USDA GUIDELINES FOR THE 

EVALUATION AND CERTIFICATION 

OF THE 

SANITARY DESIGN AND 

FABRICATION 

OF 

MEAT AND POULTRY 

PROCESSING EQUIPMENT 

February 2009 
 2

A. SCOPE:

These guidelines set forth the principles and procedures for the evaluation, acceptance, and 

certification of the sanitary design and fabrication features of equipment and utensils intended 

for use in the slaughter, processing, or packaging of livestock and poultry products. 

The Dairy Grading Branch is a user fee supported service. Therefore, charges will be made for 

the review of drawings, utensils, or equipment, and for related travel and other expenses. 

Dairy Grading Branch policy fully supports and utilizes the standards developed and published 

by the NSF/3-A Joint Committee on Food Processing Equipment. Copies of the ANSI/NSF/3-A 

Standards can be obtained from: 

 Techstreet 

 310 Miller Avenue 

 Ann Arbor, MI 48103 

 Phone: (800) 699-9277 Internet: www.techstreet.com 

NSF/3-A Standards provide criteria for materials, design and fabrication of equipment or utensils 

used in the slaughter, processing and packaging of livestock and poultry products. There are 

currently three standards available for use by the meat and poultry processing industry, and they 

are: Hygiene Requirements for the Design of Meat and Poultry Processing Equipment, 

ANSI/NSF/3-A 14159-1-2002.; Hygiene Requirements for the Design of Hand Held Tools Used 

in Meat and Poultry Processing, ANSI/NSF/3-A 14159-2-2003; and Hygiene Requirements for 

the Design of Mechanical Belt Conveyors Used in Meat and Poultry Processing, ANSI/NSF/3-A 

14159-3-2005. Additional standards may be developed in the future as specific needs occur. 

The Agricultural Marketing Service does not require that livestock and poultry equipment or 

utensils be presented to USDA for review. However, if upon routine inspection deficiencies with 

materials, design, fabrication, or workmanship are observed, which appear to violate the 

applicable standards, the inspection agency, the Food Safety and Inspection Service (FSIS), may 

request the processing plant, and subsequently the fabricator, to make appropriate modifications. 

Companies may optionally request a USDA-Dairy Grading Branch review to minimize the 

likelihood of such complaints. 

Equipment buyers are encouraged to request USDA-Dairy Grading Branch acceptance for 

equipment as a provision of a purchase contract. The requirement should be clearly written so as 

not to confuse USDA-Dairy Grading Branch acceptance with compliance with other 

requirements, such as those of the USDA, Food Safety and Inspection Service (FSIS) or State 

inspection agencies which are not provided for within this service. 

B. REQUESTS FOR SERVICE PROCEDURES:
 3

To initiate a sanitary design review, the prospective applicant may contact the Dairy Grading 

Branch by telephone, fax, e-mail, or mail. Each request for inspection is to be accompanied by an 

Equipment Review Request form (See Exhibit 1.) If the design review will require travel to an 

inspection site outside of the United States, the necessary information pertaining to foreign travel 

must be completed on the form. 

Applicants are advised that a minimum of 30 working days advance notice is required for any 

foreign travel and a minimum of 7 working days advance notice is required for domestic travel. 

Design evaluations and travel to inspection sites are based on a first-come-first-served basis and 

inspector availability. Applicants are encouraged to contact the Dairy Grading Branch, 

Washington, DC office to verify inspector availability and schedules prior to submitting a request 

for service. 

Requests for service and drawings may be sent to the following: 

Mailing Address: Street Address: 

(U.S. Postal Service deliveries) (Private express mail service deliveries) 

 RECOMMENDED 

USDA/AMS/Dairy Programs USDA/AMS/Dairy Programs 

Dairy Grading Branch Dairy Grading Branch 

Meat &Poultry Design Review Section Meat & Poultry Design Review Section 

Stop 0230 Room 2746 

1400 Independence Avenue, S.W. 1400 Independence Ave SW 

Washington, DC 20250-0230 Washington, DC 20250-0230 

 Phone 202-720-7473 

 Fax 202-720-2643 

 Internet http://www.ams.usda.gov/MPEquipment

Engineering drawings of the entire piece of equipment or utensil with emphasis on the product 

contact surfaces and exposed non-product contact surfaces are generally required for evaluation of 

details for USDA acceptance. Engineering drawings must be of sufficient detail to clearly show: 

