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FORM A
Application to Install an In-Line Sampler


Refrigerator, monitoring, upkeep and operation must follow the latest version of the NCIMS 2400 Cultural Procedures Form. (Refrigeration section attached to this SOP

All materials, approval for the installation plans, approval of the installation and all other relevant areas relating to the equipment part of the in-line sampler construction and usage must meet the requirements in the most recent addition of the PMO, item 9r. Utensils and Equipment Construction.
Revision: 03-02-2005
Producer Name:
Date://
Producer Address:
Producer City:
Producer State: (required)
Producer Phone:
Producer Fax:
Producer Email:
Producer's Regulatory License or Permit Numer:
Purchaser of milk:
Producers Regulatory Inspectory:
Pound of milk/day direct loaded:
Sampling rate:
ml.
oz.
lbs.
gal.
Based on milk flow rate:
lbs.
gal.
min.
hour
Sample end volume desired
ml.
oz.
gal.
Sample container of approved design:
Sample container of approved material:
Material Type:
Sample Container size:
ml.
oz.
gal.
In-line sampler SOP, for appropriate sampler on file:
Appropriate sampler being followed:
Sampler location:
Refigerator Type:
Refigerator Make:
Refigerator Size (cu.ft.)
Refigerator of adequate size to maintain sample(s) at correct temp.:
Person(s) operating the system trained?
Trained dates on file?
Trained certification #'s on file?
Person(s) who performed training:
SOP for the in-line sampler being used on file and being followed?
Cleaning and Sanitizing of the sampler approved by the regulatory agency?
Cleaning and sanitizing protocol posted and followed?





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426 Hayward Avenue North
Oakdale Minnesota 55128

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