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Ex 30-ATL Bills of Lading 3

Ex 30-ATL Bills of Lading 3

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Published by Robert Sloan

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Published by: Robert Sloan on Jan 05, 2013
Copyright:Attribution Non-commercial

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04/16/2014

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The
request
forIbisirirormaliDfl
i&
voluntary.
ft
isnaededtomon~orclef""",roundInlh~
inopectian
syaIem.Hisused""FSIS10
deI...-minewhether
esI"bIis_ts
ar"in
""",pliance.
9CFR301Bnd9GFR
381.
fORM
~ffiOVEO
OMS
No.Q583.OO8.9.
CI.!B
DISClOSURE
STATEMl:NT:PubliC
reporting
bi.-d""fo<lhls
coIlAeio11'"_
Ie
_imatedIDBVCfII!!C
7
mln\l\e$
pet
reopon••
including
1M
11m"""
flWhIwinginsltu<:liMs.~Il
existinO
dalll
-.gathering
andrnainlainillolhe
daIB
needed.
IInd
compleli"ll
and
revtawilllJ
Ih9
ooI!ecl;""oIlnformalion.
Send
coll1lnenk
~nQ
IIIIIl
burden
esllrmrt" or
BIIYother
a"""",
Q/
Ihl5coIIe:tion
of
InfOITnaIIan.incluciing
GUgg8$lionsfor
rBlluclng!hi,
buldvn.
\11
Dllpal1ment
ofAgricu!l1M'e.CIMranee
Of!iaor.OIRM.
Room
404-W,WUhlll!J\on,DC
2l1l5O:
and
IIlthe
OffICe
oIlnformalicmandRg"dat2'YAffairs,
OffICE!
ofManaDemen!
and
Bu<!gel
-US
DepamncmofAgric.IIWteTYPEOFNONCOMPL!AlIICE
FOOl)SAFETVANDINSPECTION
SERVlCE
Ij(1.__.•8-~
0
.••
L.._
n._"-.~
_.__..,__NON(:OMPLIANCERECORD._____~
rouu
wdy
::::::.~~~:~~::uou
I.DATEl.RECORDNO.l.
ES'tABUSHMENT
NO.
v6/13!2005
0028-2005-5622
-.::J.=8=-50:.:6:...::.:.M:.:/....;I:...-__....
5.
PERSONNELNOTIFIED
RayParksIMr.Gill
4.TO(NameandT;t!,,)
~YParks,Plant:~ger
6.
RELEVANTREGULATION(S)
416.4(a);
416.6.
;
7.SECfIONfPAGEOF
EST.PROCLDUREPLAN
HACCP
SSOPOTHERSSOP...__._
_
.
----_._-_._------------------------
&.ISPCODE
10.DESCRlPTION(j)FNONCOMPUANCE
On
Monday
June
13,2005while
performing
060011
observed
the
fonowing,
06001
9.
NONCOMPUANCECLASSIFICATIONINDICATORS
FACll.ITY-ProductBased
I-In
theboxstorageroomthere
were
2palletsofwaxed
patty
paperthatboxes
were
tomopenandpattypaperswere
exposed.TaggedwuhUSDAtag
#
B3145%56.
2-whilecheckingtheTVP.Spices,UnmadeboxesonastoragetrailerthatwasbackeduptotheshippingdockTheTVP
bagshadroach~droachdroppingsonbags
andseveralbagsweretom.TaggedwithUSDA.tag3
B314S96S7.
3-Also
while
cMckingthetrailerIobserved6bagof'batter
mix
thatbagshadholesinthem.1bagofAboboCr:illospice
that
badahole
init.
3bagsofpoultlysausageseason
with
holes..allofthisaffectedbags
were
dumpedintoinediblebarrels
by
plantmanagement1palletofunmadeboxeshadRoachandroachdroppingsthroughoutpallet.Theseboxes weretakendireCdytodumpsterbyplantmanagement.Mr.
Ray
ParksandMr.Gillawereverbally
notified.
11.SIGNAT1JR.£
of]
INSPECTIONPROGRAMEMPLOYEE
Miller
I'
.J
';1/
Mary
lJCT-1']
to.'-;"
/l1,d,GiA.-
rou
Q'~
h=m,yO<Mudaj'yournglulO
apJ"'i'llhlstkctno<t
lUtkliMal#d~'
3MS
mrd/Pr
~1IJ.1S
oj'9CFR-
12.PLANTMANAG~MENTRESPONSE(bnmedi<deadion(:
R
es
et""",>~
uB
tr»
c:.h
eeJ
13.PLANT
MANAGEMENTRESPONSE
(fiu1hcrplamed
action(s»:
---
--------------
._--._
.....
-
.
-------
--
-
-.-
Th••docum•••
t
UN"••
written
notiBc>tl.a
that,.oarrollure10complywItI>
rqubdDly•.•••••
t{o)__I"
additloul
rqlllatlll)•••
od",hdstr.U-
actIOI\.14.SIONA1lJR£OFPLANTMANAGEMENT
r.
./LJI:
16.VERIFICATIONSIGNATUREOFINSPECTIONPROGRAMEMPLOYEE
15.DATE
"..13-0>
17.DATE
I>lS"l'lUBtmON,~1
it
I
Copyu>
Est.abfubment.
ICopy
to
irtsp<x;U>1
Pt8cIof2
F5tsFORMS4OO.4(719B~
lteplKCSFSIS
FotmS4OO-'!(9197).
whidllYlll)'bn,oc!
until
em.ua..J
(7198)
PRIDE00352i
CONFIDENTIAL
 
