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| **DEPARTMENT OF HEALTH AND HUMAN  | SAMPLE COLLECTOR    |           |
| SERVICES**                        | AND TITLE           |           |
|                                   |                     |           |
| FOOD AND DRUG ADMINISTRATION      |                     |           |
|                                   |                     |           |
| **MILK SAMPLE COLLECTOR           |                     |           |
| EVALUATION REPORT DAIRY PLANT     |                     |           |
| SAMPLING -- RAW AND PASTEURIZED   |                     |           |
| MILK**                            |                     |           |
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|                                   | LOCATION            |           |
|                                   |                     |           |
|                                   |                     |           |
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| EVALUATION BY                     |                     |           |
|                                   |                     |           |
|                                   |                     |           |
+-----------------------------------+---------------------+-----------+
| AGENCY                            | DATE                | X =       |
|                                   |                     | D         |
|                                   |                     | EVIATION\ |
|                                   |                     | N/A = NOT |
|                                   |                     | A         |
|                                   |                     | PPLICABLE |
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| **EQUIPMENT**                     | h\. Fill sample     |           |
|                                   | container not more  |           |
| **1. Thermometer -- Approved      | than ¾ full         |           |
| Type**                            |                     |           |
|                                   | i\. Immediately     |           |
| a\. Accuracy - Checked against    | place samples into  |           |
| reference thermometer every 6     | sample case         |           |
| months\                           | containing ice      |           |
| (±1°C (2°F)); adjustment made;    |                     |           |
| correction factor recorded        | **9. Raw Milk for   |           |
|                                   | Pasteurization --   |           |
| b\. Date checked and checker's    | Milk Tank Trucks    |           |
| initials attached to case         | and Plant Storage\  |           |
|                                   | Tanks (Refer to     |           |
| **2. Agitation**                  | Item 8 for          |           |
|                                   | applicable          |           |
| a\. Use odor-free, pressurized    | procedures)**       |           |
| filtered air or electrically      |                     |           |
| driven stirring\                  | a\. Agitation time  |           |
| or recirculatory equipment as     | determined as       |           |
| required; all equipment           | required            |           |
| sanitized\                        |                     |           |
| before use in each successive     | b\. Collect sample  |           |
| tank (where applicable)           | aseptically from    |           |
|                                   | tank opening        |           |
| **3. Sample Transfer Instrument\  | (manhole)           |           |
| **a. Clean, sanitized, or         |                     |           |
| sterilized \                      | c\. Or from         |           |
| b. Seamless metal tube \          | pipeline            |           |
| c. Or metal dipper with long      |                     |           |
| handle; capacity at least 100 ml\ | d\. Or from balance |           |
| (4 oz.) \                         | tank prior to       |           |
| d. Or single-service paper or     | pasteurization      |           |
| plastic sampling tube \           |                     |           |
| e. Or sanitized sampling cock \   | e\. Or from         |           |
| f. Or other means for removing    | sanitized sampling  |           |
| sample aseptically                | cock                |           |
|                                   |                     |           |
| **4. Sampling Instrument Case**   | f\. Manual          |           |
|                                   | hand-disc agitator  |           |
| a\. Proper design, construction   | not used to mix     |           |
| and repair                        | milk in large       |           |
|                                   | storage\            |           |
| **5. Sample Containers**          | tanks or trucks     |           |
|                                   |                     |           |
| a\. Clean, properly sanitized, or | g\. Sample dipper,  |           |
| sterilized                        | when used, rinsed   |           |
|                                   | at least two times  |           |
| b\. Adequate supply, properly     | before transferring |           |
| stored and handled                | sample              |           |
|                                   |                     |           |
| **6. Sample Storage Case**        | h\. Dipper should   |           |
|                                   | extend 6 to 8       |           |
| a\. Rigid construction, suitable  | inches into milk to |           |
| design to maintain samples at 0°C | obtain a represen­-\ |           |
| -\                                | tative sample       |           |
| 4.4°C (32°F - 40° F); protected   |                     |           |
| from contamination; racks\        | i\. Sample dipper   |           |
| provided                          | rinsed in safe tap  |           |
|                                   | water after each    |           |
| **7. Cleaning and Sanitizing of   | use and replaced\   |           |
| Equipment**                       | in sanitizing       |           |
|                                   | solution            |           |
| a\. Sampling instruments, clean   |                     |           |
| and dry                           | **10. Pasteurized   |           |
|                                   | Milk and Milk       |           |
| b\. For sanitizing stirrer,       | Product Samples     |           |
| sampling tube, or dipper between  | (Refer to Item 8    |           |
| samples:                          | for\                |           |
|                                   | applicable          |           |
| 1\. Rinse first in one container  | procedures)**       |           |
| of clean cold water connected     |                     |           |
| with\                             | a\. Samples         |           |
| a continuous flowing source       | collected while     |           |
|                                   | product still in    |           |
| 2\. Then submerge in water        | possession of       |           |
| maintained at 82°C (180° F) for   | processor           |           |
| at\                               |                     |           |
| least 1 min.                      | b\. Representative  |           |
|                                   | samples, randomly   |           |
| 3\. Or submerge in a hypochlorite | selected            |           |
| solution at 200 ppm for at least\ |                     |           |
| 1 min. (or other bactericidally   | c\. After           |           |
| equivalent solution)              | thoroughly mixing   |           |
|                                   | product,            |           |
| 4\. Strength of sanitizing        | aseptically         |           |
| solution determined with          | transfer            |           |
| applicable test\                  | representa-\        |           |
| kit                               | tive portion to     |           |
|                                   | sterile sample      |           |
| **SAMPLING PROCEDURES**           | container           |           |
|                                   |                     |           |
| **8. General Sampling Procedures  | d\. Collect sample  |           |
| -- Plants, Raw and Pasteurized    | directly from milk  |           |
| Milk\                             | dispenser spigot    |           |
| Sampling**                        | without\            |           |
