LPS-156 Shell Egg Regulatory Inspection Report

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
LIVESTOCK AND POULTRY PROGRAM

SHELL EGG
REGULATORY
INSPECTION REPORT

1. NAME OF EGG HANDLER

2. STATE CODE

3. COUNTY CODE

7. ADDRESS (Include Street, City, State, and Zip Code)

8. TYPE OF VISIT (Check one)
Initial (Regular)

Release

Makeup

Follow-up

Other (Explain in Comments)
10.

This form reports a change in registration
information (Explain in Comments)

11. Correct refrigeration/labeling on containers?
Yes

OMB APPROVED: NO. 0581-0113
5. DATE
6. PAGE

4. HANDLER CODE

9. NATURE OF BUSINESS (Mark appropriate box)
Producer/Packer with more than 3,000 birds
Inedible Collection/Processing
Grading Station
Hatchery
Cooked Eggs
Exempt Breaker
13. Is a follow-up visit necessary?

12. Is record keeping satisfactory?

No (Explain in Comments)

Yes

No (Explain in Comments)

Yes

No

DESCRIPTION OF RETAINED PRODUCT
NO.

QUANTITY
(dz.)

GRADE
CODE

SIZE
CODE

CHECKS
(%)

LEAKERS
(%)

DIRTIES
(%)

LOSS 1
TYPE

(%)

LOSS 2
TYPE

MISLABELED

(%)

RESTRICTED

TEMP (°F)

TAG OR LOT
NUMBER

USDA
IDENTIFIED

REMARKS

1
2
3
4
5
TOTAL
INEDIBLE PRODUCT

QUANTITY (lbs):

TYPE OF CONTAINER:

TAG NO.:

RELEASE OF RETAINED PRODUCT
TAG OR LOT NUMBER

DISPOSITION CODE

QUANTITY
(dz. or lbs.)

REMARKS

1
2
3
4
5
COMMENTS:

THERMOMETER:

PRODUCT INVENTORY

AVERAGE AMBIENT AIR TEMPERATURE

Make, Model, and S/N

Cooler No.

Temp (°F)

Cooler No.

Temp (°F)

(Dozen)

J
XL
L

CALIBRATION DATE:

M
S
USDA REPRESENTATION
PRINTED INSPECTOR NAME

LICENSE NO.

PW

DUTY

PARTICIPANTS
LICENSE NO.

INSPECTOR SIGNATURE

DUTY

LICENSE NO.

DUTY

U
LICENSE NO.

DUTY
Rest.

COMPANY REPRESENTATIVE
DATE

TITLE

LP-156 (XX/20XX) Supersedes LPS-156

PRINTED NAME

SIGNATURE

(See reverse of form for Privacy Act Statement.)

EXP. DATE: XX/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 collection is 0581-0113. The time required to complete this information collection is estimated to
average .20 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, employer, and lender.

AA
A
B
C
D
CD
NR
R
S
U

RR
LR
DR
LD
IR
RD
PA
DY

GRADE CODES
AA
A
B
Checks
Dirties
Checks & Dirties
Nest Run
Restricted
Spots
Unwashed & Ungraded

J
XL
L
M
S
PW
U

SIZE CODES
Jumbo
Extra Large
Large
Medium
Small
Pee Wee
Unsized/Mixed

BLRT
BR
BW
CE
FZ
GW
LS
MR
MLDY
SR
SY

LOSS TYPE CODES
Black Rot
Blood Ring
Bloody White
Cooked Egg
Frozen
Green White
Large Spot: Blood or Meat
Mixed Rot
Moldy
Sour Rot
Stuck Yolk

CI
SI
FI
RG
SS
FS
RO
HQ

DUTY CODES
County SES Inspector/Supervisor Performing Inspection Visit
State SES Inspector/Supervisor Performing Inspection Visit
Federal SES Inspector/Supervisor Performing Inspection Visit
Scheduled Grader
State Supervisor Performing Supervision Visit
Federal Supervisor Performing Supervision Visit
Regional Office Representative
Headquarters Representative

DISPOSITION CODES
Reworked, Regraded, and Released - Reworked and regraded shell eggs based on full sample size, and released.
Labeled/Relabeled and Released - Relabeled to identify proper category of shell eggs and/or inedible product and released based on verification.
Denatured and Released - Denatured to identify proper decharacterization of shell eggs and/or inedible products and released based on verification.
Labeled, Denatured, and Released - Labeled and adequately decharacterized shell eggs and/or inedible products and released based on verification.
Placed into Inedible and Released - Disposed of shell eggs by placing into inedible product and released based on verification.
Reworked and Regraded at Destination Location - Reworked and regraded shell eggs and/or inedible product at destination location (another egg handler or at an egg products plant)
and released based on the verification by the destination surveillance inspector.
Process for Industrial Use or Animal Food - Processed shell eggs and/or inedible product for industrial use or animal food under official supervision and released based on the
verification by the destination surveillance inspector.
Destroyed - Destroyed shell eggs and/or inedible product on site with verification.

LP-156 (XX/20XX) Reverse