 The dimensions of each part; 

 The materials of construction of each part; 

 The minimum radii dimensions of internal angles of less than 135 degrees; 

 The product contact surface finish specifications; 

 The specifications for welds and other permanent joints; 

 The design details for flanges, or gasketed joints which are to include enlarged 

drawing(s) (at least 2X) of the details of O-ring retaining grooves as appropriate; 

 The dimensions of O-rings, gaskets, and any other type of seals; 

 Explanations about company welding symbols and metal finishes; and 

 Relationship of the part to other components in a subassembly or the full assembly. 
 4

Dimensions may be shown in either English or metric measurement terms but must be clearly 

identified as to which method is being used. The required materials listings and terminology on 

the drawings should be in English or include translations into English. Concept or assembly 

drawings should also be provided as they are useful in showing the general configuration of the 

equipment and the relationship of component parts to each other. 

Alternatively, the review can be performed on a finished piece of equipment on-site at either the 

equipment manufacturer or at a processing plant. The requirements for this type of review are: 

 Safe access must be provided; 

 The equipment or utensil must be clean and available for inspection; 

 Arrangements shall have been made with the processing plant to allow sufficient time to 

conduct the evaluation; 

 Competent personnel shall be available for the disassembly of the equipment to facilitate 

the evaluation of components of the machine. 

 Certifications for all rubber and plastic materials should be available. 

C. USDA REVIEW PROCEDURES:

As stated in Section B, each request for inspection is to be accompanied by an Equipment 

Review Request form (See Exhibit 1.) If the request for service has been made by telephone or 

e-mail, a completed copy of the form shall be submitted by fax or mail as soon as possible after 

the request. 

Each request will be logged in on the date received. Service will be provided on a first-comefirst-serve basis consistent with inspector availability, efficiency and cost management. 

In turn, each request will be assigned to a review specialist. The assignments will be made to 

assure continuity of follow-up inspections with initial evaluations. When appropriate for field 

evaluations, the assignment will be made to a Livestock and Seed Programs or Poultry Programs 

employee who has been designated with a collateral duty assignment to assist with the evaluation 

process. The collateral duty assignment inspector will be under the direct technical supervision of 

a Dairy Grading Branch Review Specialist. 

When assigned to a review specialist, each new project shall be assigned a unique project number. 

Follow-up evaluations or correspondence pertaining to existing projects shall use the previously 

assigned project number. The project number will be prefixed by “M” to designate it as a meat 

and poultry equipment project (e.g. M123456). The project number shall be maintained 

throughout the evaluation process in order to maintain a complete historical file of all activity 

performed on a specific piece of equipment or utensil. This may include, in addition to the initial 

evaluation, multiple follow-up reports, correspondence, possible field evaluations, and recertification of a design. 

Evaluation reports will follow a uniform format to facilitate review and use by field employees. 

The Reports shall consist of the following components: 
 5

 Cover Letter: 

 Cross reference to project number 

 Cross reference to the DE Attachment number 

 Inspector Name 

 Location and dates of service 

 Standards used as review criteria 

 Name or type of equipment evaluated 

 Special considerations or comments 

Detailed Listing of the observations, comments, and recommendations.* 

 Inspection of: (Name of equipment or utensil) 

 Model Number: (Unique Model designation required for eventual USDA 

acceptance and certification) 

 Serial Number: (If applicable) 

 Date: (Dates of the inspection) 

 Inspected by: (Name of Review Specialist) 

 Type of Inspection: (Initial, Follow-up**, Validation of prior acceptance, Etc.) 

 Project Number(s): (Assigned Project Number) 

 DE Attachment (DA Form 160, Equipment Review Report) with the billing information. 

* If the observations, comments and recommendations are 10 or less, they may be 

optionally incorporated into the cover letter to reduce the overall size of the report. 

** Follow-up inspections shall, whenever possible, maintain the same numbering 

sequence for observations, comments and recommendations as the initial evaluation. Any 

new observations, comments and recommendations will be added at the end of the report. 

