Scale Installation Permit Application - Mississippi Department Of Agriculture And Commerce Page 2
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2Scale test and calibration information (if different from applicant)
Name and address of Licensed Scale Service Repair Company or Service Repairman retained for scale test
Name
Address
Current Mississippi Scale Service Repair #
Test Weight Calibration Certificate #
Certified laboratory which issued calibration certificate
I understand that 1) only a scale service-repair company or scale service-repairman licensed by the Weights and
Measures Division, Mississippi Department of Agriculture and Commerce may test and calibrate a scale following
installation: 2) scale installation and testing must meet applicable requirements of NIST Handbook 44, and
Mississippi Weights and Measures Laws and Regulations; and 3) scale and scale foundation blueprints and
specifications must be supplied to the Director of Weights and Measures.
The undersigned applicant hereby certifies that all statements and information contained herein and schedules
attached hereto are true and correct.
This the
day of
,
.
Signature of Applicant
Title
NOTE; A Check or money order in the amount of fifty dollars ($50.00) payable to the Mississippi Department of
Agriculture and Commerce and scale and scale foundation blueprints and specifications must accompany this application.
(OFFICE USE ONLY)
Check Number
Amount Received
.
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