Record of Dumped Milk and Accidental Loss

Report Forms Under Milk Marketing Order Programs (From Milk Handlers and Milk Marketing Cooperatives)

Record of Dumped Milk & Accidental Loss 12-7-16

Report Forms Under Milk Marketing Order Programs (From Milk Handlers and Milk Marketing Cooperatives)

OMB: 0581-0032

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Form Approved,
OMB No. 0581-0032

UNITED STATES DEPARTMENT of AGRICULTURE
AGRICULTURAL MARKETING SERVICE - DAIRY PROGRAMS
MARKET ADMINISTRATOR
(Insert Federal Order's Contact Information)

RECORD OF MILK PRODUCTS DUMPED OR LOST
Instructions: To qualify for appropriate credit for dumped or lost product, notification must be made to the
Market Administrator’s office by telephone, fax, or email by the next business day. Please report dump
or loss to one of the phone numbers, fax numbers or email addresses listed above.

HANDLER NAME
(CITY/STATE)
DATE OF DUMP/LOSS

Where and how was product disposed?

TIME

Was dumped product used as animal feed? (Please indicate) Yes
(Please check description, explain if necessary)

No

Product dumped from batch tank, vat, silo or other measurable method.
Explain :
Product loss was not contained (accidental loss, quantity estimated through other methods).
Explain :

Product Description

Units of
Measure

Product Weiqht

Butterfat %

Butterfat Pounds

Handler Comments:

Handler Representative:
Name:

Date:

MA Representative Receiving Notification:
Name:
Comments:

MA Use Only
Date:

Month
Auditor
Date

According to the Paperwork Reduction Act of 1995, an agency may not conduct 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 0581-0032. The time required to complete this information collection is estimated to average .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 of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial,
parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited basis
apply to all programs.) Persons with disabilities who require alterative means for communication of program information (Braille, large print, audiotape, etc.} should contact USDA’s TARGET Center at (202) 7202600 (voice and TDD).*
To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Right, Office of the Assistant Secretary for Civil Rights. 1400 Independence Avenue, S.W. Stop 9410, Washington, DC 202509410, or call toll-free at (866} 632·9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6135 (Spanish Federal-relay), USDA is an equal opportunity provider and
employer.


File Typeapplication/pdf
AuthorCherry, Richard - AMS
File Modified2017-01-25
File Created2017-01-25

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