FGIS-936 Sampler Condition Report

Reporting and Recordkeeping Requirements (US Grain Standards Act and Agricultural Marketing Act of 1946)

FGIS 936 1.21 (508).xlsx

Reporting and Recordkeeping Requirements - State, Local, Tribal

OMB: 0581-0309

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Overview

Front
Front Instructions
Back
Back Instructions


Sheet 1: Front












OMB NO.: 0581-0309 (See reverse)
U.S. DEPARTMENT OF AGRICULTURE










AGRICULTURAL MARKETING SERVICE










FEDERAL GRAIN INSPECTION SERVICE










SAMPLER CONDITION REPORT










NAME OF ELEVATOR, CITY, AND STATE




DATE EXAMINED

FIELD OFFICE



















NAME OF OFFICIAL AGENCY





PRIMARY SAMPLER




SECONDARY SAMPLERS




BRAND/MODEL

SERIAL NO.

BRAND/MODEL

SERIAL NO.













GRAIN FLOW RATE (Past Sampler)

SAMPLING INTERVAL (Cycle Time)

BRAND/MODEL

SERIAL NO.

















SECTION 1 -- ALL SAMPLERS




SECTION 2 -- D/T SAMPLERS




ITEMS EXAMINED PASS / FAIL




ITEMS EXAMINED
PASS / FAIL


Lighting around sampler




Pelican speed approx. 0.5 m/s




Safe access to areas




Pelican dust seals (interior)




Safe access to inside of devices




Pelican go-no-go gauge




Lockouts (safety switches)




Pelican cuts entire grain stream




Cleanliness of area




Condition of excess sample return leg or belt




Cleanliness of device









Lubrication (if required)




SECTION 3 -- TRUCK PROBES




Panel board indicator lights




ITEMS EXAMINED PASS / FAIL




Air or hydraulic pressure




Tip not bent/damaged




Delivery tube secure




Tip vacuum check with paper




Delivery tube air inlet secure




Hydraulic oil level OK




Collection box secure




Vacuum adjustments sealed




Collection box screen clean




Sample size




Sampler not modified or repaired




Collection box seal




Seals/padlocks in place




Delivery tube condition




Inspected By: (LI or ACG)




Vacuum pressure if known:




Reviewed By: (ACG)










Form FGIS-936 (01/21) Previous editions are obsolete. Expires XX-XX











Sheet 2: Front Instructions









Sheet 3: Back


GRAIN TEST DATA










SAMPLING METHOD USED FOR STANDARD:

for Mechanical Truck Probes only






________ Date Sample No. Type DKG BCFM
COMMODITY:



Test Unit




________
6 Standard









HP








Test Unit









7 Standard










HP










Test Unit









8 Standard










HP










Test Unit









9 Standard










HP










Test Unit









10 Standard










HP










Test Unit









11 Standard










HP










Test Unit









12 Standard










HP


Date Sample No. Type DKG BCFM


Test Unit




Test Unit



13 Standard



1 Standard




HP










Test Unit


Difference





14 Standard


Tolerance






HP


Result - One test lot






Test Unit






15 Standard







HP










Test Unit


Date Sample No. Type DKG BCFM

16 Standard




Test Unit




HP



2 Standard




Test Unit









17 Standard




Test Unit




HP



3 Standard




Test Unit









18 Standard




Test Unit




HP



4 Standard




Test Unit









19 Standard




Test Unit




HP



5 Standard




Test Unit









20 Standard


Test Unit MDS*






HP


Tolerance




Test Unit MDS*




Result - Five test lots




Hand Probe MDS*







Regression or T-test




*Mean Deviation from Standard




Form FGIS-936 Form FGIS-936 (01/21) Previous editions are obsolete. Expires XX-XX









Sheet 4: Back Instructions


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