FGIS-936 Sampler Condition Report

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Overview

Front
Front Instructions
Back
Back Instructions

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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 P ASS / 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 (03/25) Previous editions are obsolete. Expires 03/28

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Sheet 2: Front Instructions

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Sheet 3: Back

GRAIN TEST DATA

SAMPLING METHOD USED FOR STANDARD:

for Mechanical Truck Probes only

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Date

Sample No.

Type

DKG

BCFM

COMMODITY:

Test Unit

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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 (03/25) Previous editions are obsolete. Expires 03/28

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Sheet 4: Back Instructions