WA-308 Warehouse Operator's Statement and Examiner's Comparison

Form Approved - OMB No. 0560-0120
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

WA-308
(11-01-04)

WAREHOUSE OPERATOR'S STATEMENT AND EXAMINER'S COMPARISON
OF OBLIGATIONS AND STOCKS
NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for
requesting the following information is 7 U.S.C. 242 and 7 CFR Parts 735 and 1421-5554. Furnishing the requested information is required in order to determine
continuing eligibility for a warehouse license and/or a CCC storage agreement. This information will not be disclosed outside of the U.S. Department of Agriculture except
as required by law to the Department of Justice and the Department of Treasury. This information may be provided to other agencies, IRS, Department of Justice, or other
State and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including
18 U.S.C. 286, 287, 371, 641, 651, 1001; 15 U.S.C. 3729, may be applicable to the information provided.
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 0560-0120. The time required to complete this information is
estimated to average 15 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. RETURN THIS COMPLETED FORM TO KANSAS CITY COMMODITY OFFICE, P.O. BOX 419205, KANSAS
CITY, MO 64141-6205.
1. DATE AND HOUR OF CUT-OFF

A.M.

AND/OR CODE NO.

P.M. 2. LICENSE NO.

3. NAME OF WAREHOUSE

4. LOCATION OF WAREHOUSE (City and State)

5. NAME OF WAREHOUSE OPERATOR:

6. WAREHOUSE OPERATOR'S STATEMENT OF TOTAL STOCKS AND OBLIGATIONS FOR THIS WAREHOUSE:
KIND/CLASS OF GRAIN
Lbs.

Lbs.

A. STOCKS

Bu.

Cwt.

Bu.

Lbs.
Cwt.

Bu.

Lbs.
Cwt.

Bu.

Lbs.
Cwt.

Bu.

Cwt.

(1) Stocks per company book (Last entry in DPR)

(2) Activity, if any, to measurement
cut-off, including adjustments

Inbound
Outbound

(3) Stocks at cut-off
B. OBLIGATIONS
(1) RECEIPTED OBLIGATIONS
(a) To Others
(b) To Warehouse Operator
(2) NON-RECEIPTED OBLIGATIONS
(a) To Others
(b) To Warehouse Operator
(c) Balance on CCC Loading Order
(3) TOTAL OBLIGATIONS
(4) LESS AGRICULTURAL PRODUCTS TRANSFERRED
TO OTHER WAREHOUSES FOR STORAGE
(5) TOTAL OBLIGATIONS IN THIS WAREHOUSE

YES
(6) DO YOU HAVE ANY TYPE OF AGREEMENT WITH A FIELD WAREHOUSE COMPANY?
IF "YES", HAS THIS BEEN CLEARED WITH USDA?
YES
NO (If "No" furnish copy to examiner).

NO

WAREHOUSE OPERATOR'S CERTIFICATION: I hereby certify to the U.S. Department of Agriculture and the Commodity Credit Corporation, subject to penalties of
applicable laws for knowing false representations and similar offenses (e.g., 15 U.S.C. 714m and 18 U.S.C. 1001) that the information contained in the above Warehouse
Operator's Statement is, to the best of my knowledge and belief, a true, correct and complete statement, and that I have no obligations as a warehouse operator to deliver
any agricultural product to any person as of the date and hour shown above, other than as indicated in this statement. I understand that the examination by a representative
of the U.S. Department of Agriculture in connection with which this statement is furnished and the information contained herein does not relieve me of any responsibilities
under the U.S. Warehouse Act or any Agreement I have entered into with the Commodity Credit Corporation.
(a) SIGNATURE OF WAREHOUSE OPERATOR (b) TITLE
OR AUTHORIZED AGENT

(c) DATE SIGNED
(MM-DD-YYYY)

(d) NAME OF WAREHOUSE EXAMINER
WITNESSING SIGNATURE

7. EXAMINER'S COMPARISON OF WAREHOUSE OPERATOR'S OBLIGATIONS AND INVENTORIED STOCKS:
A. MEASURED INVENTORY
B. DIFFERENCE IN ITEMS 6B (5) AND 7A
C. PERCENTAGE OF DIFFERENCE
D. RECEIPTED TO CCC DATE OF LISTING:
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability,
political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964
(voice or TDD). USDA is an equal opportunity provider and employer.

WA-308 (11-01-04)

(Page 2 of 2)

WAREHOUSE OPERATOR'S STATEMENT AND EXAMINER'S COMPARISON OF OBLIGATIONS,
INVENTORIED STOCKS, AND RELATED INFORMATION
8. CUT-OFF INFORMATION:
A. SCALE TICKETS

B. TRUCK/CAR/BARGE

In

No.

Out

No.

C. DRAFT OR CHECK

D. OTHER

In No.
Date

9. WAREHOUSE RECEIPT INFORMATION:
A.
B.
C.
D.
TYPE

OUTSTANDING
LAST
EXAMINATION

USED
SINCE
LAST
EXAMINATION

CANCELED
SINCE
LAST
EXAMINATION

E.
OUTSTANDING
THIS
EXAMINATION

Out

F.
UNUSED W/R
ON HAND LAST
EXAMINATION
From

To

(MM-DD-YYYY)

G.
USED SINCE
LAST
EXAMINATION
No.

From

To

H.
UNUSED W/R
ON HAND THIS
EXAMINATION
No.

From

To

No.

I.
WAREHOUSE
RECEIPTS
CANCELED
THROUGH
NO.

10. WAREHOUSE OPERATOR'S STATEMENT OF COMMODITIES TRANSFERRED TO OTHER WAREHOUSES FOR STORAGE (Complete Form WA-300)

A. NAME AND ADDRESS OF WAREHOUSE

B. DATE SHIPPED
(MM-DD-YYYY)

C. KIND/CLASS

D. GRADE

E. QUANTITY

11. STORAGE OBLIGATIONS NOT COVERED BY WAREHOUSE RECEIPTS FROM LISTINGS PREPARED BY WAREHOUSE OPERATOR (NOT LISTED ON
FORM WA-312 (REVERSE)).

A.
IDENTIFICATION

B.
DATE

C. KIND/GRADE OR KIND/CLASS

(

Bu.

Lbs.

Cwt.)

(MM-DD-YYYY)

12. Total Non-Receipted
Obligations
13. MINUS-Transferred to
other warehouses
14. NET TOTAL STORED
IN THIS WAREHOUSE

15A. SIGNATURE OF EXAMINER

15B. DATE SIGNED (MM-DD-YYYY)