FGIS 1001 Application for Approval to Operate as a Weight Facility

U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND STOCKYARDS ADMINISTRATION
FEDERAL GRAIN INSPECTION SERVICE
APPLICATION FOR APPROVAL TO OPERATE AS A WEIGHING FACILITY

This application form must be completed and approved before operating as a weighing facility
(7U.S.C.7A (f).) See reverse for additional information required.

1. NAME OF FACILITY (Where The Weighing Equipment Is Located):

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 44 minutes per response,
including the time for reviewing instructions, searching
for existing data sources, gathering and maintaining
sources, gathering and maintaining the data
needed, and completing and reviewing the collection
of information.

ADDRESS (Street, City, State, and Zip Code):

OWNER OF FACILITY:
2. NAME:
ADDRESS (Street, City, State, and Zip Code):

OPERATOR OF FACILITY
3. Contact Person

Telephone Number

Email

4. The following named persons are employed at this facility as weighers. Each individual has demonstrated the technical ability to
operate grain weighing equipment and has a reputation for honesty and integrity (fill-out additional forms if necessary).

5. NAME AND SIGNATURE OF OPERATOR AND DATE

FORM FGIS-1001 (01/08)

(Replaces Form FGIS-1001 (07/04) which is obsolete.). Expires January 2015

Clear Entire Form

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of

SCALE SYSTEM TO BE USED OFFICIALLY (Fill out additional sheets for each scale system differing
in design or use; answer questions 6-13 only if this is for the initial test)
6. Type Scale
Railway Track

7. Load-Receiving Element
Vehicle Platform

Automatic Bulk Weighing System

Platform
Reset

Reset

9. Type of Movement (may check more than one)

8. Load-Sensing
Full-electronic (2 or more load cells)
Lever-tronic (1 load cell)

Hopper

Mechanical

Inbound
Reset

10. WEIGHING ELEMENT MANUFACTURER (Scale):

Outbound

Export

Reset

MODEL:

11. CERTIFICATE OF CONFORMANCE NUMBER:

12. DIGITAL WEIGHT INDICATOR MANUFACTURER:

MODEL:

CERTIFICATE OF CONFORMANCE NUMBER:

13. LOAD CELL MANUFACTURER:

CERTIFICATE OF CONFORMANCE NUMBER:

COMMENTS:

Form FGIS-1001 (Reverse)

MODEL:

FORM FGIS-1001,
“APPLICATION FOR APPROVALTO OPERATE AS A WEIGHING FACILITY”
The U.S. Grain Standards Act and regulations require facilities to submit information showing
that the weighing facility and the elevator personnel operating weighing equipment at that
facility meet the conditions necessary to have official weighing. Facilities are required to
provide this information when service is first established, and when operating personnel
change (or at least annually if personnel change). Operators fill out the Form FGIS-1001,
“Application For Approval To Operate As A Weighing Facility”, to document that their weighing
facility complies with these conditions.
Questions 1-5 pertain to facility’s location, operation, and ownership and lists weighers who the
operator has trained adequately and will see that they use scales as directed by official
personnel. Questions 6-14 have to do with the scales’ use, design, and component
specifications. Assistance may be required of the person(s) or company who installs or
maintains the scale to answer some of these questions.
INSTRUCTIONS ON COMPLETING THE FORM:
(1)

Name of the facility, mailing and street address for the facility’s physical location.

(2)

Owner's name and address.

(3)

Name of person to contact in case additional clarification needed about the
information submitted.

(4)

Names of persons employed at the facility that operate the facility's scales as
weighers. By listing employees here, the facility is stating that these individuals can
demonstrate a technical ability to operate grain weighing equipment and have a
reputation for honesty and integrity. If the facility's personnel fluctuates because
personnel are hired from employment pools, such as longshore personnel, the
individuals who directly supervise these individuals (facility) or "key" longshore
personnel can be listed. These blanks do not require the signature of the individual.

(5)

Operator's signature with date (usually the plant superintendent or manager). The
person who controls or is accountable for the weighers’ employment, training, or
oversight.

(6)

Type scale -- check the box adjacent signifying whether the scale is a railway track,
vehicle platform, or automatic bulk weighing system.

(7)

Load-receiving element -- check “Platform” if the vehicle or railway track car carriers
are placed on the weighing element; check “hopper” if the weighing element is a tank
or hopper for an automatic bulk weighing system or hopper scale.

(8)

Load-Sensing -- check full-electronic if an electronic scale with 2 or more load cells
which directly support the load-receiving element; check lever-tronic if a mechanical
scale that has a load cell inserted into a lever system; check mechanical if a scale
which operates purely on a lever system or has any other non-electrical balance
system.

(9)

Inbound or outbound movements -- grain unloaded or loaded respectively into or out
of carriers; outbound is also defined as grain leaving the facility where the grain is
weighed; export means grain exported or moved outside the boundaries of the
United States. More than one box may be checked.

(10)

Weighing Element Manufacturer -- list the company name and model, including certificate
number manufacturing the scale part (the weighing element or the load-receiving
element is the portion of a scale that supports and transmits to the indicating element
the signal or force resulting from the load applied, also know as a hopper or platform).

(11)

Certificate of Conformance (cc) -- provide the device’s certificate number. A “cc” is a
document issued by the National Conference on Weights and Measures (NCWM)
based on testing by a Participating Laboratory; said document constitutes evidence
of conformance of a type with the requirements of National Institute of Standards and
Technology Handbooks 44, 105-1, following State, and GIPSA weighing regulations.
See NCWM certificate and or “certificate database” at http://www.ncwm.net for that
number or if it came with documentation when equipment was purchased or was
provided by the scale installer. The weighing element, digital weight indicator,
and load cells each have separate certificate numbers.

(12)

Digital Weight Indicator Manufacturer -- list the company name, model, and
certificate number that manufactured the weight display or indicating element
mechanism. The digital weight indicator is a system of indication or recording of the
selector type or one that advances intermittently in which all values are presented
digitally, or in numbers. In a digital indicating or recording element, or in digital
representation, there are no graduations. NCWM lists these device types as
“Indicating Elements” in its certificate databases.

(13)

Load Cell Manufacturer -- a load cell, also known as “force transducer” is a device,
whether electric, hydraulic, or pneumatic, that produces a signal proportional to the
load applied. List the company name, model, and certificate number that has
manufactured the scale’s load cells.

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

The signed form should also be mailed to this location.
For further information on the “Application For Approval To Operate As A Weighing Facility”.
Joseph D. Han
Policies, Procedures and Market Analysis Branch
Field Management Division
10383 N. Ambassador Drive
Kansas City, MO 64153
Telephone 816-659-8407
[email protected]