P&SP 4300 Monorail Scale Test Report

OMB Control No. 0580-0015

U.S. Department of Agriculture Grain Inspection, Packers and Stockyards Administration Packers and Stockyards Program

Monorail Scale Test Report

1 Page No.

2 Test Agency (Name, address, city, state, zip code)

3 Scale Owner

4 Address

5 City

6 County

7 State

8 Scale Manufacturer (Indicator)

9 Model Number

10 Serial Number

11 Class of Scale  Marked III  Not Marked

12 Type Indicator  Printer  Beam  Dial  Digital

13 Scale Location  Kill Floor  Shipping  Cooler

14 Scale Capacity Lbs.

15 Scale Division (d) Lbs.

16 Minimum Tare Division Lbs.

17 Tare Setting (As found) Lbs.

18 Type of Weighing  Static  Dynamic

19 Type of Livestock Weighed

20.How is Tare Deducted?  Tare Bar & Poise  Tare Module  In Accounting  Push Button Zero  Zero Knob or Screw`  Balance Ball  By Computer

21.Weighing Speed (head per hour) /Hour

22 Test Weights Used:  Service Company  Feed Company  Weights And Measures

23 Date Test Weights Were Last Verified

24 Test Date (mm/dd/yyyy)

25 Last Test Date (mm/dd/yyyy)

26 Times and Days When Scale is Not in Use and Available for Testing:

27 Test Results

 Approved  Condemned  Scale & Computer  Rejected  Other_________

Test Data

28 Type of Test  Static  Dynamic

29 SR (Sensitivity Response) Or Discrimination Test Zero Load = __________ Lbs. Maximum Load = __________ Lbs.

30 Motion Detection Range = ______________ Lbs.

31 AZSM (auto zero setting mech.) Range = ______________ Lbs.

32 Test Weights

Indicating Element (32c)

Error (Pounds) (32d)

32 Test Weights

Indicating Element (32c)

Error (Pounds) (32d)

32 Test Weights

Indicating Element (32c)

Error (Pounds) (32d)

Position (32a)

Pounds (32b)

Position (32a)

Pounds (32b)

Position (32a)

Pounds (32b)

33 Decreasing Load Test (Dial and Digital Only)

Balance

34 Remarks

35 Receipt of Report Acknowledged (Signature):

36 Scale Inspector (Signature):

Response is required in order to assure that tests and inspections have been made on scales to show their accuracy so that livestock carcasses may be weighed (9 CFR 201.72). Information held confidential (9 CFR 201.96).

According to the Paperwork Reduction Act of 1995, no persons are 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 0580-0015. The time required to complete this information collection is estimated to average .25 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

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 P&SP-4300 August 2007 Page 2 of 2