FORM FGIS-921-2

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OMB No. 0580-0013
U.S. Department of Agriculture
Grain Inspection, Packers and 
Stockyards Administration
Animal and Plant Health Inspection Service

INSPECTION REPORT – INSECTS IN GRAIN

Page             of         

1. Name and Address of Shipper
     






2. Location of Elevator
     

3. Grain/Commodity    
     

4. Quantity
     

5. Grain Inspection Certificate Number. 
     
6. Status of Report 
 Original     Corrected



7. Country of Destination
     

8. Name of Carrier/Vessel
     



9. Loading Date Start/Date Finished
     

10. Sublot Number/
    Carrier Identification
11. Date 
      Inspected
12. Stowage
     (Hold Nos.)
13. Quantity


14. No. of Live Insects
15. Lot Infested
16. Name of Insect
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
     
     
     
     
     

     
17. Remarks (Use reverse for additional space)
     

18. Name of Inspector and name of official service provider
     




Fumigation Information
19. Date of Fumigation
     
20. Treatment
     
21. Hold Nos.
     
22. Type of Chemical
     
23. Concentration Level
     
24. Duration of Exposure
     
25. Temperature at Time of Fumigation
     
26. Quantity (metric tons)
     
27. Name of Inspector
     
Form FGIS-921-2 (07-10) Edition 05-08 may be used.  Expires January 2015
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 5 minutes 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.
Additional Remarks: (Additional information from boxes 10 - 17 may be continued on this page, or use additional forms if needed.





Instructions for Completing Form FGIS 921-2
“INSPECTION REPORT – INSECTS IN GRAIN.”

    1. Name and address of the shipper.

	2.	Location of elevator where the barge, vessel or carriers (railcars, containers) were loaded.

    3. Type of grain/commodity examined for insects. 

    4. Total quantity (pounds or metric tons) of the grain/commodity that was loaded on the barge or vessel, or the number of containers and/or hopper cars.  

    5. If applicable grain inspection certificate number representing the containers/vessel shown on this report.

    6.  Indicate if this “Insects in Grain Report” is the original or has been corrected. 

    7. Destination country for the grain/commodity.

    8. Name of the vessel or barge identification number/name.

    9. Dates the loading of the barge/vessel, unit train, container booking started and completed.  

    10. Sublot Number or Carrier Identification (e.g., container, railcar, or truck).  List individual carrier IDs separately in the space provided on front of form.  If the number of Sublots or carrier ID’s exceed the available spaces, then use the front of another 921-2 for remainder of sublots or carrier ID’s. Use the back of the form for unit trains to list the railcar ID’s associated with the sublot listed on front of the form.”

    11. Applicable for containers only.  Date the grain/commodity was loaded and examined for insects.

    12. Stowage (Hold Nos.), location where the grain/commodity for that particular sublot is stowed. 

    13. Enter the approximate quantity (pounds) of the grain/commodity in the bargelot or sublot.  For railcars and containers, use the actual weight of the lot or use the appropriate carrier terms (e.g., hopper, carlot, unit train, and container).

    14. Number of live insects found in the corresponding sublot or carrier (if any).

    15. Check the box if the grain/commodity examined meets the FGIS criteria for “Infested” or “Sample Grade” (SG) because of live insect infestation.  Mark this column only as it applies to insects, not any other SG condition.

Note:  The FGIS designation “Sample Grade” is applicable to beans, lentils, peas, and rice when infested with live weevils or other live insects injurious to stored grain.  Sample Grade is also applicable to lots of milled rice that contain dead insects.  Do not report milled rice lots that are “Sample Grade” due to dead insects.  The FGIS designation of “Infested” is applied to the grains, barley, canola, corn, flaxseed, mixed grain, oats, rye sorghum, soybeans, sunflower seed, triticale, and wheat when they are infested with live weevils or other live insects injurious to stored grain.

    16. Name of any insect found in the corresponding sublot or carrier.  Identify by using the insect’s common name (e.g., Rice Weevil, Red Flour Beetle).  DO NOT USE TERMS THE TERMS “BRAN BUG” OR “OLI.”

    17. Place any remarks, if needed, in this section.  The reverse of the form may be used if additional space is needed.

    18. Name of inspector completing this form along with the name of the official service provider or the official service provider’s alpha identifier.

Note Section 19 - 27:  Complete these sections for fumigation of vessels where official personnel are present to witness the application of the fumigant.  For containers or railcars that are fumigated when official personnel are not physically present to witness the fumigation, the required fumigation documentation may be attached to the form.

    19. Date that the grain/commodity in the noted sublot/barge/railcar/container was fumigated.

    20. Fumigation method used to treat the grain/commodity.  (Leave this space blank)

    21. The stowage space (e.g., hold numbers, container number, rail car number) that was fumigated.

    22. Type of chemical used to fumigate the grain/commodity. 

    23. The concentration level of the fumigant used.

    24. Length of time the stowage area (e.g., vessel holds, railcar, container, and barge) needs to be secured for a proper treatment of the grain/commodity.

    25. The air temperature at the time of fumigation.

    26. Total quantity of grain/commodity fumigated expressed in metric tons, if known.  For railcars and containers, use the actual weight or use the appropriate carrier terms (e.g., hopper, carlot, unit train, and container).

    27. Name of the inspector who verified the fumigation process.  Complete this block only if official personnel were present to observe the fumigation.

CONTACT INFORMATION:

Contact the field office responsible for the geographic area in which the service will be provided.  Details for these locations can be found at:  

http://www.gipsa.usda.gov/GIPSA/webapp?area=home&subject=fc&topic=fsp

For further information on the Inspection Report - Insects in Grain:

Robert J. Dorman
Policies, Procedures Market Analysis Branch
Field Management Division
1400 Independence Avenue, SW, Room 2409 N 
Washington, DC 20250-3630

Telephone: 	(202) 720-0276
Fax: 		(202) 720-1015
Email:		[email protected]