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[]
["U.S. Department of Agriculture",{"$nulls":22},"OMB APPROVED NO. 0580-0013"]
["Grain Inspection, Packers and Stockyards Administration"]
["QUESTIONNAIRE FOR PROPOSED DIVERTER-TYPE"]
["MECHANICAL SAMPLER"]
["Facility Name, City, State"]
[]
["Field Office"]
[{"$nulls":23},"Capacity"]
[]
["Kind of Elevator"]
[]
["Authorization Code - Circle Appropriate Numbers"]
["D  Diverter      N  Non-diverter      P  Probe      0  All Grains      1  Small Grains      2  Coarse Grains - Not Corn"]
["3  In      4  Out      5  Cargo      6  Barges      7  Hopper Cars      8  Carlots      9  Trucks",{"$nulls":51}," "]
["D/T Make and Model",{"$nulls":10},"S/N",{"$nulls":21},"Spout / Belt Size"]
[]
["General Location",{"$nulls":10},"Spout / Belt Name",{"$nulls":10},"Spout / Belt Angle",{"$nulls":10},"Belt Speed"]
[]
["Power:",{"$nulls":10},"Body Dimensions",{"$nulls":10},"Pelican Stroke",{"$nulls":10},"Pelican Opening     L x W"]
[]
["Grain Drop Before Sampler",{"$nulls":10},"Grain Drop After Sampler",{"$nulls":10},"Access Safe",{"$nulls":10},"Inspection Door OK?"]
[{"$nulls":9},"(ft)",{"$nulls":10},"(ft)"]
["Verified No Auxilliary Controls",{"$nulls":10},"Location of Lockout OK?",{"$nulls":10},"Lights OK for Exams?"]
[]
["Is Pelican Movement Steady?",{"$nulls":10},"Does Pressure Return Promptly?",{"$nulls":10},"Air Pressure at Rest PSI"]
[]
["Timer Make and Model",{"$nulls":10},"Grain Flow Rate Past Sampler",{"$nulls":10},"Calculated Timer Setting"]
[{"$nulls":30},"(s)"]
["Secondary Make and Model",{"$nulls":10},"S/N",{"$nulls":10},"Delivery System",{"$nulls":10},"Grams per Sample"]
[]
["Total No. of Samples",{"$nulls":10},"Quantity Adjustment Sealed?",{"$nulls":10},"Delivery and Collection Box Secure?",{"$nulls":10},"Excess Returned to Lot?"]
[]
["Dust Control Locations"]
[]
["Weights:"]
["NO SCALE"]
["Number of Shipping Bins:",{"$nulls":10},"Depth",{"$nulls":10},"Graded",{"$nulls":10},"Procedures to Stop Breakage:"]
[{"$nulls":20},"(ft)"]
[]
["Carrier I.D. by:"]
["Remarks/special restrictions when used to sample officially:"]
[]
["Signature of Official Personnel:",{"$nulls":34},"Date:"]
[]
["FORM FGIS-998 (7/04)   Previous edition may be used."]

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[]
[{"$nulls":13},"DIRECTIONS FOR COMPLETING QUESTIONNAIRE"]
[]
[{"$nulls":13},"1. Facility name, city, and state."]
[{"$nulls":13},"2. Name of FGIS field office."]
[{"$nulls":13},"3. Check the box indicating kind of elevator."]
[{"$nulls":13},"4. Storage capacity of elevator."]
[{"$nulls":13},"5. Authorization Code-circle the numbers that apply to the intended sampler use."]
[{"$nulls":13},"6. Sampler Make & Model; e.g., Gamet 6800S."]
[{"$nulls":13},"7. Sampler Serial Number."]
[{"$nulls":13},"8. Is the sampler in a spout or on a belt end? For spout samplers-diameter or length x width"]
[{"$nulls":13},"cross sectional measurements or;"]
[{"$nulls":13},"9. Belt Size-width and depth of grain carried."]
[{"$nulls":13},"10. General location of sampler; e.g., Headhouse 6th Floor; or Gallery."]
[{"$nulls":13},"11. Spout/belt name; e.g., Scale #1 lower garner."]
[{"$nulls":13},"12. Spout angle-90_ is vertical. Belt Angle-0_ is horizontal. Show normal angle and max/min"]
[{"$nulls":13},"limits of travel, if angle can be varied."]