Evaluation reports will be distributed to the Applicant and may be sent to the user or fabricator as 

designated by the Applicant. File copies are to be maintained both electronically and as hard 

copies by the Branch. 

Upon completion of the evaluation report all pertinent data items will be entered and verified in 

the USDA Meat and Poultry Equipment database. 

DE Attachments (DA Form 160, Equipment Review Report) will be entered into the USDA 

billing system as soon as possible but in no case less than weekly. 

D. CERTIFICATION AND DISPLAY OF THE AGRICULTURAL MARKETING 

SERVICE MARK
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An Equipment Acceptance Certificate (See Exhibit 2) may be requested by the Applicant upon 

successful completion of the review and evaluation process that has demonstrated that the 

designated model of equipment or utensil complies with the criteria of the appropriate standards. 

The certificate may include a single model of equipment, a single model of a utensil, or a model 

series designation of which the various units in the series are of an identical basic design, except 

for scaling up or down in size. 

An Applicant may also optionally request the authority to display the Agricultural Marketing 

Service official identification mark (See Exhibit 3.) In such case, the Applicant shall submit a 

completed copy of form DA-155 (See Exhibit 4) to the National Program Coordinator for Grade 

Labels and Official Identification requesting authorization to display official identification. This 

form is generally submitted on a one-time basis by the Applicant. However, the form must be updated should the Applicant change its name or relocate its offices. 

An authorized Applicant shall then submit a form DA-156 (See Exhibit 5) identifying the specific 

piece of equipment, utensil, or descriptive or promotional materials upon which the official 

identification is to be displayed. For a new Applicant, this form may be submitted concurrently 

with the form DA-155. 

E. ACCEPTED MEAT AND POULTRY EQUIPMENT LISTING

Any model of equipment or utensil which has successfully completed the review and evaluation 

process and has been demonstrated to comply with the criteria of the appropriate standards will be 

included in the Accepted Meat and Poultry Equipment Listing. The listing will be published 

semi-annually and available on the Dairy Grading Branch web page. Additions and deletions to 

the listing which occur during the period between the semi-annual publication dates will be 

available on the web page only. 

F. VALIDATION OF PRIOR ACCEPTANCE

An Applicant who has any model of equipment or utensil which has successfully completed the 

review and evaluation process, and is published in the Accepted Meat and Poultry Equipment 

Listing is required to re-validate its acceptance every four years. 

Each applicant will be sent a written notification six months prior to the pending lapse of 

acceptance and provided with a REQUEST TO VALIDATE A PRIOR MEAT AND 

POULTRY EQUIPMENT ACCEPTANCE form (See Exhibit 6). 
 7

G. RESOLUTION OF REPORTS OF NONCOMPLIANCE OF USDA ACCEPTED 

EQUIPMENT

When a question arises as to whether a piece of USDA Accepted equipment or utensil complies, 

a user, fabricator, or other interested party may submit a letter of complaint to the Chief of the 

Dairy Grading Branch via mail, facsimile, or e-mail at: 

 USDA, AMS, Dairy Programs 

 Dairy Grading Branch 

 Design Review Section 

 Room 2746 - South Building 

 1400 Independence Avenue, SW STOP 0230 

 Washington, DC 20250-0230 

 Phone: (202) 720-3171 

 Fax: (202) 720-2643 

E-mail: Ken.Vorgert@usda.gov 

The letter should contain the following: 

A. The party making the complaint 

B. The address and phone number of the complainant 

C. The name or type of equipment or utensil in question 

D. Where the equipment or utensil is located 

E. The equipment or utensil manufacturer 

F. The model number and serial number (if known) 

G. The specific reason(s) for suspecting noncompliance (reference the standard if known) 

Examples: Improper finish on product contact surfaces, piano-style hinge on cover, 

tack welds on exterior surfaces, or unacceptable materials used for construction. 

(Noncompliance is not limited to the above examples.) 

The Dairy Grading Branch, Equipment Review Staff will act in an expeditious manner to 

determine the validity of the complaint, and if it is determined to be valid, who is the responsible 

party. 

