United States Department of Agriculture

Agricultural Marketing Service

Federal Grain Inspection Service

Directive 9180.36 September 25, 2006

Distribution: FGIS, OSP, Industry Originating Office: FMD PPMAB

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, and marital or familial status. (Not all prohibited 

bases apply to all programs.) Persons with disabilities who require alternate means for communication 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 to the USDA, Office of Civil Rights, Room 326-W, 1400 Independence Avenue, SW, 

Washington, DC 20250-9410, or call (202) 720-5964 (voice and TDD). USDA is an equal employment opportunity 

employer.

WAREHOUSEMAN’SAMPLE-LOT INSPECTIONS

Contents

WAREHOUSEMAN’SAMPLE-LOT INSPECTIONS�����������������������������������������������������������������1

1. PURPOSE����������������������������������������������������������������������������������������������������������������������������

2. REPLACEMENT HIGHLIGHTS��������������������������������������������������������������������������������������������

3. POLICY ��������������������������������������������������������������������������������������������������������������������������������

4. PREREQUISITES FOR OBTAINING INSPECTION SERVICES ����������������������������������������

5. QUESTIONS ������������������������������������������������������������������������������������������������������������������������

5. PROCEDURES FOR WAREHOUSEMAN SAMPLERS ������������������������������������������������������

6. CERTIFICATING INSPECTION RESULTS �������������������������������������������������������������������������

7. REVIEWS�����������������������������������������������������������������������������������������������������������������������������

8. FEES AND CHARGES���������������������������������������������������������������������������������������������������������

ATTACHMENT 1���������������������������������������������������������������������������������������������������������������������10

ATTACHMENT 2���������������������������������������������������������������������������������������������������������������������14

ATTACHMENT 3���������������������������������������������������������������������������������������������������������������������16
FGIS Directive 9180.36 September 25, 2006

Page 2

1. PURPOSE

This directive:

a. Establishes contract procedures for warehouseman’s sample-lot inspection service

b. Outlines the responsibilities of the field office manager, agency manager1,

warehouse management, and warehouseman sampler; and

c. Outlines procedures for performing warehouseman’s sample-lot inspection

2. REPLACEMENT HIGHLIGHTS

This directive replaces Directive 9180.36, dated 8/16/04. This directive is revised to

correct errors in the text, and revises Forms FGIS-944 and FGIS-950, but does not 

revise policy.

3. POLICY

Warehouseman’s sample-lot inspection service is authorized by Sections 2, 7, 11, and 

16 of the U.S. Grain Standards Act, as amended (USGSA), and is provided for and

implemented by section 800.75(c) of the regulations thereunder, to facilitate the

merchandising of grain in locations where official sample-lot inspections are impractical.

This service consists of:

a. A licensed warehouseman sampler sampling an identified lot of grain using an

approved diverter-type mechanical (D/T) sampler;

b. Sending the sample to official personnel; and

c. Official personnel analyzing the sample for grade, official factors, official criteria,

or any combination thereof, according to the regulations, Official U.S. Standards 

for Grain, and the instructions.

________

1 For the purpose of this directive, the responsibilities and functions assigned to an agency manager will be 

 assumed by the field office manager when there is no agency operating in the area where the service is 

 requested
FGIS Directive 9180.36 September 25, 2006

Page 3

4. PREREQUISITES FOR OBTAINING INSPECTION SERVICES

a. Warehouseman’s sample-lot inspection services may be provided when:

(1) An approved D/T sampler is available;

(2) All necessary equipment/supplies are provided;

(3) A contract regarding the service has been established between FGIS, the

agency, and the warehouse (a separate contract must be entered into for 

each facility where the service is requested); and

(4) The warehouse employee designated to draw samples is licensed under the

USGSA

b. D/T Sample

(1) Warehouse management must have an approved D/T sampler in each facility 

where warehouseman’s sample-lot inspection services are to be performed

(2) Warehouse management must arrange with the agency manager for testing

the D/T sampling equipment.

