VS 13-16 Garbage Treatment Facility Inspection

OMB Approved
0579-0065
EXP. Date
XX/XXXX

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 is 0579-0065. The time required to complete this information collection is estimated to average 1 hour
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.

A license cannot (1) be issued, or (2) remain in effect, unless an inspection is made of the treatment (PL 96-468 and 9 CFR 166).
1. LICENSE NUMBER

U.S, DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

2. COUNTY

3. STATE

(If relicensing inspection, so state)

GARBAGE TREATMENT FACILITY INSPECTION
INSTRUCTIONS – After inspection, distribute copies of this form as shown below. All items are to be completed.

5. NAME AND MAILING ADDRESS OF FACILITY

4. NAME OF OPERATOR (First Name, MI, Last Name)

PHONE NUMBER ( ______) ________________________

6. ADDRESS WHERE YOU MAY BE CONTACTED IN PERSON

For each item, “X” one column only indicating satisfactory,
unsatisfactory, or not applicable. Explain deficiencies AND not
applicable notation in item 27.

8. General sanitation of treatment area . . . . . . . . . . . . . . . .

7. SOURCE(S) OF GARBAGE

Satis.

For each item, “X” one column only indicating satisfactory,
UnNot
unsatisfactory, or not applicable. Explain deficiencies AND not
satits. Appl.
applicable notation in item 27.

Satis.

UnNot
satits. Appl.

18. Containers for untreated garbage?
a. Covered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Leak-proof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Garbage cooked to time/temperature
specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. Disposal of excess garbage . . . . . . . . . . . . . . . . . . . . . .
10. Untreated garbage not accessible to swine . . . . . . . . . . .
11. Material associated with untreated garbage
not accessible to swine . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Drainage from untreated garbage not
accessible to swine . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Garbage cooking area not accessible to swine to
swine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. Pest control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15. Separate equipment for untreated/treated
garbage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16. Cooking equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17. Separate containers for untreated/treated
garbage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20. Health of all animal species . . . . . . . . . . . . . . . . . . . . . .
21. Cleaning and disinfection of vehicles. . . . . . . . . . . . . . . .
22. Maintenance of records. . . . . . . . . . . . . . . . . . . . . . . . . .

23. Feeding untreated garbage:

UNKNOWN

YES

NO

(If unknown or yes, explain in item 27)

24. Type of cooking equipment:

STEAM

DIRECT FIRE

YES

NO

25. Date of last temperature check:
26. Means of agitation available
(If required in steam equipment)

27. EXPLANATION OF DEFICIENCY(IES) AND NOT APPLICABLE NOTATION(S) (Cite item numbers, explain corrective measures necessary, and give due date(s) for correction.)

If more space is needed, “X”

28. SIGNATURE OF INSPECTOR

29. DATE OF INSPECTION

30. SIGNATURE OF Licensee (Signature indicates a copy of the
completed inspection report has been received)

VS FORM 13-16
JUN 2011

Previous edition may be used

and continue on reverse.

31. DATE