Equipment Manufacturer Responsibilities

If the equipment manufacturer is determined to be the responsible party and they agree to correct 

the noncompliance issue, they are to submit an Equipment Review Request (See Exhibit 1) to 

initiate a USDA review of the corrective actions. The Dairy Grading Branch will then determine 

with the manufacturer a mutually agreeable time in which to correct the noncompliance of the 

identified piece of equipment and, if necessary, of all like items in the marketplace with the same 

deficiency. While the corrections are being made, the USDA Acceptance will continue 

uninterrupted. Additionally, the manufacturers will provide documentation on their quality 

control procedures to assure that the noncompliance will not recur. 
 8

If the equipment manufacturer is determined to be the responsible party and they decide not to 

correct the noncompliance, they will be notified that the USDA Acceptance for the equipment is 

withdrawn. Notification of the withdrawal of USDA Acceptance will be provided to the Food 

Safety and Inspection Service (FSIS), State regulatory officials, and appropriate Trade 

Associations. 

The manufacturer is responsible for all costs associated with evaluation of the resolution of the 

noncompliance. 

Equipment User Responsibilities

If the equipment user is determined to be the responsible party and they agree to correct the 

noncompliance, they are to submit an Equipment Review Request (See Exhibit 1) to initiate a 

USDA review of the corrective actions. The Dairy Grading Branch will determine with the user 

a mutually agreeable time in which to correct the noncompliance. While the corrections are 

being made, the USDA Acceptance will continue uninterrupted. 

If the equipment user is determined to be the responsible party and they decide not to correct the 

nonconformance, they will be notified that the USDA Acceptance for their specific piece of 

equipment is withdrawn. Notification of the withdrawal of USDA Acceptance will be provided 

to the FSIS, State regulatory officials, appropriate Trade Associations, and the equipment 

manufacturer. 

The user is responsible for all costs associated with evaluation of the resolution of the 

noncompliance. 
 9

Exhibit 1 

 Reproduce Locally. Include form number and edition date on all reproductions Form Approved OMB No. 0581-0126 

U. S. DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

DAIRY PROGRAMS 

EQUIPMENT REVIEW REQUEST

Applicant (Name and Address) Party Responsible for Payment if other than 

Applicant (Name and Address) 

Confirmation Required (Letter or Fax) 

Received 

Equipment Located at (Name and Address) 

Website 

Tax Identification No. (TIN) (new applicant only) Tax Identification No. (TIN) (new applicant only) Tax Identification No. (TIN) (new applicant only)

Contact Contact Contact 

Telephone Telephone Telephone 

Fax Fax Fax 

Type of Equipment:  Dairy 

 Livestock and Poultry 

 3-A Third Party Verification 

 Appeal 

Signature of Applicant Date Email 

 Domestic Inspection: 

A minimum of seven (7) working days notification is required to insure specialists have ample time to make arrangements for the trip. If specialists are unavailable, the next 

available date acceptable to all parties will be assigned. 

 Foreign Inspection:

A minimum of thirty (30) working days advance notice is required for any foreign travel. The 30 days will start from the date this request form 

Is received by the Dairy Grading Branch. If specialists are unavailable, the next available date acceptable to all parties will be assigned. 

Hotel accommodations (USDA Dairy must pay): Best mode of transportation from airport (train, taxi, company pickup...): 

Does the Hotel accept Visa credit cards:  Yes  No 

Mail or Fax this form to the address below: 

Dairy Equipment Review , and Livestock and Poultry Equipment Review Address: 

USDA/AMS/DAIRY PROGRAMS 

Dairy Grading Branch 

Design Review Section 

Room 2746 – South Building 

1400 Independence Ave. SW STOP 0230 

Washington, DC 20250-0230 

Tel: 202 720-3171 

Fax: 202 720-2643 

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this 

information collection is 0581-0126. The time required to complete this collection of information is estimated to average 3 minutes per person including time for reviewing instructions, searching existing data sources, gathering and maintaining the 

data needed, and completing and reviewing the collection of information. 

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual 

orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means 

for communications of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write USDA Director, Office of Civil Rights, 1400 

Independence Avenue, SW, Washington, DC 20250-9410 or call (800) – 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer. 

