FGIS 1001 Application for Approval to Operate as a Weight Facility

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
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.

FORM APPROVED OMB NO. 0581-0309
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 0581-0309. 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.

1. NAME OF FACILITY (Where The Weighing Equipment Is Located):
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 (01/21) Previous editions are obsolete. Expires XX-XX

CLEAR ENTIRE FORM

Page ______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

7. Load-Receiving Element

Railway Track
Vehicle Platform
Automatic Bulk Weighing System

Platform
RESET

Hopper

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

8. Load-Sensing
Full-electronic (2 or more load cells)

Inbound

Lever-tronic (1 load cell)

Outbound

Mechanical

10. WEIGHING ELEMENT MANUFACTURER (Scale):

RESET

RESET

RESET

Export

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:

FGIS-1001
“APPLICATION FOR APPROVAL TO 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 for Completing FGIS-1001
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 loadreceiving 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 on the FGIS website. The signed form should also be mailed
to this location.
For further information on the “Application For Approval To Operate As A Weighing Facility” contact:
Patrick McCluskey, Chief
Field Management Division
Policies, Procedures, and Market Analysis Branch
[email protected]