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Results of Sediment Pad Grading Template

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									                                          DEPARTMENT OFHEALTH AND HUMAN SERVICES

                                                    FOOD AND DRUG ADMINISTRATION

                                                RESULTS OF SEDIMENT PAD GRADING
Firm Name                                                                                                   Inv. No.



Address                                                                                                     Date



City                                                                       State                                           ZIP Code




                                                                   MILK TESTED
                         0 & 0.5 mg.            3.0 mgs.                  6.0 mgs.                12.0 mgs.                     Total                              %
                      cans       gals.   cans         gals.        cans            gals.      cans          gals.        cans           gals.                    gals.
         0
        fly

         1
        fly

          2
        flies

  3 or more
     flies

       Totals                                                                                                                                                   100%


   Percent                                                                                                                             100%


                                                                MILK ACCEPTED
                         0 & 0.5 mg.            3.0 mgs.                  6.0 mgs.                12.0 mgs.                     Total                              %
                      cans       gals.   cans         gals.        cans            gals.      cans          gals.        cans           gals.                    gals.
         0
        fly

         1
        fly

          2
        flies

  3 or more
     flies

       Totals                                                                                                                                                   100%


   Percent                                                                                                                             100%




Total milk received                                           gals.                    Sediment Factor

Amount tested                                                 gals.                    6.0 mgs & 12.0 mgs


Percent tested                                                 %                       3.0 mgs, 6.0 mgs & 12.0 mgs


Number of patrons


Patrons tested
                                                                                                             Inspector

Percent patrons tested                                         %
                                                                                                             District

FDA-1533 (10/01)                                                                                                                  Created by: PSC Media Arts (301) 443-2454   EF

								
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