Free 2359j - Federal

U.S. Department of Health and Human Services Food and Drug Administration

MILK SANITATION RATING REPORT
(Shipper's Name and Address) MILK SANITARIAN

SECTION A. REPORT OF THE MILK SANITATION RATING
As of
ORDINANCE IN EFFECT Edition Date Adopted APPROVED LABORATORY (Name or #) (Date)

Of
REGULATORY AGENCY RATED BY

NAME TITLE AGENCY

DATE CERTIFIED BY PHS/FDA

RATING BASED ON

Edition of the Pasteurized Milk Ordinance
SUMMARY OF RATING RESULTS
Number of Dairy Farms Number of Dairy Farms Inspected Number of Milk Plants, Receiving Stations or Transfer Stations Number of Milk Plants, Receiving Stations or Transfer Stations Inspected Total Pounds of Pasteurized Milk Produced Daily

DATE

Sanitation Compliance Rating of Raw Milk for Pasteurization Sanitation Compliance Rating of Milk Plant, Receiving Station or Transfer Station Enforcement Rating

Recommendations of the Milk Rating Officer

FORM FDA 2359j (10/08) (PAGE 1)

(PREVIOUS EDITIONS ARE OBSOLETE)

PSC Graphics (301) 443-1090

EF

MILK SANITATION RATING REPORT
SHIPPER DATE OF RATING

SECTION B. REPORT OF ENFORCEMENT METHODS
ENFORCEMENT RATING

DAIRY FARMS PART I
Item
Number Complying Percent Complying Ordinance Section Ordinance Section Number Inspected

MILK PLANT PART II
Item
Number Complying Percent Complying Ordinance Section Number Inspected

INDIVIDUAL SHIPPER RATING PART III
Item
Number Complying Percent Complying Number Inspected

Number

Number

Number

Weight

Weight

Weight
47 47 / 94 6

Credit

Credit

1 2 3 4 5 6 7 8

3 5 5 7 8 7 5 6 6

All dairy farmers hold a valid permit All dairy farms inspected at least once every six (6) months or as required in Appendix "P" Inspection sheet posted or available Requirements interpreted in accordance with PHS/FDA PMO as indicated by past inspections TB & Brucellosis Certification on file as required Water samples tested and reports on file as required Milking time inspection program established At least four (4) samples collected from each dairy farm's supply every six (6) months and all necessary laboratory examinations made Sampling procedures approved by PHS/FDA

5 15 5 10 10 5 5 10

1 2 3 4 5 6 7 8 9 10

3 5 5 7 7

All milk plant, receiving station and transfer station operators hold a valid permit Milk plant and receiving station(s) inspected at least once every three (3) months; transfer station(s) once every six (6) months Inspection sheet posted or available Requirements interpreted in accordance with PHS/FDA PMO as indicated by past inspections

5 15 5 10 15 5 10 10 15 10

1 2 3 4

Enter TOTAL CREDIT from PART I under Percent Complying Enter TOTAL CREDIT from PART II under Percent Complying All milk and milk products properly labeled TOTAL CREDIT, PART III



INDIVIDUAL SHIPPER ENFORCEMENT RATINGS
INDIVIDUAL SHIPPER OF RAW MILK FOR PASTEURIZATION : · Without Milk Plant, Receiving Station or Transfer Station: ­ Evaluate all Items PART I. and record. · With Receiving Station(s) or Transfer Station(s): ­ Evaluate all Items PART I. ­ Evaluate all Items PART II., except Numbers 5 and 7. Divide by 75. ­ Evaluate all Items PART III. INDIVIDUAL SHIPPER OF PASTEURIZED MILK AND MILK PRODUCTS: · With Attached Raw Supply: ­ Evaluate all Items PART I. ­ Evaluate all Items PART II., use 47 Weight. ­ Evaluate all Items PART III. · With Unattached Raw Supply: ­ Evaluate all Items PART II., use 94 Weight. ­ Evaluate all Items PART III., except Number 1.

Pasteurization equipment tested at required App I frequency
7 6 6

Individual and cooling water samples tested and reports on file as required Samples of each plant's milk and milk products collected at required frequency and all necessary laboratory examinations made Sampling procedures approved by PHS/FDA

9 10 11

App B evaluation methods

10 15 10

App B evaluation methods

Permit issuance, suspension, revocation, 3, 5 reinstatement, hearings, and/or court actions 6, 16 taken as required Records systematically maintained and current TOTAL CREDIT, PART I

3, 5 Permit issuance, suspension, revocation, 6, 16 reinstatement, hearings, and/or court actions taken as required

Records systematically maintained and current TOTAL CREDIT, PART II





REMARKS

REMARKS

REMARKS

FORM FDA 2359j (10/08) (PAGE 2)

(PREVIOUS EDITIONS ARE OBSOLETE)

Credit

MILK SANITATION RATING REPORT
SHIPPER

SECTION C. EVALUATION OF SAMPLING PROCEDURES
The calculations below address Items from Section B. REPORT OF ENFORCEMENT METHODS on Page 2 of this Form.

For the Calculation of DAIRY FARM SAMPLING PROCEDURES
(Refer to PART I, ITEM 9 on Page 2 of this Form)
LOCATION

For the Calculation of MILK PLANT SAMPLING PROCEDURES
(Refer to PART II, ITEM 8 on Page 2 of this Form)
Item
Number Complying Percent Complying Number Inspected

Item
Number Complying Percent Complying Number Inspected

Number

Number

Weight

Weight
5 5 10
30

Credit

BTU / PLANT NUMBER

1 2

Sampling surveillance officers properly certified Adequate training program provided Sampling surveillance authority properly delegated All samplers hold a valid permit Samplers evaluated every two (2) years and reports properly filed Sampling procedures in substantial compliance Permit suspension, etc., taken as required Records systematically maintained and current

5 5 10 10
30

1 2 3 4
5

Sampling surveillance officers properly certified Adequate training program provided Sampling surveillance authority properly delegated All samplers hold a valid permit Samplers evaluated every two (2) years and reports properly filed Sampling procedures in substantial compliance Permit suspension, etc., taken as required Records systematically maintained and current N/A N/A N/A N/A N/A N/A

INSPECTING AGENCY

3 4
5

DATE(S)

6 7 8

15 15 10 100 TOTAL CREDIT

6 7 8

15 N/A 10 75 TOTAL CREDIT





REMARKS

NOTE: Items 4 and 7 above are not applicable when calculating Milk Plant Sampling Procedures (Part II, Item 8 from Section B, "Report of Enforcement Methods" on Page 2 of this Form). Calculation of the Score: Divide the TOTAL CREDIT by seventy-five (75)* for milk plants, receiving stations (RS) and transfer stations (TR).
* Then multiply by 100 to create a percentage.

FINAL TOTAL CREDIT (Milk Plant, RS or TR)



REMARKS

FORM FDA 2359j (10/08) (PAGE 3)

(PREVIOUS EDITIONS ARE OBSOLETE)

Credit
N/A