FGIS-980 Authorization to Use Mechanical Sampler

United States Department of Agriculture Federal Grain Inspection Service			FORM APPROVED OMB NO. 0580-0013 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 0580-0013. 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.
AUTHORIZATION TO USE MECHANICAL SAMPLER FOR SAMPLING
Installed in: (Name of facility)			Mechanical Sampler Make & Model:		Serial Number
City and State			Secondary Sampler (Divider) Make & Model:		Serial Number
Commodity to be sampled:	All Grains  (Groups 1 & 2)	Coarse Grains  (Except Corn)	Small Grains  (Group 1)	Powders  (Group 3)

Subject to the conditions listed below, authorization is issued to official inspection personnel to use the mechanical sampler for the official sampling of the commodities as indicated above. All interested parties shall be notified by FGIS when the authorization

has been suspended of cancelled.

1. Facility management shall service and maintain the mechanical samplers in accordance with existing regulations and

instructions under the U.S. Grain Standards Act and the Agricultural Marketing Act of 1946.

2. Official personnel shall make daily or more frequent spot checks, when the samplers are in use for official sampling, to

determine that the mechanical samplers are being serviced, operated, and maintained in an approved manner.

3. The mechanical samplers shall be secured or constantly manned by official personnel when they are used for official sampling.

4. All quantities in excess of the amounts required for the official inspection shall be returned to the carrier or the stream of gain

or other commodity being sampled.

5. No changes in structure, accessories, location or operation of the mechanical samplers shall be made without specific written authorization from the FGIS Field Office Manager.

6. No manipulation of the commodities to be sampled or other efforts shall be made which would result in the above mechanical samplers failing to obtain and deliver a correct and representative sample.

7. The elevator manager acknowledges personal responsibility for the correct installation of the mechanical samplers.

8. This shall be signed by the manager or superintendent of the facility on behalf of the company that operates the elevator or

plant in which the mechanical samplers are installed, and by the Agency or Field Office Manager whose personnel will attend

the sampler.

9. The authorization shall be automatically suspended for noncompliance with any of the above conditions; but may be reinstated when corrective action has been taken and approved by the Field Office Manager.

Date		Location			Facility Manager Signature
Official Agency					Agency Manager Signature
Date		Location			Authorization Approved – USDA
Date		Field Office Location			Field Office Manager Signature
Form FGIS-980 (7/04) (Previous edition may be used)					Authorization Code:

Expires January 2015

INSTRUCTIONS

a. Granting of Authorization. Upon notification of a successful test, the FGIS field

office shall prepare and issue (or finalize) the Form FGIS-980, "Authorization to

Use Mechanical Sampler for Sampling".

Fill in the header information:

The name of the facility, city and state where the facility is located.

The name of the sampler manufacturer, model name or number and the serial number.

The name of the secondary sampler (divider) manufacturer, model name or number and the serial number.

Insert a check mark on the appropriate commodity to be sampled.

The agreement shall be signed by the parties indicated for each signature line.

(1) The authorization is an agreement among representatives of the facility

where the sampling system is installed, the testing office, the FGIS field

office and any other persons or firms that may be directly involved.

(2) The agreement says that the sampler shall be installed, serviced, operated,

and maintained following existing regulations.

b. Distribution of Form FGIS-980.

(1) The FGIS field office will distribute copies of the Form FGIS-980 to each

person who has signed the authorization. A certificate is not issued for the

authorization of a sampling system.