DA-201B Application for Butter Grading Service

OMB APPROVED – NO. 0581-0126 Page of

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE						CERTIFICATE NO.
APPLICATION FOR BUTTER GRADING SERVICE
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

CHURN NUMBER	NO. PKGS.	MFG. DATE	TEST WEIGHT	CLASSIFICATION			DEFECT RATING				U.S. GRADE	COMMENTS (S-Slight, D-Definite, P-Pronounced)	FAT	% H2O	SALT
				FLAVOR	COLOR	SALT	BODY	COLOR	SALT	TOTAL

SIGNATURE OF AGENT FOR APPLICANT	REMARKS:	US GRADE	NO. OF PACKAGES			WEIGHT			FEES
	G rading Temp ˚F Marked Net Wt	GRADE AA						lbs	INSPECTION	$
		GRADE A						lbs	EXPENSE
		GRADE B						lbs	LABORATORY
		BELOW GRADE						lbs	TOTAL	$

DA-201B (01-09) (Destroy previous edition dated 12-00)

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