Milk Tank Truck Inspection Form - Alabama

This Alabama-specific "Milk Tank Truck Inspection Form" is a document released by the Alabama Department of Public Health.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Permit No.
ALABAMA DEPARTMENT OF PUBLIC HEALTH
Tanker
MILK TANK TRUCK INSPECTION FORM
Owner:________________________________ Address:__________________________________________________
Driver:_________________________________ Address:__________________________________________________
Inspection Location:
Date:
Time:
AM
PM
Receiving Plant:
Tank Serial #:________________________
State Issuing Permit #:
To the Driver or Owner: An official inspection of the above named bulk milk tanker has been made this day and you
are respectfully notified of such violations of the “Rules of State Board of Health, Bureau of Environmental Services,
Division of Food, Milk, and Lodging governing the Production, Processing, Handling or Distribution of Milk,
Milk Products and Frozen Desserts” as indicated by an “X” in the inspection report. This report, if any items are marked,
constitutes a written notice to comply with Section 6 of the aforesaid regulations.
Compliance
Non-Compliance
NA
1. SAMPLES AND SAMPLING EQUIPMENT
(PMO APPENDIX B)
A. Storage of sample containers
B. Sample box in good repair, clean
C. Sample transfer instrument
D. Sampling transfer instrument container
E. Sample storage
F. Sample storage compartments
G. Samples 32 - 40 degrees, control temperature
H. Approved thermometer available
2. PRODUCT TEMPERATURE 45 DEGREES OR LESS.
(PMO Sec. 7, items 18r and 17p)
A. Temperature of product in tank
B. Product in external fluid transfer systems that
exceeds 45 degrees F is discarded
3. EQUIPMENT CONSTRUCTION, CLEANING, SANITIZING
AND REPAIR
(PMO Sec. 7, items 10p and 11p)
A. Dome lid assembly
B. Gasket(s)
C. Vent(s)
D. Pump(s)
E. Hose(s)
F. Hose connection(s)
G. Hose(s) more than 8 feet in length mechanically cleaned
H. Valve(s)
I. Protection from contamination
J. Interior condition of tank
K. Other______________________________________
4. EXTERIOR CONDITION OF TANK
(PMO Appendix B)
5. WASH & SANITIZE RECORD
(PMO Sec 7, item 12p)
A. Is wash/sanitize recording chart available?
B. Is wash/sanitize tag available?
I. Recording chart available for cross-reference?
II. Attached to tanker?
III. Date of last wash/sanitize (PMO Appendix B)
IV. Properly completed (PMO Appendix B)
6. LOCATION OF LAST CLEANING
7. LABELING
8. VEHICLE & MILK TANK TRUCK PROPERLY IDENTIFIED
9. PREVIOUS INSPECTION SHEET AVAILABLE
10. SAMPLE CHAIN OF CUSTODY
REMARKS:____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Inspector_________________________________________________
ADPH-FML-248B.03.13.ch
Permit No.
ALABAMA DEPARTMENT OF PUBLIC HEALTH
Tanker
MILK TANK TRUCK INSPECTION FORM
Owner:________________________________ Address:__________________________________________________
Driver:_________________________________ Address:__________________________________________________
Inspection Location:
Date:
Time:
AM
PM
Receiving Plant:
Tank Serial #:________________________
State Issuing Permit #:
To the Driver or Owner: An official inspection of the above named bulk milk tanker has been made this day and you
are respectfully notified of such violations of the “Rules of State Board of Health, Bureau of Environmental Services,
Division of Food, Milk, and Lodging governing the Production, Processing, Handling or Distribution of Milk,
Milk Products and Frozen Desserts” as indicated by an “X” in the inspection report. This report, if any items are marked,
constitutes a written notice to comply with Section 6 of the aforesaid regulations.
Compliance
Non-Compliance
NA
1. SAMPLES AND SAMPLING EQUIPMENT
(PMO APPENDIX B)
A. Storage of sample containers
B. Sample box in good repair, clean
C. Sample transfer instrument
D. Sampling transfer instrument container
E. Sample storage
F. Sample storage compartments
G. Samples 32 - 40 degrees, control temperature
H. Approved thermometer available
2. PRODUCT TEMPERATURE 45 DEGREES OR LESS.
(PMO Sec. 7, items 18r and 17p)
A. Temperature of product in tank
B. Product in external fluid transfer systems that
exceeds 45 degrees F is discarded
3. EQUIPMENT CONSTRUCTION, CLEANING, SANITIZING
AND REPAIR
(PMO Sec. 7, items 10p and 11p)
A. Dome lid assembly
B. Gasket(s)
C. Vent(s)
D. Pump(s)
E. Hose(s)
F. Hose connection(s)
G. Hose(s) more than 8 feet in length mechanically cleaned
H. Valve(s)
I. Protection from contamination
J. Interior condition of tank
K. Other______________________________________
4. EXTERIOR CONDITION OF TANK
(PMO Appendix B)
5. WASH & SANITIZE RECORD
(PMO Sec 7, item 12p)
A. Is wash/sanitize recording chart available?
B. Is wash/sanitize tag available?
I. Recording chart available for cross-reference?
II. Attached to tanker?
III. Date of last wash/sanitize (PMO Appendix B)
IV. Properly completed (PMO Appendix B)
6. LOCATION OF LAST CLEANING
7. LABELING
8. VEHICLE & MILK TANK TRUCK PROPERLY IDENTIFIED
9. PREVIOUS INSPECTION SHEET AVAILABLE
10. SAMPLE CHAIN OF CUSTODY
REMARKS:____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Inspector_________________________________________________
ADPH-FML-248B.03.13.ch

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