(3) The agency manager must test the D/T sampler according to instructions

contained in the Mechanical Sampling Systems Handbook.

c. Related Equipment and Supplies. Warehouse management must furnish t

licensed warehouseman sampler the following equipment:

(1) An approved divider if the secondary mechanical (SM) sampler does not 

reduce the samples to a representative sample of approximately 2,800 grams.

(2) Plastic-lined canvas bags (for forwarding samples for inspection)1;

(3) Approved sampling report forms1;

(4) Mailing tags1;

(5) Security cabinet, as needed, to safeguard the samples from manipulation or 

substitution

________

1

 These materials may be obtained from the agency manager.
FGIS Directive 9180.36 September 25, 2006

Page 4

5. QUESTIONS

d. Contracting for Service. Once the warehouse manager has complied with th

requirements of paragraphs a and b of this section, a service contract may be 

executed with FGIS for the performance of official sampling on identifiable lots of 

grain for warehouseman’s sample-lot inspection

The contract authorizes only the obtaining and forwarding of official samples of 

grain to official personnel. Contracts do not allow an elevator employee to obtain 

official samples of export grain, test grain, grade grain, or certificate the results of 

any official inspection.

(1) Warehouse management may initiate a contract by:

(a) Obtaining Form FGIS-950, “Warehouseman’s Sample-Lot Inspection 

Service Contract,” (attachment 1) from the agency;

(b) Having the warehouseman sampler sign the original and three copies of 

the form;

(c) Signing the original and all copies of the form; and

(d) Forwarding the original and all copies to the agency or FGIS field office 

having jurisdiction over the area in which the service is desired

(2) The agency manager will:

(a) Determine if the warehouse has an approved and currently checktested 

D/T sampler and other necessary equipment available for the licensed 

sampler’s use; and

(b) Review the form, sign the original and all copies, if approved, and 

forward the signed form to the field office manager having jurisdiction 

over the circuit

(3) The field office manager will:

(a) Review form FGIS-950 for completeness. If the form is not completed 

properly, return it with completion instructions; and

(b) Sign the original and all copies of the properly completed form, assign a 

contract number, date the contract, and distribute the form as follows:

Original----Warehouse

1st copy----Licensed Warehouseman Sampler

2nd copy----Agency

3rd copy----Field Office
FGIS Directive 9180.36 September 25, 2006

Page 5

e. Licensing of the Warehouseman Sampler(s). The warehouseman sampler ma

not perform the warehouseman sampling function until a license has been issued 

or during any period of suspension. Warehouseman samplers are not considered 

official personnel, but are licensed under authority of Section 11 of the USGSA. 

A warehouseman sampler license will be issued if: (1) a USGSA application for 

license has been submitted; (2) the applicant is found to be knowledgeable, 

competent, and otherwise qualified to obtain a sample; and (3) a form FGIS-950 

has been submitted by the warehouse management and accepted by FGIS.

(1) Applying for a License.

(a) The applicant for a warehouseman sampler’s license must complete 

Form FGIS-944, “Application For License Under the United States 

Grain Standards Act as Amended and/or The Agricultural Marketing Act 

(AMA) of 1946” (attachment 2) and submit the completed form to the 

warehouse management

(b) Warehouse management must sign item 14 of FGIS-944 and forward all 

copies to the agency designated for the location.

(c) The agency manager will review the completed application for 

completeness, return to the warehouse if not completed correctly, if 

completed forward to the field office for approval.

(d) If approved, the field office manager will check the appropriate block for 

approval or dismissal, sign and date, prepare written, practical and 

sensory examinations.

