WA-222 Examination Report of Individual Buildings

Form Approved - OMB No. 0581-0305

This form is available electronically. (See Page 2 for Privacy Act and Paperwork Reduction Act Statements.)

WA-222 U.S. DEPARTMENT OF AGRICULTURE (07-31-18) Agricultural Marketing Service EXAMINATION REPORT OF INDIVIDUAL BUILDINGS (Supplement 2)

1. NAME AND LOCATION OF WAREHOUSE      

2. LICENSE AND CODE      

3. DATE (MM-DD-YYYY)      

4A. THIS REPORT APPLIES TO:      

4B. DISTANCE TO HEADQUARTERS OFFICE      

5. APPLICANT'S INTEREST IN: A. LAND IS: OWNER LESSEE

B. WAREHOUSE IS: OWNER LESSEE

C. EQUIPMENT IS: OWNER LESSEE

6. IF OWNER OF LAND, GIVE RECORDING OR TAX INFORMATION:

A. VOLUME      

B. PAGE      

C. RECORDS OF COUNTY/PARISH      

D. STATE      

7. SURROUNDINGS:

A. DISTANCE

B. LANDMARK

C. LANDMARK OWNER/TENANT USE

NORTH:      

FEET TO:      

OCCUPANCY:      

EAST:      

FEET TO:      

OCCUPANCY:      

SOUTH:      

FEET TO:      

OCCUPANCY:      

WEST:      

FEET TO:      

OCCUPANCY:      

8. TYPE OF CONSTRUCTION (Check one) BRICK CONCRETE FRAME IRONCLAD OTHER (Describe)

9. NO. OF STORIES      

10. AVERAGE HEIGHT EACH STORY (floor to ceiling)      

11. INSIDE DIMENSIONS:

11A. LENGTH      

11B. HEIGHT      

11C. WIDTH      

STATE MATERIAL OF THE FOLLOWING:

12. FOUNDATION      

13. BASEMENT FLOOR      

14. GROUND FLOOR      

15. OTHER FLOORS      

16. ROOF      

17. DOORS AND FRAMES      

18. WINDOW SASH AND FRAMES      

19. SKYLIGHT SASH AND FRAMES      

20. STATE MATERIAL AND CONSTRUCTION OF FIREWALLS      

21. STATE SUBSTANDARD FEATURES OF DIVISION FIREWALLS, IF ANY      

22. STATE SIZE OF FIRE DOORS      

23. MATERIAL      

24. ACCEPTABLE CLOSING DEVICE (If "NO", Issue WA-125) YES NO

25. ACCEPTABLE LIGHTING (If "NO", Issue WA-125) YES NO

26. IF THE ENTIRE BUILDING IS "NOT" TO BE LICENSED, OR APPROVED, STATE HOW SPACE COVERED BY APPLICATION IS SEPARATED FROM SPACE "NOT" COVERED:      

27. IF BUILDING OR PARTS THEREOF, INCLUDING DOORS, WINDOWS, AND SKYLIGHTS, ARE IN NEED OF REPAIR, EXPLAIN FULLY:      

28. ARE ANY OF THE FLOORS DAMP? IF "YES," STATE WHAT PORTION, GIVE CAUSE, AND DESCRIBE DUNNAGE USED, IF ANY:      

YES

NO

  

  

29. IS WAREHOUSE EQUIPPED WITH HUMIDIFIERS? IF "YES," EXPLAIN FULLY:      

  

  

30. IS THE BUILDING COVERED BY THIS REPORT PROVIDED WITH AUTOMATIC SPRINKLER? IF "YES" IS IT: WET DRY

  

  

31. NUMBER AND ARRANGEMENT OF INSIDE STANDPIPES:      

USDA is an equal opportunity provider, employer, and lender.

WA-222 (07-31-18) Page 2 of 2
32. IF PRODUCTS OTHER THAN THOSE COVERED BY THE APPLICATION ARE STORED IN THE SPACE, WILL THESE PRODUCTS INCREASE THE FIRE HAZARD OR INJURE THE PRODUCTS COVERED BY THIS APPLICATION? IF "YES," EXPLAIN FULLY.      			YES	NO
			  	  
33. ARE ANY PRODUCTS NAMED IN THE APPLICATION NOW STORED IN THE PROPOSED SPACE? IF "YES," EXPLAIN FULLY.      			  	  
34. IS STORED COTTON ARRANGED IN ACCORDANCE WITH UNDERWRITERS SPECIFICATIONS?      			  	  
35. DOES ANY ADJOINING PROPERTY, OR NEARBY STREAM, CONSTITUTE A SECURITY, FIRE OR FLOOD HAZARD? IF "YES," EXPLAIN FULLY.      			  	  
36. DO YOU RECOMMEND ISSUANCE OF A WAREHOUSE OPERATOR'S LICENSE AND/OR APPROVAL FOR STORAGE OF GOVERNMENT LOAN OR OWNED COTTON? IF "NO", EXPLAIN N ITEM 39.			  	  
37. DOES THE WAREHOUSE OPERATOR HAVE WRITTEN PERMISSION FROM THEIR UNDERWRITER TO DEVIATE FROM NORMAL UNDERWRITING SPECIFICATIONS? IF "NO", ISSUE A WA-125.			  	  
38. DOES WAREHOUSE OPERATOR HAVE A SIGNED LEASE, IF APPLICABLE? IF "NO", ISSUE A WA-125 AND NOTE ON WA-101.			  	  
39. REMARKS (Attach additional sheets if necessary)      
40A. EXAMINER'S INITIALS     		40B. DATE (MM-DD-YYYY)      
NOTE:	The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 735, 7 CFR Part 1423, 7 CFR Part 1427, the United States Warehouse Act (Pub. L. 106-472), and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.).  The information will be used to determine whether licensee has required facilities and is operating in accordance with the United States Warehouse Act, regulations or contractual requirements. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated) and USDA/FSA-3, Consultants File.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of ineligibility to obtain new licensing or retain existing licensing under the United States Warehouse Act. 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 0581-0305. The time required to complete this information collection is estimated to average 10 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE WAREHOUSE AND COMMODITY MANAGEMENT DIVISION, STOP 9148, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.