<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 35%" />
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 16%" />
<col style="width: 6%" />
<col style="width: 18%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="4"><h3
id="department-of-health-and-human-services">DEPARTMENT OF HEALTH AND
HUMAN SERVICES</h3>
<p><strong>FOOD AND DRUG ADMINISTRATION</strong></p></td>
<td colspan="6"><h3 id="inspection-summary-">INSPECTION SUMMARY-</h3>
<h3 id="railroad-watering-point-or-service-area-sanitation">RAILROAD
WATERING POINT OR SERVICE AREA SANITATION</h3></td>
</tr>
<tr class="even">
<td colspan="10"><strong>NOTE:</strong> The items marked below identify
deficiencies in operations or facilities which must be corrected within
a reasonable time<br />
period or by such date as may be specified by the regulatory authority.
Failure to comply with any time limits for cor-<br />
rection specified in reference to this notice may result in cessation of
acceptability of your operations, service or product for use on or by
interstate conveyances.</td>
</tr>
<tr class="odd">
<td colspan="4">OWNER/OPERATOR AND ADDRESS</td>
<td colspan="6">ESTABLISHMENT NAME</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="3">     </td>
<td colspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="4">INSPECTION DATE</td>
<td colspan="2">FEI NO.</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="10">CLASSIFICATION RECOMMENDED <em>(Check One)</em></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"><blockquote>
<p> APPROVED PROVISIONAL <em>(Expiration Date</em></p>
</blockquote></td>
<td colspan="5">     </td>
<td colspan="3" rowspan="2"><em>)</em> NOT APPROVED</td>
</tr>
<tr class="odd">
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="10">REPORT PREPARED BY <em>(Name and Title)</em></td>
</tr>
<tr class="odd">
<td colspan="10">     </td>
</tr>
<tr class="even">
<td colspan="10"><strong>DEFICIENCIES ARE INDICATED BY AN "X" NOT
OBSERVED BY AN "N", SATISFACTORY BY A "S".</strong></td>
</tr>
<tr class="odd">
<td colspan="5"><strong>WATERING PIPING SYSTEM</strong></td>
<td colspan="5"><strong>HANDLING TOILET WASTES</strong></td>
</tr>
<tr class="even">
<td>1</td>
<td colspan="2">No cross connections*</td>
<td colspan="2"> </td>
<td>36</td>
<td colspan="3">Personnel who remove wastes do not handle water or
food</td>
<td> </td>
</tr>
<tr class="odd">
<td>2</td>
<td colspan="2">No backflow connections*</td>
<td colspan="2"> </td>
<td>37</td>
<td colspan="3">Soil cans enclosed or covered during transportation to
disposal area</td>
<td> </td>
</tr>
<tr class="even">
<td>3</td>
<td colspan="2">Adequate pressure</td>
<td colspan="2"> </td>
<td>38</td>
<td colspan="3">Waste tanks and flushing tanks labeled</td>
<td> </td>
</tr>
<tr class="odd">
<td colspan="5"><strong>HYDRANTS</strong></td>
<td>39</td>
<td colspan="3">Sewage removed without spillage</td>
<td> </td>
</tr>
<tr class="even">
<td>4</td>
<td colspan="2">Hydrants of acceptable type</td>
<td colspan="2"> </td>
<td>40</td>
<td colspan="3">Construction and maintenance of toilet-waste carts
satisfactory</td>
<td> </td>
</tr>
<tr class="odd">
<td>5</td>
<td colspan="2">Separation from centerline of nearest track
satisfactory</td>
<td colspan="2"> </td>
<td rowspan="2">41</td>
<td colspan="3" rowspan="2"><p>Equipment available for flushing car
sewage-retention tanks</p>
<p>(not by direct connection to water supply)*</p></td>
<td rowspan="2"> </td>
</tr>
<tr class="even">
<td>6</td>
<td colspan="2">Outlets have quick type coupling</td>
<td colspan="2"> </td>
</tr>
<tr class="odd">
<td>7</td>
<td colspan="2">Outlets directed downward or horizontal</td>
<td colspan="2"> </td>
<td>42</td>
<td colspan="3">No toilet wastes discharges to ground*</td>
<td> </td>
</tr>
<tr class="even">
<td>8</td>
<td colspan="2"><p>Outlets less than 18" above rail or surrounding
surface</p>
<p>completely enclosed with self-closing cover</p></td>
<td colspan="2"> </td>
<td>43</td>
<td colspan="3"><p>Direct connection to sewer of proper design and
construction;</p>
<p>and properly maintained and operated</p></td>
<td> </td>
</tr>
<tr class="odd">
<td>9</td>
<td colspan="2">Hydrant installations adequately drained</td>
<td colspan="2"> </td>
<td colspan="5"><h5 id="disposal-of-toilet-wastes">DISPOSAL OF TOILET
WASTES</h5></td>
</tr>
<tr class="even">
<td>10</td>
<td colspan="2">Impervious platform around hydrants</td>