|                                   | sanitizing or       |           |
| a\. Hands washed, clean, and dry  | flushing            |           |
| during sampling                   |                     |           |
|                                   | **11. Pasteurized   |           |
| b\. Milk temperature determined   | Milk and Milk       |           |
| and recorded at all sampling\     | Product Containers  |           |
| locations                         | and Closures        |           |
|                                   | (Refer\             |           |
| c\. Temperature control sample    | to Item 8 for       |           |
| provided at first sampling        | applicable          |           |
| location\                         | procedures)**       |           |
| and labeled with time, date,      |                     |           |
| temperature, and collector        | a\. In the case of  |           |
| identifica-\                      | single-service      |           |
| tion                              | containers and/or   |           |
|                                   | closures used for   |           |
| d\. Sample containers legibly     | packaging milk and  |           |
| identified at collection point    | milk products,      |           |
|                                   | collect a randomly  |           |
| e\. Sample containers and         | selected sample set |           |
| closures handled aseptically      | from each           |           |
|                                   | manufacturing line  |           |
| f\. Sample container not held     | (process)           |           |
| over milk when transferring       |                     |           |
| sample into container             | --OR--              |           |
|                                   |                     |           |
| g\. Sampling instrument protected | In the case of      |           |
| from contamination before and\    | multi-use           |           |
| during sampling                   | containers used for |           |
|                                   | packaging milk and  |           |
|                                   | milk\               |           |
|                                   | products, collect   |           |
|                                   | at least four       |           |
|                                   | randomly selected   |           |
|                                   | containers          |           |
|                                   |                     |           |
|                                   | Regarding both of   |           |
|                                   | the above cases:    |           |
|                                   |                     |           |
|                                   | 1\. Lip or interior |           |
|                                   | of bottles or       |           |
|                                   | containers not      |           |
|                                   | contaminated        |           |
|                                   |                     |           |
|                                   | 2\. Milk or water   |           |
|                                   | prevented from      |           |
|                                   | dripping into empty |           |
|                                   | milk\               |           |
|                                   | containers: filler  |           |
|                                   | valves by-passed    |           |
|                                   |                     |           |
|                                   | 3\. Containers      |           |
|                                   | sealed or capped    |           |
|                                   | with line equipment |           |
|                                   |                     |           |
|                                   | 4\. Laboratory      |           |
|                                   | sterilized          |           |
|                                   | closures, when      |           |
|                                   | used, aseptically   |           |
|                                   | applied to\         |           |
|                                   | containers          |           |
|                                   |                     |           |
|                                   | 5\. Containers      |           |
|                                   | delivered to        |           |
|                                   | laboratory without  |           |
|                                   | rinse solution,\    |           |
|                                   | properly protected  |           |
|                                   | from crushing or    |           |
|                                   | damage              |           |
|                                   |                     |           |
|                                   | 6\. Single-service  |           |
|                                   | containers not      |           |
|                                   | stored or shipped   |           |
|                                   | in refrigerated\    |           |
|                                   | cases               |           |
|                                   |                     |           |
|                                   | **12. Sample        |           |
|                                   | Storage and         |           |
|                                   | Transportation**    |           |
|                                   |                     |           |
|                                   | a\. Ice or other    |           |
|                                   | refrigerant         |           |
|                                   | maintained slightly |           |
|                                   | above milk level    |           |
|                                   | in\                 |           |
|                                   | sample container;   |           |
|                                   | sample not frozen   |           |
|                                   |                     |           |
|                                   | b\. Sample          |           |
|                                   | protected against   |           |
|                                   | contamination; ice  |           |
|                                   | water no higher     |           |
|                                   | than\               |           |
|                                   | milk level in       |           |
|                                   | sample containers;  |           |
|                                   | do not bury tops of |           |
|                                   | containers in\      |           |
|                                   | ice                 |           |
|                                   |                     |           |
|                                   | c\. Samples and     |           |
|                                   | sample data         |           |
|                                   | promptly submitted  |           |
|                                   | to laboratory       |           |
|                                   |                     |           |
|                                   | d\. Use tamper      |           |
|                                   | proof shipping case |           |
|                                   | with top labeled    |           |
|                                   | "This Side Up"      |           |
|                                   | (when using common  |           |
|                                   | carrier shipping)   |           |
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| REMARKS *(If additional space is  |                     |           |
| required, please place            |                     |           |
| information on the back of this   |                     |           |
| Form or on a separate page.)*     |                     |           |
|                                   |                     |           |
|                                   |                     |           |
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| **FORM FDA 2399 (10/06) (PREVIOUS |                     |           |
| EDITIONS ARE OBSOLETE)** PSC      |                     |           |
| Graphics: (301) 443-1090 EF       |                     |           |
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