(2) Training for a License

(a) The agency manager must make available in an area accessible to

all applicants, a copy of:

1 This directive;

2 The Grain Inspection Handbook, Book I, “Grain Sampling;”

3 The Mechanical Sampling Systems Handbook;

4 FGIS-9180.48, “Stowage Examination Services,”

5 The USGSA and the regulations

(b) If requested by warehouse management, the agency manager will 

instruct the prospective licensee on procedures for using a D/T sampler 

and on the duties of an official sampler. The training should consist of 

proper operation of D/T samplers and related equipment, obtaining 

samples, dividing samples, and forwarding samples to official personnel 

for inspection and certification.
FGIS Directive 9180.36 September 25, 2006

Page 6

(c) After determining that the applicant is knowledgeable, the agency 

manager will administer a written examination to the prospective sampler 

in accordance with the Licensing Handbook.

(3) Licensing

When the applicant passes the examination, the agency manager will forward 

the application for license and the examination score sheet to the field office 

manager. The field office manager will review all records and issue a license 

to the warehouse sampler and notify the warehouse management and the 

agency manager. 

If the applicant fails the examination, FGIS will provide an opportunity to be 

retested on any written, practical, or sensory examination. The FOM and/or 

agency manager (as applicable) will determine the appropriate waiting period 

before an applicant can be retested

(4) Renewing a License

(a) The Field Office Manager responsibilities.

1 Issue a termination notice to licensees at least 60 days in advance 

of the termination date;

2 Provide detailed instructions for requesting a renewal of license;

3 Provide a statement whether reexamination is required; and

4 If a reexamination is required, state the nature of and scope of the 

reexamination

5 Update the profile sheet;

6 Issue a new license; and

7 Send the updated profile sheet and license to the agency.

(b) The Official Agency Manager responsibilities.

1 Review the completed renewal notice and profile sheet;

2 Prepare and administer written exams (if applicable);

3 Complete a score sheet (if applicable); and

4 Promptly forward score sheet and renewal notice to the field office. 

(The field office must receive all material prior to the license 

termination date.)
FGIS Directive 9180.36 September 25, 2006

Page 7

5. PROCEDURES FOR WAREHOUSEMAN SAMPLERS

The warehouseman sampler will perform the following functions:

a. Before loadin

(1) Visually inspect each carrier or container for the presence of insects or other 

vermin, moisture, foreign material, residue from previous cargoes, loose 

rust, scale, sand, salt, broken glass, whitewash or cement, commercially 

objectionable foreign odor, and other conditions which could contaminate or 

otherwise lower the quality of the grain. When a carrier or container is not 

suitable for loading, withhold sampling until the carrier or container has been 

cleaned and is ready to receive grain. (Refer to FGIS Program Directive 

9180.48, “Stowage Examinations.”)

(2) Examine the D/T sampler and the SM sampler sites. (Refer to chapter 4, 

Book I, Grain Inspection Handbook, and the Mechanical Sampling Systems 

Handbook.)

(a) Ensure that the areas surrounding the D/T sampler and SM sampler are 

clean and well lighted

Caution: Be sure that the power to the D/T sampler and SM sampler has 

been turned off before examining internal mechanism.

(b) Open the D/T sampler and SM sampler inspection doors and visually 

examine the inside for blockage, unusual wear, and mechanical 

malfunction. When cargo dividers are used as an SM sampler, take apart 

and check for any blockage.

(c) Visually examine and measure the pelican of the D/T sampler for the 

correct opening width (3/4” to 7/8”). To measure the width of the pelican, 

use a go-no-go gauge, tape, or ruler. The required frequency for this 

examination is a minimum of once every 6 months.1

(d) Observe the operation of the pelican to see whether it is traversing 

smoothly from side to side without any lag or hesitation. If the D/T

sampler is air operated, check the air pressure gauges frequently during 

sampling to see if the air pressure remains constant

(e) Check the timer on the D/T sampler control panel to ensure that it is set 

for the correct time interval

(f) When applicable, verify whether the communication system is working 

properly. This system aids the sampler in verifying the identity of the 

carrier being loaded

________ 

1

 At facilities where the D/T sampler is not in use for 6 months, it does not need to be checked until the 

 sampler is to be used for official services.
FGIS Directive 9180.36 September 25, 2006

Page 8

b. During loadin

(1) Remain at the sample collection box or within sight of it at all times. This does 

not preclude performing other duties concurrently with sampling. However, 

the sampler is still responsible for sample security and for determining that the 

D/T sampler and SM sampler are operating properly.