<td colspan="2"> </td>
<td>44</td>
<td colspan="3">Disposal facilities removed from food-or drink-servicing
areas</td>
<td> </td>
</tr>
<tr class="odd">
<td>11</td>
<td colspan="2">No connection of drains to sewers or storm drains</td>
<td colspan="2"> </td>
<td>45</td>
<td colspan="3">Sewage disposal satisfactory</td>
<td> </td>
</tr>
<tr class="even">
<td>12</td>
<td colspan="2">Weephole drainage entirely separate*</td>
<td colspan="2"> </td>
<td>46</td>
<td colspan="3">Can- or tank-cleaning facilities completely enclosed,
flyproof</td>
<td> </td>
</tr>
<tr class="odd">
<td>13</td>
<td colspan="2">to surface</td>
<td colspan="2"> </td>
<td>47</td>
<td colspan="3">Smooth, impervious floors, sloped to drain</td>
<td> </td>
</tr>
<tr class="even">
<td>14</td>
<td colspan="2">to sump</td>
<td colspan="2"> </td>
<td>48</td>
<td colspan="3">Room clean, good repair</td>
<td> </td>
</tr>
<tr class="odd">
<td>15</td>
<td colspan="2">to subsoil</td>
<td colspan="2"> </td>
<td>49</td>
<td colspan="3">At least 20 p.s.i water pressure</td>
<td> </td>
</tr>
<tr class="even">
<td rowspan="2">16</td>
<td colspan="2" rowspan="2"><p>If flush type hydrant, box overflow
protected against</p>
<p>flooding</p></td>
<td colspan="2" rowspan="2"> </td>
<td>50</td>
<td colspan="3">Hot water or stream available</td>
<td> </td>
</tr>
<tr class="odd">
<td>51</td>
<td colspan="3">Suitable backflow preventer, properly installed*</td>
<td> </td>
</tr>
<tr class="even">
<td rowspan="2">17</td>
<td colspan="2" rowspan="2"><p>Water outlets containing non-potable
water labeled and</p>
<p>provided with different type hose couplings*</p></td>
<td colspan="2" rowspan="2"> </td>
<td>52</td>
<td colspan="3">Soil cans emptied and cleaned after removal from
car</td>
<td> </td>
</tr>
<tr class="odd">
<td>53</td>
<td colspan="3">Carts emptied and flushed frequently</td>
<td> </td>
</tr>
<tr class="even">
<td colspan="5"><h5 id="water-hose">WATER HOSE</h5></td>
<td>54</td>
<td colspan="3">Satisfactory storage of clean soil cans</td>
<td> </td>
</tr>
<tr class="odd">
<td>18</td>
<td colspan="2">Acceptable material</td>
<td colspan="2"> </td>
<td colspan="5"><strong>GARBAGE AND REFUSE</strong></td>
</tr>
<tr class="even">
<td>19</td>
<td colspan="2">Smooth nozzle</td>
<td colspan="2"> </td>
<td>55</td>
<td colspan="3">Garbage stored in covered metal cans</td>
<td> </td>
</tr>
<tr class="odd">
<td>20</td>
<td colspan="2">Nozzle guard adequate</td>
<td colspan="2"> </td>
<td>56</td>
<td colspan="3">collected or disposed of frequently</td>
<td> </td>
</tr>
<tr class="even">
<td>21</td>
<td colspan="2">Ends not dragged</td>
<td colspan="2"> </td>
<td>57</td>
<td colspan="3">Satisfactory can washing facilities</td>
<td> </td>
</tr>
<tr class="odd">
<td>22</td>
<td colspan="2">Hose properly protected or stored</td>
<td colspan="2"> </td>
<td>58</td>
<td colspan="3">No garbage discharged to ground</td>
<td> </td>
</tr>
<tr class="even">
<td>23</td>
<td colspan="2">Hose flushed before use</td>
<td colspan="2"> </td>
<td>59</td>
<td colspan="3">Servicing area free of litter and debris</td>
<td> </td>
</tr>
<tr class="odd">
<td>24</td>
<td colspan="2">Car filing connection flushed before watering</td>
<td colspan="2"> </td>
<td colspan="5"><h5 id="toilets-washrooms-and-clothes-lockers">TOILETS,
WASHROOMS AND CLOTHES LOCKERS</h5></td>
</tr>
<tr class="even">
<td colspan="5"><h5 id="water-tanks-or-tank-carts">WATER TANKS OR TANK
CARTS</h5></td>
<td>60</td>
<td colspan="3">Toilets adequate</td>
<td> </td>
</tr>
<tr class="odd">
<td>25</td>
<td colspan="2">Separate from toilet-waste and sewage-tank-flushing
carts</td>
<td colspan="2"> </td>
<td>61</td>
<td colspan="3">Convenient</td>
<td> </td>
</tr>
<tr class="even">
<td>26</td>
<td colspan="2">Smooth, heavy-gauge, corrosion-resistant material</td>
<td colspan="2"> </td>
<td>62</td>
<td colspan="3">maintenance satisfactory</td>
<td> </td>
</tr>
<tr class="odd">
<td>27</td>
<td colspan="2">Completely enclosed from filling inlet to discharge
outlet</td>
<td colspan="2"> </td>
<td>63</td>
<td colspan="3">Handwashing facilities adequate</td>
<td> </td>
</tr>
<tr class="even">
<td>28</td>
<td colspan="2">Vents, if provided, properly protected</td>
<td colspan="2"> </td>
<td>64</td>
<td colspan="3">Convenient</td>
<td> </td>
</tr>
<tr class="odd">
<td>29</td>
<td colspan="2">Complete drainage possible</td>
<td colspan="2"> </td>
