FR-19 CA Raisins--Raisins Produced from Grapes Grown outside o

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FR-19
Revised 12/06

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HANDLER'S NON-CALIFORNIA RAISIN CERTIFICATION
RAISIN ADMINISTRATIVE COMMITTEE
P.O. Box 5217
Fresno, CA 93755-5217

This is to certify that this lot or partial lot identified by scale tag no.
received from
NON-CALIFORNIARAISINS.

Office of Management

and Budget

Control Number 0581-0178

Dehydrator after reconditioning are

This lot of raisins was originally received and identified as Non-Califomia Raisins at my location by the USDA
Inspection service. RAC Non-Califomia Pallet Control Cards were attached to the bins on

. The

pallet control

card numbers

are listed below.

The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States,
knowing it to be false, is a violation of Title 18, Section 1001, UnitedStates Code, whichprovides fora penalty of a fine of $10,000
or imprisonment of not more than five years, or both.

Signature:
Plant President/Manager

Plant:
Date:

PALLET CONTROL CARD NUMBERS:

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 0581-0178. The time required to complete this information collection is estimated to
average 5 minutes per response, including the 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
ftom any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative 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 of discrimination, write to
USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an
equal opportunity provider and employer.