PSD- 4500 Grain Hopper Test Report

Hopper Test Report

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FAIR TRADE PRACTICES PROGRAM
PACKERS AND STOCKYARDS DIVISION
2a. Test Agency

3a. Scale Owner

b. Address

b. Physical Address of Scale

c. City

d. State e. Phone

4. Indicator Manufacturer
8. Scale Capacity
lbs.

lbs.

1. Page

c. City

5. Serial Number

9. Scale Division

12. Test Date (mm/dd/yyyy)

f. E-mail

OMB Control No. 0581-0308

10. Accuracy Class
Not Marked
Marked III

d. State

6. Model Number 7. Type of Indicator
Beam
Dial
11. Scale and Computer interfaced
Yes

Digital
No

If yes, list system _____________________________________________

13. Previous Test Date (mm/dd/yyyy)
Test Data

14. SR (Sensitivity Response) or Discrimination Test – As Found

Zero Load = __________ lb.

15. Increasing Load Test
Feed
(15a)

Balance Weights
(15b)

16. Test Results

Test Weights
(15c)

Maximum Load = _______________ lb.
15. Increasing Load Test

Error Weights
(lbs.) (15d)

Feed
(15a)

Balance Weights
(15b)

Test Weights
(15c)

Marking approved indicates that the errors indicated on this test report are within the
accuracy requirements specified in National Institute of Standards and Technology (NIST)
Handbook 44 as required in the regulations (9 CFR 201.71)

Error Weights
(lbs.) (15d)

Approved
Condemned
Rejected
Other ___________

17. Remarks (If serial number has changed, please note here)

18. Receipt of Report Acknowledged (Signature):

19. Scale Inspector (Signature):

Response is required to assure that tests are made on feed scales, and to show accuracy of scales used to weigh feed when feed weight is a
factor in determining payment or settlement for livestock or live poultry. (9 CFR 201.72.) Information held confidential (9 CFR 201.96).
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 0581-0308. The time required to complete
this information collection is estimated to average .75 hours 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 U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age,
disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or
because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET
Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence
Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Form PSD 4500

Expires XX/XX/XXXX

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Form PSD 4500

Expires XX/XX/XXXX

Page 2 of 4

Instructions to Complete Hopper Scale Test Report Form PSD 4500
Submit the completed form to the PSD regional office that covers your area. The areas covered by
each regional office are listed below the regional office's address.
For questions about Form PSD 4400, or additional copies of the form, please contact the regional
office that covers your area, as listed below. Forms and instructions are also located on PSD's
website at https://www.ams.usda.gov/resources/forms.
Regional Offices of the Packers and Stockyards Division
Agricultural Marketing Service, Fair Trade Practices Program
Eastern Regional Office
Midwestern Regional Office
Western Regional Office
75 Ted Turner Drive SW, Ste 230 210 Walnut Street, Room 317
3950 Lewiston St., Suite 200
Atlanta, GA 30303-3308
Des Moines, IA 50309-2110
Aurora, CO 80011-1556
Telephone: (404) 562-5840
Telephone: (515) 323-2579
Telephone: (303) 375-4240
FAX: (404) 562-5848
FAX: (515) 323-2590
FAX: (303) 371-4609
e-mail:
E-mail:
E-mail:
[email protected]
[email protected] [email protected]
Areas Covered
Areas Covered
Areas Covered
AL, AR, CT, DC, DE, FL, GA,
IA, IL, IN, KY, MI, MN, MO,
AK, AZ, CA, CO, HI, ID, KS,
LA, MA, MD, ME, MS, NC,
ND, NE, OH, SD, WI
MT, NM, NV, OK, OR, TX,
UT, WA, WY
NH, NJ, NY, PA, PR, RI, SC,
TN, VA, VT, WV

Line
Number
1

2
a.
through
e.
3
a
through
e.
4
5

Form PSD 4500

Subject
Page Number

Testing Agency,
Address, City,
State, Phone, and
Email
Scale Owner,
Address, City,
State, Phone, and
Email
Indicator
Manufacturer
Serial Number

Instruction
The page number is normally 1 of 1. If additional space is
needed or when testing multiple indicator/platform
installations, number pages identifying the current page
number and the total number of pages. For example, page 2
of 3.
Enter the name, address, city, state, zip code, phone number,
and e-mail address of the scale test agency
Enter the name, address, city, state, zip code, phone
number, and e-mail address of the scale owner or operator.
Enter the name of the manufacturer of the beam, dial or digital
indicator
Enter the serial number of the indicator being tested. If the
serial number has changed since the last test, show the previous
serial number in the remarks.
Expires XX/XX/XXXX

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Line
Number
6

Subject

Instruction

Model Number

Enter the model number from the manufacturer’s ID plate.

7
8

Type of Indicator
Scale Capacity

Check the appropriate box to indicate the type of indicator
Enter the total scale capacity (maximum nominal capacity), in
pounds.

9
10

Scale Division
Accuracy Class

Enter the minimum scale division quantity, in pounds.
Check the appropriate box to indicate the class of scale
(Marked III or Not Marked).

11

Computer
Interfaced

Indicate if the scale is interfaced with a computer. If yes,
list the computer system used.

12
13

Test Date
Last Test Date

Enter the date (month, day, and year) you tested the scale.
Enter the date (month, day, and year) the scale was last tested.

14
15
a.
through
d.

Test Data
Sensitivity
Enter the sensitivity response (SR) on beam scales or the
Response or
discrimination on dial and digital scales, in pounds, at zero
Discrimination
and maximum test loads.
Increasing load test For the increasing load test, enter, in pounds, the weight of
feed used, balance weights, test weights, weight indication,
error weights, and error.
NOTE: The weight shown on the indicator after removing
the error weights is NOT entered on the form. The amount
of the error will be the difference between column d and the
amount shown on the indicator after removing the error
weights.

16

Test Results

The State official or the scale company that conducted the
test enters the test results.

17

Remarks

18

Receipt Signature

Use the “Remarks” section to enter needed explanations,
comments, adjustments you made, recommendations
needed to correct a defective condition, etc. If the serial
The owner or responsible person must sign the form
acknowledging receipt of a copy of the test report form.

19

Inspector Signature The scale inspector or person(s) testing the scale must sign
the test report form.

Form PSD 4500

Expires XX/XX/XXXX

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