Delivery Detail Rept.

UNITED STATES DEPARTMENT OF AGRICULTURE
Address: XXX
XXX
Phone: XXX
Fax: XXX

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM
XXX FEDERAL MILK ORDER XXX

E-mail: XXX

Delivery Detail Report

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 0581-0032. The time required to complete this information collection is estimated to average 1.5 hours 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. 202509410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE

Form Approved, OMB No. 0581-0032

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

Address: XXX
XXX
Phone: XXX
Fax: XXX
E-mail: XXX

XXX FEDERAL MILK ORDER XXX

DELIVERY DETAIL REPORT
Handler
Producer No.
Producer Name
Address
City, State, Zip

Pick Up Date

Delivery Date

Destination

FMMO

Manifest/Ticket

Tank ID #

Pounds

Butterfat

Protein

Other Solids

SCC