[{"$nulls":13},"13. Belt speed-measure with belt loaded."]
[{"$nulls":13},"14. Check the box showing type of power."]
[{"$nulls":13},"15. Body dimensions for the sampler."]
[{"$nulls":13},"16. Pelican stroke is the distance traveled from one side to the other."]
[{"$nulls":13},"17. Length and width of the pelican opening."]
[{"$nulls":13},"18. Distance in feet from release point."]
[{"$nulls":13},"19. Distance grain falls is used to estimate impact and breakage. For example, measure from"]
[{"$nulls":13},"sampler to bin bottom."]
[{"$nulls":13},"20. Is access to the sampler by approved ladder or stairs, and does the platform have an"]
[{"$nulls":13},"approved railing?"]
[{"$nulls":13},"21. Are the inspection doors properly located on the sampler? Do they have appropriate seal"]
[{"$nulls":13},"hasps and hinges?"]
[{"$nulls":13},"22. Check verified after you determine that the system controls have no bypasses, dump"]
[{"$nulls":13},"counters, timer interrupts, or programmable controllers."]
[{"$nulls":13},"23. Location of lockout ok-does the lockout provided meet FGIS requirements?"]
[{"$nulls":13},"24. Light for examinations-can all exterior examination checks be made with lighting supplied?"]
[{"$nulls":13},"25. For pneumatic/hydraulic samplers-is pressure sufficient to move the pelican across the"]
[{"$nulls":13},"stream of grain evenly, without lagging or slowing down."]
[{"$nulls":13},"26. For pneumatic/hydraulic samplers-pressure returns to maximum before next cut is initiated."]
[{"$nulls":13},"27. For pneumatic samplers-gauge pressure at rest. Maximum reached when no cuts are"]
[{"$nulls":13},"initiated."]
[{"$nulls":13},"28. Timer Make & Model; e.g., Eagle HP5 Model 9."]
[{"$nulls":13},"29. Flow past sampler should be figured out by timing a known amount, such as one scale draft,"]
[{"$nulls":13},"as it passes the sampler."]
[{"$nulls":13},"30. Calculate the timer setting in seconds based on grain flow rate past sampler. Also show"]
[{"$nulls":13},"whether this is based on a 200, 350, or 500 bushel sampling rate."]
[{"$nulls":13},"31. Secondary Sampler (divider) Make & Model; e.g., InterSystems MD300."]
[{"$nulls":13},"32. Secondary Sampler Serial Number."]
[{"$nulls":13},"33. Check box indicating type of sample delivery system."]
[{"$nulls":13},"34. Weight in grams received for the official sample."]
[{"$nulls":13},"35. Total number of samples needed for all interested parties."]
[{"$nulls":13},"36. Are the quantity adjustment features on secondary sampler fixed or sealed in place?"]
[{"$nulls":13},"37. Is the sample delivery system secure from the air inlet to the collection box?"]
[{"$nulls":13},"38. Is excess grain automatically returned from the secondary to the lot from which the sample"]
[{"$nulls":13},"was taken?"]
[{"$nulls":13},"39. Location of dust collection ducts-are they located where they can affect the sample"]
[{"$nulls":13},"constituents? The measurements will serve as a record of approved duct work."]
[{"$nulls":13},"40. Weights-are weights official; i.e., supervised under the USGSA as Class X or Y-are weights"]
[{"$nulls":13},"Certified; i.e., supervised unofficially by a local organization-or are weights unofficial and"]
[{"$nulls":13},"not supervised, or not provided?"]
[{"$nulls":13},"41. Shipping bins-number used."]
[{"$nulls":13},"42. Shipping bin depth(s)."]
[{"$nulls":13},"43. Grading-will bin be held for grade or factor results before being released?"]
[{"$nulls":13},"44. Procedures to stop breakage-will the bins require use of cushion level indicators, grain"]
[{"$nulls":13},"ladders, or baffles to reduce impact of grain and resulting breakage?"]
[{"$nulls":13},"45. Carrier identification or stowage locations."]
[{"$nulls":13},"46. Special restrictions-any special procedural restrictions; e.g., weighback belt must be sealed,"]
[{"$nulls":13},"turnhead must be locked in position, cushion must be maintained in shipping bin, etc."]
[{"$nulls":13},"47. Name or signature of the official personnel who filled out the questionnaire."]
[{"$nulls":13},"48. Date information obtained."]