ACP-3 Failed Lot Disposition and Rework Report

Administrative Committee for Pistachios OMB No. 0581-0215

1318 E. Shaw Avenue, Suite 420

Fresno, CA 93710-7912

Ph (559) 221-8294 Fax (559) 221-8044

Email: [email protected]

ACP Form 3 - Failed Lot Disposition and Rework Report

Section A: Complete and submit the following information for the failed lot within 10 days after rework is completed. Send original to the ACP office and retain a copy for your records. If rework is not selected as a remedy, submit the failed lot disposition within 10 days to the ACP office.

L ot description: Lot Id marks:

W eight: Lbs. Container size/description:

H andler of the product:

A ddress: City: State: Zip code:

M aximum Aflatoxin: pass / fail Cert #: Date:

M inimum Quality: pass / fail Cert #: Date:

I s this an inshell lot and has it failed aflatoxin more than once? (yes/no)

Note: Inshell lots can be reworked only once for aflatoxin. Upon second rejection they must be shelled, sold as export, or sold for non-human consumption.

Section B: Complete the applicable sections based on product disposition.

B 1. Non-Human Consumption: Pounds shipped: BL #:

P roduct Shipped To: Phone #:

A ddress: City: State: Zip code:

D escription of use:

B 2. Export: Pounds shipped: BL #:

C ustomer: Country:

A ddress:

B 3. Rework: Total Pounds: Accepted: Rejected:

L ocation of rework:

A ddress: City: State: Zip code:

D escription of rework process:

B3 Continued:

N ew lot description: New lot ID:

N ew container / size description:

I f reworked for Minimum Quality did lot pass retest? (yes/no): Cert #:

I f reworked for aflatoxin, did the lot pass retest? (yes/no): Cert #:

A flatoxin Results: Sample 1: Sample 2: Sample 3:

A verage: Samples 1 & 2: Samples 1, 2 & 3:

B 4. Shelled: Pounds shelled:

L ocation of sheller:

A ddress: City: State: Zip code:

H andler Signature: Date:

N ame: Title:

The making of any false statements 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, United States Code, which provides for a penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more than five years, or both.

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 0581-0215. The time required to complete this information collection is estimated to average 12 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 from 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. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.

ACP-3 (Rev. 5/06) Page 2 of 2