(2) Operate the D/T sampler in accordance with the manufacturer’s instructions. 

If the D/T or SM sampler is not operating properly, the sample obtained is 

not considered representative and will not be forwarded as a warehouseman 

sample-lot inspection

c. After loadin

(1) Complete an original and one copy of the sampling report (attachment 3) for 

each official sample or groups of samples. The original of the report will 

accompany the sample(s), and the copy given to the warehouse.

(2) When the SM sampler does not reduce the initial sample to the appropriate 

size (approximately 2,800 grams or 3 quarts), use an approved divider to 

reduce the sample

(3) Pour the sample into a canvas bag containing a plastic bag as an insert. 

Close and secure the plastic bag. Slip the original copy of the sampling report 

or other identification between the plastic bag insert and the canvas bag. 

Close and secure the canvas bag. When samples are hand-carried to the

agency, a plastic bag with the identification attached to the outside may be 

used

(4) When more than three samples are being mailed to the agency, place the 

samples, packaged as described in item (3), into a mailing bag and attach a 

mailing tag or label. When a sampling report is used to show the identification 

of more than one carrier or container, each sample must have identification as 

to the carrier or container it represents

(5) Maintain and protect the sample(s) from manipulation, substitution, or from 

conditions which could affect the representativeness of the sample. Retain 

official sample(s) in your possession (or in a security cabinet or lock box if 

applicable) until the loading of all of the carriers or containers is completed or 

until there is a break in loading. Then forward the samples to the agency.

(6) Return the excess grain to the carrier or the elevator. Portions of grain 

samples may be provided to the elevator. Such portions may be obtained 

from any excess grain remaining after the official 2,800-gram sample.
FGIS Directive 9180.36 September 25, 2006

Page 9

Note: Warehouse management will be responsible for supervising 

the day-to-day activities of a licensed warehouseman sampler. When 

the samples obtained by a licensed sampler are found to be not 

representative, warehouse management shall notify the agency. The 

agency manager will make the determination whether the samples are 

representative. If the samples are found to be not representative, the 

agency manager will notify the field office manager immediately.

6. CERTIFICATING INSPECTION RESULTS

In accordance with the request on the sampling report, the results of each 

warehouseman’s sample-lot inspection will be certificated by official personnel on FGIS913, “Official Certificate Warehouseman’s Sample-Lot Inspection.”

7. REVIEWS

The agency manager will make a minimum of two reviews per year at each location

where a licensed warehouseman sampler is stationed. (Locations that have a very low

volume of service or are seasonal may, at the agency manager’s discretion, be 

reviewed only once a year.) During each visit, the agency manager will check the 

D/T sampler and other sampling equipment to determine that it is in proper working 

condition. The agency manager will also determine if the procedures found in this 

directive are being followed

After conducting the review, a report summarizing the findings of the review shall be

included in the agency supervision log.

8. FEES AND CHARGES

a. Agency. Each agency manager will make the agency’s schedule of fees and

charges available to the warehouse management upon request. The agency 

manager may assess fees and charges for the following services:

(1) Testing sampling equipment;

(2) Instructing warehouseman samplers;

(3) Examining prospective warehouseman samplers;

(4) Inspecting warehouseman’s samples (including expenses incurred, if any, for 

special telephone or electronic reports) and certificating the results; and

(5) Reviews.

b. FGIS. If no agency is available, the field office manager will assess the appropriate

fees in accordance with the FGIS fee schedule

Attachments
FGIS Directive 9180.36 September 25, 2006

Page 10

ATTACHMENT 1

Form FGIS-950. “WAREHOUSEMAN’S SAMPLE-LOT INSPECTION SERVICE CONTRACT”

FORM APPROVED OMB NO. 0580-0013): 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 OMB control number for this information collection is 0580-0013. The time required to complete this

information collection is estimated to average 5 minutes per response and 1 minute of recordkeeping, 

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

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

Warehouse Sample Contract No. Date

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

FEDERAL GRAIN INSPECTION SERVICE

Warehouseman’s Sample-Lot Inspection Service Contract Authority

United States Grain Standards Act, as amended (7 U.S.C. 71 et. seq.) and the regulations thereunder (7 CFR 800-810).

