U.S. Department of Agriculture |
OMB APPROVED NO. 0580-0013 |
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Grain Inspection, Packers and Stockyards Administration |
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QUESTIONNAIRE FOR PROPOSED DIVERTER-TYPE |
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MECHANICAL SAMPLER |
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Facility Name, City, State |
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Field Office |
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Capacity |
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Kind of Elevator |
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Authorization Code - Circle Appropriate Numbers |
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D Diverter N Non-diverter P Probe 0 All Grains 1 Small Grains 2 Coarse Grains - Not Corn |
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3 In 4 Out 5 Cargo 6 Barges 7 Hopper Cars 8 Carlots 9 Trucks |
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D/T Make and Model |
S/N |
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Spout / Belt Size |
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General Location |
Spout / Belt Name |
Spout / Belt Angle |
Belt Speed |
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Power: |
Body Dimensions |
Pelican Stroke |
Pelican Opening L x W |
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Grain Drop Before Sampler |
Grain Drop After Sampler |
Access Safe |
Inspection Door OK? |
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(ft) |
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(ft) |
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Verified No Auxilliary Controls |
Location of Lockout OK? |
Lights OK for Exams? |
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Is Pelican Movement Steady? |
Does Pressure Return Promptly? |
Air Pressure at Rest PSI |
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Timer Make and Model |
Grain Flow Rate Past Sampler |
Calculated Timer Setting |
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(s) |
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Secondary Make and Model |
S/N |
Delivery System |
Grams per Sample |
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Total No. of Samples |
Quantity Adjustment Sealed? |
Delivery and Collection Box Secure? |
Excess Returned to Lot? |
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Dust Control Locations |
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Weights: |
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NO SCALE |
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Number of Shipping Bins: |
Depth |
Graded |
Procedures to Stop Breakage: |
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(ft) |
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Remarks/special restrictions when used to sample officially: |
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Signature of Official Personnel: |
Date: |
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FORM FGIS-998 (7/04) Previous edition may be used. Expires January 2015 |
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DIRECTIONS FOR COMPLETING QUESTIONNAIRE |
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1. Facility name, city, and state. |
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2. Name of FGIS field office. |
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3. Check the box indicating kind of elevator. |
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4. Storage capacity of elevator. |
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5. Authorization Code-circle the numbers that apply to the intended sampler use. |
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6. Sampler Make & Model; e.g., Gamet 6800S. |
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7. Sampler Serial Number. |
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8. Is the sampler in a spout or on a belt end? For spout samplers-diameter or length x width |
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cross sectional measurements or; |
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9. Belt Size-width and depth of grain carried. |
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10. General location of sampler; e.g., Headhouse 6th Floor; or Gallery. |
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11. Spout/belt name; e.g., Scale #1 lower garner. |
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12. Spout angle-90_ is vertical. Belt Angle-0_ is horizontal. Show normal angle and max/min |
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limits of travel, if angle can be varied. |
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13. Belt speed-measure with belt loaded. |
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14. Check the box showing type of power. |
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15. Body dimensions for the sampler. |
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16. Pelican stroke is the distance traveled from one side to the other. |
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17. Length and width of the pelican opening. |
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18. Distance in feet from release point. |
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19. Distance grain falls is used to estimate impact and breakage. For example, measure from |
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sampler to bin bottom. |
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20. Is access to the sampler by approved ladder or stairs, and does the platform have an |
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approved railing? |
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21. Are the inspection doors properly located on the sampler? Do they have appropriate seal |
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hasps and hinges? |
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22. Check verified after you determine that the system controls have no bypasses, dump |
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counters, timer interrupts, or programmable controllers. |
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23. Location of lockout ok-does the lockout provided meet FGIS requirements? |
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24. Light for examinations-can all exterior examination checks be made with lighting supplied? |
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25. For pneumatic/hydraulic samplers-is pressure sufficient to move the pelican across the |
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stream of grain evenly, without lagging or slowing down. |
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26. For pneumatic/hydraulic samplers-pressure returns to maximum before next cut is initiated. |
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27. For pneumatic samplers-gauge pressure at rest. Maximum reached when no cuts are |
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initiated. |
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28. Timer Make & Model; e.g., Eagle HP5 Model 9. |
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29. Flow past sampler should be figured out by timing a known amount, such as one scale draft, |
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as it passes the sampler. |
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30. Calculate the timer setting in seconds based on grain flow rate past sampler. Also show |
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whether this is based on a 200, 350, or 500 bushel sampling rate. |
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31. Secondary Sampler (divider) Make & Model; e.g., InterSystems MD300. |
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32. Secondary Sampler Serial Number. |
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33. Check box indicating type of sample delivery system. |
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34. Weight in grams received for the official sample. |
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35. Total number of samples needed for all interested parties. |
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36. Are the quantity adjustment features on secondary sampler fixed or sealed in place? |
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37. Is the sample delivery system secure from the air inlet to the collection box? |
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38. Is excess grain automatically returned from the secondary to the lot from which the sample |
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was taken? |
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39. Location of dust collection ducts-are they located where they can affect the sample |
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constituents? The measurements will serve as a record of approved duct work. |
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40. Weights-are weights official; i.e., supervised under the USGSA as Class X or Y-are weights |
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Certified; i.e., supervised unofficially by a local organization-or are weights unofficial and |
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not supervised, or not provided? |
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41. Shipping bins-number used. |
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42. Shipping bin depth(s). |
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43. Grading-will bin be held for grade or factor results before being released? |
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44. Procedures to stop breakage-will the bins require use of cushion level indicators, grain |
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ladders, or baffles to reduce impact of grain and resulting breakage? |
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45. Carrier identification or stowage locations. |
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46. Special restrictions-any special procedural restrictions; e.g., weighback belt must be sealed, |
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turnhead must be locked in position, cushion must be maintained in shipping bin, etc. |
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47. Name or signature of the official personnel who filled out the questionnaire. |
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48. Date information obtained. |