<td>65</td>
<td colspan="3">properly equipped</td>
<td> </td>
</tr>
<tr class="even">
<td>30</td>
<td colspan="2">Inlet and outlet directed downward</td>
<td colspan="2"> </td>
<td>66</td>
<td colspan="3">maintenance satisfactory</td>
<td> </td>
</tr>
<tr class="odd">
<td>31</td>
<td colspan="2">Inlet and outlet provided with caps or closures with
keeper chains</td>
<td colspan="2"> </td>
<td>67</td>
<td colspan="3">Handwashing signs</td>
<td> </td>
</tr>
<tr class="even">
<td>32</td>
<td colspan="2">Water tanks labeled*</td>
<td colspan="2"> </td>
<td>68</td>
<td colspan="3">Lockers adequate</td>
<td> </td>
</tr>
<tr class="odd">
<td>33</td>
<td colspan="2">Quick-type couplings, where required</td>
<td colspan="2"> </td>
<td>69</td>
<td colspan="3">satisfactory maintained</td>
<td> </td>
</tr>
<tr class="even">
<td>34</td>
<td colspan="2">If hose transported on cart, proper storage facilities
provided</td>
<td colspan="2"> </td>
<td>70</td>
<td colspan="3">Drinking fountains, if provided, satisfactory</td>
<td> </td>
</tr>
<tr class="odd">
<td>35</td>
<td colspan="2">Proper transfer of water</td>
<td colspan="2"> </td>
<td colspan="5">*CRITICAL Items Requiring Immediate Attention.</td>
</tr>
<tr class="even">
<td colspan="10"><p><strong>NOTE:</strong> See Reverse for Sections
On:</p>
<p>OTHER, OTHER COMPANIES SERVICED, and REMARKS</p></td>
</tr>
</tbody>
</table>

+---+------------------------------+---+---+-----------------------------+---+
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| * |                              |   | M |                             |   |
| * |                              |   | P |                             |   |
|   |                              |   | A |                             |   |
|   |                              |   | N |                             |   |
|   |                              |   | I |                             |   |
|   |                              |   | E |                             |   |
|   |                              |   | S |                             |   |
|   |                              |   | S |                             |   |
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|   |                              |   | C |                             |   |
|   |                              |   | E |                             |   |
|   |                              |   | D |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| 7 | EPA Acceptable Water Supply  |   | 7 |                             |   |
| 1 | As Required\*                |   | 6 |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| 7 | Conveyance Watering          |   |   |                             |   |
| 2 | Operations and Procedures    |   |   |                             |   |
|   |                              |   |   |                             |   |
|   | Acceptable\*                 |   |   |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| 7 | Conveyance Waste Removal     |   |   |                             |   |
| 3 | Operations and Procedures    |   |   |                             |   |
|   |                              |   |   |                             |   |
|   | Acceptable\*                 |   |   |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| 7 | Other Critical Areas\*       |   |   |                             |   |
| 4 |                              |   |   |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| 7 | Other Non-Critical Areas     |   |   |                             |   |
| 5 |                              |   |   |                             |   |
+---+------------------------------+---+---+-----------------------------+---+
| R |                              |   |   |                             |   |
| E |                              |   |   |                             |   |
| M |                              |   |   |                             |   |
| A |                              |   |   |                             |   |
| R |                              |   |   |                             |   |
| K |                              |   |   |                             |   |
| S |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
|   |                              |   |   |                             |   |
+---+------------------------------+---+---+-----------------------------+---+