Description of Service

The warehouseman’s sample-lot inspection service consists of (1) the official sampling of an identified 

lot of grain by a licensed employee of a grain elevator or warehouse using an approved diverter-type 

mechanical sampler; (2) the submitting of the sample and a completed sampling ticket by or for the 

applicant to an agency; (3) the inspection of the grain in the sample by official inspection personnel for 

official grade or for official factor, or for official criteria, or any combination thereof, in accordance with 

the regulations, the instructions, and the request for inspection; and (4) issuance by official inspection 

personnel of an official inspection certificate in accordance with regulations and instructions under the U.S. 

Grain Standards Act, as amended (Act), all pursuant to the terms of this contract.

Participants

FGIS – The Federal Grain Inspection Service of the Grain Inspection, Packers and Stockyards 

Administration, U.S. Department of Agriculture.

Agency – Any State or local government agency or person designated by the Administrator to conduct 

official inspection under the Act.

Warehouse – An operator of a grain warehouse or elevator who participates in the warehouse sample-lot 

inspection service under this contract

Warehouseman Sampler – An employee of a contract warehouse licensed under the Act to obtain official 

samples and to submit them to an agency for official inspection under this contract. NOTE: A licensed 

warehouseman sampler, when performing the services for which he is licensed, shall operate under the 

direction and supervision of the contract warehouse

Form FGIS-950 (7-04) (Previous edition of Form FGIS-950 (8-90) may be used.
FGIS Directive 9180.36 September 25, 2006

Page 11

Responsibilities

In carrying out their responsibilities, the parties agree as follows:

A. The FGIS will:

1. Supply each agency with instructional material and warehouseman’s sample-lot inspection 

service contract forms

2. Review contract forms for completenes

3. License qualified warehouseman samplers.

4. Monitor the agency with respect to its assigned duties and responsibilities under this contract.

5. Assume the agency’s functions and responsibilities in areas where field offices provide original 

inspection services

B. The Agency will:

1. Provide specific inspection services in accordance with the provisions of the Act and the 

regulations and instructions, thereunder that relate to the warehouseman’s sample-lot 

inspection service. (See section 8 and 11 of the Act, sections 800.75(c), 800.161, 800.171, 

800.174(a) (2), 800.185, and 800.186 of the regulations, and FGIS Directive 9180.36.)

2. Provide such personnel, equipment and resources as may be needed for the conduct of the 

warehouseman’s sample-lot inspection service and maintain such records as FGIS may 

require. (See regulation 800.155(b).)

3. Handle requests for service under the program without delay and without discrimination. 

(See regulation 800.155(b).)

4. Upon request of an applicant, test the diverter-type mechanical sampling equipment for use in 

obtaining official samples under this contract.

5. Instruct each warehouseman sampler how to (a) obtain representative samples by using 

approved diverter-type mechanical samplers and (b) complete the sampling ticket.

6. Furnish instructional material and sampling tickets and, upon request of the warehouse, furnish 

shipping materials for use by warehouse samplers.

7. Recommend approval or denial of application for license

8. Promptly certificate the results of inspections for warehouseman samples and, when requested

promptly furnish such information by telephone, facsimile or electronically (email). (A

“Submitted Sample” certificate shall be issued if the sample is not received in accordance with 

section 5, Procedures for Warehouseman Samplers, FGIS Directive 9180.36.)