FOR OFFICIAL USE ONLY 

Date Received: __________ 

Date Assigned: __________ 

Specialist Assigned: __________ 

Project Number (s): __________ 

DA-162 (01-09) Destroy previous edition dated 10-03
 10

Exhibit 2
 11

Exhibit 3
 12

 Exhibit 4 

 Reproduce Locally. Include form number and edition date on all reproductions. Form Approved OMB No. 0581-0126 

U. S. DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

DAIRY PROGRAMS 

APPLICATION TO USE OFFICIAL IDENTIFICATION OR GRADE LABELS 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control 

number. The valid control number for this information is 0581-0126. The time required to complete this information collection is estimated to average 1 

minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and 

completing and reviewing the collection information. 

The U.S. Department of Agriculture (USDA) prohibits discrimination in its programs on the basis of race, color, national origin, sex, religion, age, disability, 

political beliefs, marital or familial status. (Not all prohibited bases apply for all programs.) Persons with disabilities who require alternative means for 

communications of program information (Braille, large print, audiotape, etc.) should contact USDA’s Target Center at 202-720-2600 (voice and TDD). To 

file a complaint, write the Secretary of Agriculture, U. S. Department of Agriculture, Washington, DC 20250, or call (800) 245-6340 (voice) or (202) 720-

1127 (TDD). USDA is an equal opportunity employer. 

USDA official identification or grade labels may not be used unless a completed application has been received and approved.

Application is hereby made, in accordance with the provisions of the appropriate sections of the Regulations 

Governing the Inspection and Grading of Manufactured or Processed Dairy Products (7 CFR, Ch. I, Part 58, 

Subpart A), or the Regulations Governing the Certification of Sanitary Design and Fabrication of Equipment 

Used in the Slaughter, Processing, and Packaging of Livestock and Poultry Products (7 CFR, Ch. I, Part 54, 

Subpart C), for the privilege of using official identification or grade labels on product packaging materials, 

equipment, utensils, or descriptive or promotional materials. 

In requesting this privilege, the applicant (listed below) agrees to conform to the aforesaid regulations and 

such instructions as may be issued by the Administrator, Agricultural Marketing Service covering inspection, 

grading and evaluation of products, packaging materials, equipment, utensils, or descriptive or promotional 

materials. The applicant further agrees to furnish copies of the official identification or grade labels at no 

cost to the Government. 

The applicant further agrees not to offer for sale or publicly display any inspected, graded or evaluated 

product in packaging materials, equipment, utensils, descriptive or promotional materials bearing official 

identification or grade label under a trade name other than that of the applicant unless such trade name is 

submitted, together with the proper address, to the Administrator at the time approval is requested of the 

official identification or grade label to be used. 

In the event the privilege to use official identification or grade labels on product packaging materials, 

equipment, utensils, or descriptive or promotional materials is withdrawn in accordance with the appropriate 

provisions of the aforesaid regulations, the applicant agrees to promptly place under the jurisdiction and 

control of a USDA licensed grader or design review specialist all packaging materials, descriptive or 

promotional materials, and other supplies bearing printed reference to the inspected, graded or evaluated 

character of the products, equipment, or utensils for such subsequent use by the applicant as may be 

approved by the Administrator 

Name, Address and Plant No. (if applicable) of Applicant: Send this form and attached materials to: 

Grade Label Coordinator 

USDA/AMS/Dairy Programs 

Dairy Grading Branch 

Room 2746-S 

1400 Independence Ave. SW - STOP 0230 

Washington, DC 20250-0230 

Tel: 202-720-3171 

Fax: 202-720-2643 

Name and Title of Applicant Representative (Print or Type): 

Applicant Representative Signature: Date:

Approval By Chief Dairy Grading Branch: Date: Control Number: 

 Form DA-155 (07-03) Destroy all previous editions.
 13

Exhibit 5 

Reproduce Locally. Include form number and edition date on all reproductions. Form Approved OMB No. 0581-0126 

U. S. DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

DAIRY PROGRAMS 

REQUEST TO DISPLAY OFFICIAL IDENTIFICATION OR GRADE LABELS 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. 

The valid control number for this information is 0581-0126. The time required to complete this information collection is estimated to average 1 minute per response, 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the 

collection information. 

