FGIS-980 Authorization to Use Mechanical Sampler

United States Department of Agriculture
Federal Grain Inspection Service

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 5 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.

AUTHORIZATION TO USE
MECHANICAL SAMPLER FOR SAMPLING
Installed in: (Name of facility)

Mechanical Sampler Make & Model:

Serial Number

City and State

Secondary Sampler (Divider) Make & Model:

Serial Number

Commodity to be sampled:

All Grains q
(Groups 1 & 2)

Coarse Grains
(Except Corn)

q

Small Grains
(Group 1)

q

Powders
(Group 3)

q

Subject to the conditions listed below, authorization is issued to official inspection personnel to use the mechanical
sampler for the official sampling of the commodities as indicated above. All interested parties shall be notified by FGIS
when the authorization has been suspended of cancelled.
1.

Facility management shall service and maintain the mechanical samplers in accordance with existing regulations
and instructions under the U.S. Grain Standards Act and the Agricultural Marketing Act of 1946.

2.

Official personnel shall make daily or more frequent spot checks, when the samplers are in use for official
sampling, to determine that the mechanical samplers are being serviced, operated, and maintained in an
approved manner.

3.

The mechanical samplers shall be secured or constantly manned by official personnel when they are used for
official sampling.

4.

All quantities in excess of the amounts required for the official inspection shall be returned to the carrier or the
stream of gain or other commodity being sampled.

5.

No changes in structure, accessories, location or operation of the mechanical samplers shall be made without
specific written authorization from the FGIS Field Office Manager.

6.

No manipulation of the commodities to be sampled or other efforts shall be made which would result in the above
mechanical samplers failing to obtain and deliver a correct and representative sample.

7.

The elevator manager acknowledges personal responsibility for the correct installation of the mechanical samplers.

8.

This shall be signed by the manager or superintendent of the facility on behalf of the company that operates the
elevator or plant in which the mechanical samplers are installed, and by the Agency or Field Office Manager
whose personnel will attend the sampler.

9.

The authorization shall be automatically suspended for noncompliance with any of the above conditions; but may
be reinstated when corrective action has been taken and approved by the Field Office Manager.

_________________ _____________________________________ _____________________________________
Date
Location
Facility Manager Signature
_________________ _____________________________________ _____________________________________
Date
Official Agency
Agency Manager Signature
________________ _____________________________________ _____________________________________
Date
Location
Authorization Approved – USDA
________________ _____________________________________ _____________________________________
Date
Field Office Location
Field Office Manager Signature
Form FGIS-980 (01/21) Previous editions
are obsolete. Expires XX-XX

Authorization Code: _____________________

Instructions for Completing FGIS-980
A.

Granting of Authorization.
Upon notification of a successful test, the FGIS field office shall prepare and issue (or finalize)
the Form FGIS-980, “Authorization to Use Mechanical Sampler for Sampling”.

B.

1.

Fill in the header information:

2.

The name of the facility, city and state where the facility is located.

3.

The name of the sampler manufacturer, model name or number and the serial number.

4.

The name of the secondary sampler (divider) manufacturer, model name or number,
and the serial number.

5.

Insert a check mark on the appropriate commodity to be sampled.

6.

The agreement shall be signed by the parties indicated for each signature line.
a.

The authorization is an agreement among representatives of the facility where
the sampling system is installed, the testing office, the FGIS field office and any
other persons or firms that may be directly involved.

b.

The agreement says that the sampler shall be installed, serviced, operated, and
maintained following existing regulations.

Distribution of Form FGIS-980.
The FGIS field office will distribute copies of the Form FGIS-980 to each person who has
signed the authorization. A certificate is not issued for the authorization of a sampling system.