DA-201C Cheese Graders Memorandum

OMB APPROVED – NO. 0581-0126 REPRODUCE LOCALLY Include form number and edition date on all reproductions

Page

of

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE CHEESE GRADERS MEMORANDUM

CERTIFICATE NO.

TO: APPLICANT (Name and address)

SHIPPER OR SELLER (Name and address)

RECEIVER OR BUYER (Name and address)

DATE INSPECTED

NO. SAMPLES TAKEN

INSPECTED AT (Name and address)1

INSPECTED BY:

CONDITION OF CONTAINERS

SAMPLE CONTAINERS STAMPED WITH USDA LOT NO.

applicable U.S. standards for condition of food containers

MANUFACTURED BY (Name and address)1

ANNOUNCEMENT NO.

CONTRACT NO.

SEED NO.

SIZE AND KIND OF CONTAINERS

STORAGE LOT

SERVICE DATE

MOISTURE TEST

VAT NUMBER

YR__MFG. DATE

NO. PKGS.

MARKED WEIGHT

TEST SHORTAGE

NET WEIGHT

DEFECT RATING

U.S. GRADE

COMMENTS (S-Slight, D-Definite, P-Pronounced)

FDB

% H2O

pH

FLA­VOR

BODY & TEX

COLOR

FINISH

SIGNATURE OF AGENT FOR APPLICANT

US GRADE

NO. OF PACKAGES

WEIGHT

FEES

GRADE

lbs

INSPECTION

$

GRADE

lbs

EXPENSE

GRADE

lbs

LABORATORY

GRADE

lbs

TOTAL

$

GRADE

BELOW

lbs

DA-201C (01-09) (Destroy previous edition DA-132 dated 01-95 & 12-00)

(See reverse of form for Burden Statement)

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 0581-0126. The time required to complete this information collection is estimated to average 5 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 202-795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.