9. Schedule and perform a minimum of two review visits per year to each sampling site to 

determine whether the diverter-type mechanical sampler is operating in an approved manner. 

Make a written report summarizing the results of the review and make the reports available to 

the field office upon request.

10. Bill the warehouse (in accordance with published schedule of fees and charges) for services 

performed under items 4, 5, 6, 8, and 9.
FGIS Directive 9180.36 September 25, 2006

Page 12

C. The Warehouse will:

1. Install a diverter-type mechanical sampler (including a secondary sampler with an approved 

divider where needed to reduce the initial samples to representative portions of approximately 

2,800 grams) for use in obtaining official samples under this contract; arrange with the agency 

for testing the sampling equipment; and, after approval assume responsibility for maintaining 

the authorized diverter-type mechanical sampler for use by licensed warehouse samplers in 

obtaining official samples under this contract.

2. Promptly notify the agency of changes or proposed changes (including significant repairs or 

alterations) in the mechanical sampling equipment or in the operation at the elevator or 

warehouse which could affect the flow of grain to or through the mechanical sampling equipment.

3. Provide for handling samples as submitted samples in the event the samples are not obtained

in accordance with section 5, Procedures for Warehouseman Samples, FGIS Directive 9180.36.

4. Arrange with the agency and the field office for instructing and licensing of sampler-employee(s

 to obtain official samples under this contract.

5. Provide for and permit only competent licensed samplers employed by him/her to obtain, handle

and prepare official samples for submission to the agency.

6. Assume responsibility for his/her licensed sampler and provides adequate supervision to 

ensure that the licensed sampler performs his/her duties properly.

7. Obtain from the agency suitable plastic lined canvas mailing bags (as prescribed in section 5, 

Procedures for Warehouseman Samplers, FGIS Directive 9180.36) for submitting samples to 

the agency.

8. Remit prompt payment of the fees and charges to the agency.

9. Load grain, under this contract, only into those carriers or containers which have been examine

immediately before loading and found to be substantially clean, dry, free of insect infestation, 

and other conditions that could contaminate or otherwise lower the quality of the grain.

10. Have general responsibility for making the service effective and efficient.

D. The Sampler will:

1. Perform official sampling services for only the designated warehouse and at only those locations

where an authorized diverter-type mechanical sampler is available for use.

2. Obtain and handle each official sample in accordance with section 5, Procedures for 

Warehouseman Samplers, FGIS Directive 9180.36. (If the sample is not obtained in 

accordance with section 5, Procedures for Warehouseman Samplers, it may be forwarded to 

the agency as a “submitted sample.”)

3. Permit only licensed samplers to assist in obtaining and handling official samples and preparing

official samples for submission to the agency.

4. Prepare an original and one copy of a prescribed “sampling ticket” for each official sample 

obtained under this contract and distribute the report as follows: Original: To accompany the 

sample. First copy: To the warehouse.
FGIS Directive 9180.36 September 25, 2006

Page 13

Termination

This contract may be terminated by any of the signatories upon notice in writing. The undersign accept the terms and 

provisions set forth above. Service under this contract shall commence on , 20 , and shall

continue until terminated by one or more of the signatories.

Sampler

See Instructions

Name and Mailing Address of Sampler Signature Date

Warehouse

See Instructions

Name, Location & Mailing Address of Warehouse Name of Warehouse Representative Title

Signature Date

Agency

See Instructions

Name and Mailing Address of Agency Name of Agency Official Title

Signature Date

FGIS

See Instructions

Name and Mailing Address of Field Office Name of Field Office Representative Title

Signature Date

Form FGIS-950 (Reverse) Previous editions may be used.
FGIS Directive 9180.36 September 25, 2006

Page 14

ATTACHMENT 2

FORM FGIS - 944, “APPLICATION FOR LICENSE UNDER THE USGSA/AGRICULTURAL MARKETING ACT OF 1946”

