Form LP-240P Poultry Grading Volume Report

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

1. NAME AND ADDRESS OF WORK LOCATION
(Include Zip Code)

POULTRY
GRADING VOLUME REPORT

2 (a). Scheduled Plant No.

OMB APPROVED: NO. 0581-0128

2 (b). Unscheduled Request No.

Page _________ of _________
3. REPORTING PERIOD
Daily

Weekly

4. From

5. To

Billing Period

ACCEPTANCE SERVICE VOLUME
6.
KIND

7.
CLASS

8.
TYPE

9.
STYLE

10.
ACCEPTANCE SERVICE
CODE

11.
EXPORT
COUNTRY CODE

12.
GRADED

13.
CONSUMER
LABELED

14.
LBS
ACCEPTED

15.
LBS
RETAINED

CERTIFICATION STATEMENTS
I certify that the volumes of products processed as stated above, are correct to the best of my knowledge and the product officially identified as marked.
__________________________________________________________________________________
Signature of Grader

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 0581-0128. The time required to complete this information collection is estimated to average 45 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.
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.

LP-240P (XX/20XX) Supersedes LPS-240P

EXP. DATE: XX/XX/XXXX