

2. STATE CODE

3. COUNTY CODE

8. TYPE OF VISIT (Check one)

9. NATURE OF BUSINESS (Mark appropriate box)

Initial (Regular)

Release

Makeup

Followup

Producer/Packer with more than 3,000 birds
Inedible Collection/Processing
Grading Station
Hatchery
Cooked Eggs
Exempt Breaker

Other (explain in comments)
10.

This form reports a change in registration information
(explain in comments)

CHECKS LEAKERS DIRTIES
(%)
(%)
(%)

11. Is record keeping satisfactory?
YES

(%)

TYPE

(%)

12. Is a followup visit necessary?

NO (explain in comments)

DESCRIPTION OF RETAINED PRODUCT
LOSS 1
LOSS 2
MISLABELED
TYPE

OMB APPROVED: NO. 0581-0113
5. DATE
6. PAGE

4. HANDLER CODE

Restricted Temp (°F)

N/A

YES

TAG OR LOT
NUMBER

NO

USDA
IDENTIFIED

REMARKS

1
2
3
4
5
TOTAL
INEDIBLE PRODUCT

QUANTITY (lbs)

TYPE OF CONTAINER

TAG NUMBER

RELEASE OF RETAINED PRODUCT
TAG OR LOT NUMBER

QUANTITY
(dz or lbs)

DISPOSITION CODE

REMARKS

1
2
3
4
5
6
THERMOMETER:

COMMENTS:

AVERAGE AMBIENT AIR TEMPERATURE
Cooler No.

Temp(°F)

Cooler No.

Temp(°F)

SIGNATURE OF INSPECTOR

LICENSE
NUMBER

USDA REPRESENTATION
DUTY
LICENSE
NUMBER

J
XL

CALIBRATION DATE:

TYPED OR PRINTED NAME OF INSPECTOR

PRODUCT INVENTORY
(Dozen)

L
M

DUTY

PARTICIPANTS
LICENSE
DUTY
NUMBER

S
LICENSE
NUMBER

DUTY

PW
U
Rest.

DATE

TITLE

LPS-156 (01/2018) (Previous edition dated 01/2015 may be used.)

COMPANY REPRESENTATIVE
TYPED OR PRINTED NAME

SIGNATURE
(See reverse of form for Privacy Act Statement.)

NOTE: 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 0581-0113. The time required to complete this information collection is estimated to
average .20 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 individuals 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 USDAs 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, employer, and lender.
GRADE CODES
AA
A
B
C
D
CD
NR
R
S
U

SIZE CODES

AA
A
B
Checks
Dirties
Checks & Dirties
Nest Run
Restricted
Spots
Unwashed & Ungraded

J
XL
L
M
S
PW
U

Jumbo
Extra Large
Large
Medium
Small
Pee Wee
Unsized/Mixed

LOSS TYPE CODES
BLRT
BR
BW
CE
FZ
GW
LS
MR
MLDY
SR
SY

Black Rot
Blood Ring
Bloody White
Cooked Egg
Frozen
Green White
Large Spot, Blood or Meat
Mixed Rot
Moldy
Sour Rot
Stuck Yolk

DUTY CODES
CI
SI
FI
RG
SS
FS
RO
HQ

County SES Inspector/Supervisor Performing Inspection Visit
State SES Inspector/Supervisor Performing Inspection Visit
Federal SES Inspector/Supervisor Performing Inspection Visit
Resident Grader
State Supervisor Performing Supervision Visit
Federal Supervisor Performing Supervision Visit
Regional Office Representative
Headquarters Representative

DISPOSITION CODES
RR

Reworked, Regraded, and Released - Reworked and regraded shell eggs based on full sample size, and released.

LR

Labeled/Relabeled and Released - Relabeled to identify proper category of shell eggs and/or inedible product and released based on verification.

DR

Denatured and Released - Denatured to identify proper decharacterization of shell eggs and/or inedible products and released based on verification.

LD

Labeled, Denatured, and Released - Labeled and adequately decharacterized shell eggs and/or inedible products and released based on verification.

IR

Placed into Inedible and Released - Disposed of shell eggs by placing into inedible product and released based on verification.

RD

Reworked and Regraded at Destination Location - Reworked and regraded shell eggs and/or inedible product at destination location (another egg
handler or at an egg products plant), and released based on the verification by the destination surveillance inspector.

PA

Process for Industrial Use or Animal Food - Processed shell eggs and/or inedible product for industrial use or animal food under official supervision
and released based on the verification by the destination surveillance inspector.

DY

Destroyed - Destroyed shell eggs and/or inedible product on site with verification.

LPS-156 (01/2018) (Previous edition dated 01/2015 may be used.)