The following declaration is made pursuant to Public Law 93-579 (Privacy Act of 1974), solicitation of personal information. FGIS program Systems 

of Records includes History Records for Licensed Nonfederal Employees. Statutory authority to collect personal information is contained in 7 U.S.C. 

et seq. Pursuant to Executive Order 9397 of November 22, 1943, disclosure of your social security number is necessary to provide requested 

information. The principal purpose for the collection of this data is the enforcement of the United Grain Standards Act and the Agriculture Marketing 

Act of 1943. The routine use of this information is to evaluate acceptability of applicant and to evaluate/resolve possible conflicts of interest. The 

information may be referred to states or other federal agencies for purposes relating to verification of employment or required records or reports. 

Information also may be referred to the Department of Justice or to other investigative and law enforcement agencies for investigation, prosecution 

and/or administrative action resulting from violation of law, rule, regulation, instruction, or order, or to a Congressional Office in response to a 

constituent’s request for release of his/her record. FORM FGIS-944 (OCT03) previous edition obsolete. This form replaces Form FGIS-943 which is 

obsolete
FGIS Directive 9180.36 September 25, 2006

Page 15

INSTRUCTIONS FOR COMPLETING FORM FGIS-944,

“APPLICATION/LICENSE UNDER THE USGSA”

(Warehouseman Samplers Only)

1. Enter name (last, first, and middle initial).

2. Enter birth date (month, day, year).

3. Enter social security number.

4. Enter the applicant’s mailing addres

5. Enter the warehouse addres

6. Not applicabl

7. Not applicabl

8. Check applicable block.

9. Check applicable block.

10. Check “Warehouseman sampler” block.

11. Check the applicable blocks to answer the questions.

12. Applicant should read thoroughly and understand before signing.

13. Enter the date the application was signe

14. The warehouse management should read thoroughly and understand before signing

15. Enter the title of the person signing block 13.

16. Enter the date the application was signe

17. The FOM or field office representative shall approve or dismiss the application, 

enter their name or sign, list title and enter the date they signed the application.
FGIS Directive 9180.36 September 25, 2006

Page 16

ATTACHMENT 3

SAMPLING REPORT (APPLICATION FOR INSPECTION)
FGIS Directive 9180.36 September 25, 2006

Page 17

INSTRUCTIONS FOR COMPLETING SAMPLING REPORT FORM

1. Enter the name of the agency to whom the sample is submitted for inspection.

2. Enter the location of the agency.

3. Check applicable box. If request is for “factor,” specify which factors are requested.

4. Check the type of movement.

5. Check the type of inspection requested.

6. Enter the approximate quantity in terms of carlot, trucklot, trailerlot, part-carlot, 

part-trailerlot, or pounds.

7. Enter “D/T sampler.” If a D/T sampler was not used or the D/T sampler malfunctioned

write “SUBMITTED SAMPLE” in BOLD letters diagonally across the face of the 

Sampling Report Form

8. Record the date the sampling was complete

9. Enter the location of the grain at the time of samplin

10. Identify the carrier, container, or sample as follows:

Railcar - Initials and numbers. Compartmented cars shall be further identified as 

“Covered Hopper,” or “Open Top Hopper.”

Trucks and Trailers - License number of carrier and name of State

Other - Name of carrier, container, or storage facility and identifying name or number.

NOTE: One sampling report may be used to show the identity of more than 

one carrier or container under the following conditions:

• The grain being loaded into the carrier(s) or container(s) is sampled the same 

day by the same sampler under the same contract,

• Item (10) of the sampling report form shows the wording “See reverse side” on 

all copies of the sampling report, and 

• Each sample clearly shows the identification of the carrier or container which it 

represents

11. Enter name of warehouseman sampler (print or type).

12. Record the contract number assigned to the warehouse and the warehouseman

sample

13. The warehouseman sampler signs and date

14. Enter the complete firm name and mailing address for assessing the applicable 

fee(s) and charge(s).

15. Enter name of warehouse, manager’s signature, title, and date.