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 PASS / 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 (01/21) Previous editions are obsolete. Expires XX-XX

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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
				________	Date	Sample No.	Type	DKG	BCFM
COMMODITY:								Test Unit
					________		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 Form FGIS-936 (01/21) Previous editions are obsolete. Expires XX-XX

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Sheet 4: Back Instructions