Free 2359k - Federal

9.

8.

7.

6.

5.

4.

3.

2.

1.

Shipper

Date of Rating

17.

16.

15.

14.

13.

12.

11.

10.

Total or Subtotal

NAME OF DAIRY FARM

% of Dairy Farms Violating ITEM WEIGHT

Pounds Sold Daily (100# Units) 3
Abnormal Milk

5

FORM FDA 2359k (10/08) PAGE 1
1
Somatic Cell Count* Floors Walls and Ceilings Separate Stalls Lighting Ventilation Cleanliness Cowyard Floors Walls and Ceilings Lighting and Ventilation

5* A B 2 C D E 3 4 A B 5 C D 2 2 4 E 6 7
Cleanliness Toilet Water Supply Cleaning Facilities Miscellaneous Requirements

1 1 1 1 1 3 3 1 1 2

Milking Barn Construction Milkhouse Construction and Facilities

(PREVIOUS EDITIONS ARE OBSOLETE)
8 4 2 or 5 4 5 5 2 5 3 A-C DE 16 17 2 AB C AB CD 2 2 2 10* 19 EF GH 1 5 - (5) - 1 3 18 2 - (7) - 5
Construction

ITEMS OF SANITATION

Food and Drug Administration

DEPARTMENT OF HEALTH AND HUMAN SERVICES

STATUS OF RAW MILK FOR PASTEURIZATION

9 10 11 12 13 14 15

Cleaning Sanitization Storage Flanks, Udders and Teats Protection from Contamination Cleaners/Sanitizers, Drug Equipment and Drugs Labeled, Handled and Stored Labeled for Use, Stored to Preclude the Contamination of Milk or Product-Contact Surfaces Handwashing Facilities Personnel Cleanliness Cooling, Recirculated Cooling Water Safe/Protected Temperature-Recording Device when Required Fly Breeding Minimized, Manure Packs Maintained Milkhouse Openings Screened, Doors Tight, Milkhouse Free of Insects/Rodents Approved Pesticides Used, Equipment and Utensils not Exposed to Contamination Surroundings Neat and Clean, Free of Harborages and Breeding Areas Bacterial Count or Drug Residue Analysis* Total Debits 2 Pounds Sold Daily (100# Units) 3 X Total Debits 2

Utensils and Equipment Drug and PerMilking Chemical Control sonnel Insects and Rodents

Sanitation Compliance Rating
1

REMARKS

PSC Graphics (301) 443-1090

EF

CONTINUATION OF THE "STATUS OF RAW MILK FOR PASTEURIZATION" FOR
ITEM

AS OF 5 6 D 2 E 2 4 4 2 or 5 4 5 5 2 5 3 7 8 9 10 11 12 13 14 15 A-C DE 2 16 17 18 AB C AB CD 2 19 EF 2 GH 2
Total Debits 2 Pounds Sold Daily (100 # Units) 3 X Total Debits2 BACTI

1 A B 1 5*

2 C 1 D 1 E 1

3

4 A B 1

C 2

REMARKS

WEIGHT

5

1

3

3

1

2 - (7) - 5

1 5 - (5) - 1 3

10*

Subtotal from Page 1 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. Total or Subtotal
% of Dairy Farms Violating
2

Footnotes:

1 Sanitation

Compliance Rating = 100 ­

Total Pounds Sold Daily (100# Units) 3 X Total Debits Total Pounds Sold Daily (100# Units)
3

2 3

Total Debits for each dairy farm is the sum of the weights of the Items violated. (NOTE: Any Item violated indicate by placing the debit value (weight) of that Item or an "X" under that Item.) Total Pounds Sold Daily are calculated in 100# Units.

* Used only when not in compliance. COMMENTS

FORM FDA 2359k (10/08) PAGE 2

(PREVIOUS EDITIONS ARE OBSOLETE)