SPOILAGELOG
Est-.
#
18506
~
DATEPRODUCT
LOT/CODE
AMquNT. ...CAUSEDF.UAMAGE
.DlSP9SlTIQN
sf.21f2005 iSolate
2x44
exposuretoroachesJvermln
inedible
881be.
612112005
tvp
22xSO
exposureto
roacheslvermininedible1100Ibs.
i
6/2212005
r'P
24X50
exposuretoroacheslVermin
inedible
1200
6f.22!2OO5
isjolate
2x44
exposuretoroacheslvermininedible
;
612412005
richmohdbreader
8x50
exposuretoroacheslvermininedible
400100.
I
RECAP
TOTALS
TVP
2300
LaS.exposuretoroache5/vennin
inedlbl&
ISOLATE176LBS.exposuretoroacheslY&rmin
inedible
BREADER
400LBSexposure
toroacheslYermln
inedible
QASUPERVISOR::Gill
t
AOJ'
I
PLANT
MAN;;.A,;,;;;G;.;;;;E:;.;R:;.,-_
PRIDE003387
CONFIDENTIAL
 
ATLINDUSTRIES
1125-CCAlvlBFJDGESQ.,ALPHAREliAGA30004
REMITTO:
POBOX890591CHARLOTTE,NC28289-0591
Phone:678-566-0257 Fax:678-566-3335
I
BILLTO
SHIPTO
US
PENlTENTlARY-ATL601MCDONOUGHBLVDSE ATLANTA,GA30315A1TN:ACCOUNTSPAYABLE
REP/BROKER
INVOICENUMBER
19309
DATE
8/17/2004
u.s.
PENITENTIARYATLANTAFOODSERVICEWAREHOUSE601MCDONOUGHBLVDSE ATLANTA,GA
30315
(404)635-5365
SHIPVIA
TRINITYONE
P.O.NUMBER
DJBATL4A160205
TERMS
Net30
356CS
PRODUCTRDERED
PA-lOlOI-JO-CJ-**
180/20
GRBFPAT40/4oz.
DESCRIPTIONSHIPPEDIWEIGHT
Allunpaidinvoicesshallbearinterestatanamountequalto1.5%permonthoftheoutstandingbalance commencinguponthedatepaymentisdueATLIndustries,Inc.Buyeragreestoberesponsibleforallcosts associatedwiththecollectionofpastdueinvoices.
1
35613560LBS
Total
3,417.60
PRICE
TOTAL9.60
$3,417.60

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