The U.S. Department of Agriculture (USDA) prohibits discrimination in its programs on the basis of race, color, national origin, sex, religion, age, disability, political 

beliefs, marital or familial status. (Not all prohibited bases apply for all programs.) Persons with disabilities who require alternative means for communications of 

program information (Braille, large print, audiotape, etc.) should contact USDA’s Target Center at 202-720-2600 (voice and TDD). To file a complaint, write the 

Secretary of Agriculture, U. S. Department of Agriculture, Washington, DC 20250, or call (800) 245-6340 (voice) or (202) 720-1127 (TDD). USDA is an equal 

opportunity employer. 

USDA official identification or grade labels may not be used unless a completed application has been received and approved.

Application is hereby made, in accordance with the provisions of the appropriate sections of the Regulations 

Governing the Inspection and Grading of Manufactured or Processed Dairy Products (7 CFR, Ch. I, Part 58, 

Subpart A), or the Regulations Governing the Certification of Sanitary Design and Fabrication of Equipment Used in 

the Slaughter, Processing, and Packaging of Livestock and Poultry Products (7 CFR, Ch. I, Part 54, Subpart C), for 

the privilege of displaying official identification or grade labels on the following product packaging materials, 

equipment, utensils, or descriptive or promotional materials. The applicant (listed below) affirms compliance to the 

aforesaid regulations and such instructions as may be issued by the Administrator, Agricultural Marketing Service 

covering inspection, grading and evaluation of products, packaging materials, equipment, utensils, or descriptive or 

promotional materials, and attests that an approved Application To Use Official Identification or Grade Labels, Form 

DA-155 is on file with Dairy Programs. 

Three copies of the product packaging materials or descriptive or promotional materials displaying the official 

identification or grade label are attached or, if this request has been faxed for review, are being mailed under 

separate cover.

Product packaging materials, equipment, utensils, or descriptive or promotional materials to 

display official identification or grade label (Brand name, item description, etc.):

 Distributor if different from Applicant: 

1. 

2. 

3. 

4. 

5. 

Name, Address and Plant No. (if applicable) of Applicant: Send this form and attached materials to: 

Grade Label Coordinator 

USDA/AMS/Dairy Programs 

Dairy Grading Branch 

Room 2746-S 

1400 Independence Ave. SW - STOP 0230 

Washington, DC 20250-0230 

Tel: 202-720-3171 

Fax: 202-720-2643 

Name and Title of Applicant Representative (Print or Type): Telephone: Fax:

Applicant Representative Signature: Date:

Form DA-156 (07-03) Destroy all previous editions.
 14

Exhibit 6

U. S. DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

DAIRY PROGRAMS 

REQUEST TO VALIDATE A PRIOR MEAT AND POULTRY EQUIPMENT ACCEPTANCE 

Application is hereby made, in accordance with the provisions of the appropriate sections of the Regulations Governing the Inspection and Grading of 

Manufactured or Processed Dairy Products (7 CFR, Ch. I, Part 58, Subpart A), or the Regulations Governing the Certification of Sanitary Design and 

Fabrication of Equipment Used in the Slaughter, Processing, and Packaging of Livestock and Poultry Products (7 CFR, Ch. I, Part 54, Subpart C), for 

validation of a prior meat and poultry equipment acceptance. The applicant (listed below) certifies to the statements made below and affirms compliance to 

the aforesaid regulations and such instructions as may be issued by the Administrator, Agricultural Marketing Service covering evaluation and certification 

of equipment or utensils by the Dairy Programs.

Name and Address of Applicant: Equipment or Utensil: 

Telephone No: Project Number: 

Fax No: Date of Prior Acceptance: 

 I certify that the design, materials of construction, and fabrication of the above referenced equipment or utensil has not been 

modified, changed, or revised and remains the same as previously reviewed and accepted by the Dairy Grading Branch. 

 I certify that the design, materials of construction, or fabrication of the above referenced equipment or utensil has been 

modified and that all modifications, changes, or revisions to the design, materials of construction, or fabrication are submitted for 

evaluation in the attached engineering drawings or listing of materials. I further acknowledge that if the submitted information is not 

evaluated before the expiration date of my equipment or utensil that the accepted listing will be deleted until completion of the 

evaluation. 

 I request that our listing for acceptance of the above referenced equipment or utensil be deleted. 

Signature of Applicant President/CEO: Signature of Applicant Director of Engineering: Date: 

Dairy Grading Branch Concurrence: Date: