Free 1533 - Federal

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.
cans gals. cans

3.0 mgs.
gals. cans

6.0 mgs.
gals.

12.0 mgs.
cans gals. cans

Total
gals.

%
gals.

0 fly 1 fly 2 flies 3 or more flies Totals Percent 100% 100%

MILK ACCEPTED
0 & 0.5 mg.
cans gals. cans

3.0 mgs.
gals. cans

6.0 mgs.
gals.

12.0 mgs.
cans gals. cans

Total
gals.

%
gals.

0 fly 1 fly 2 flies 3 or more flies Totals Percent 100% 100%

Total milk received Amount tested Percent tested Number of patrons Patrons tested

gals. gals. %

Sediment Factor
6.0 mgs & 12.0 mgs 3.0 mgs, 6.0 mgs & 12.0 mgs

Inspector Percent patrons tested

%
District
Created by: PSC Graphics (301) 443-1090

FDA-1533 (10/01)

EF