WA-570 Inventory Adjustment Notice

Form Approved - OMB No. 0560-0120

(See Page 2 for Privacy Act and Public Burden Statements)
U.S. DEPARTMENT OF AGRICULTURE
WA-570

1. CLAIM NO.

2. CONTROL ORDER NO.

3. COMMODITY CODE

4. STORAGE START DATE

5. PROGRAM CODE

6. PROGRAM YEAR

Farm Service Agency

(02-22-06)

INVENTORY ADJUSTMENT NOTICE

UPWARD
ADJUSTMENT

ACKNOWLEDGEMENT
OF LIABILITY

REJECTION

12. NAME AND ADDRESS OF WAREHOUSE OPERATOR

(MM-DD-YYYY)

7. DOCKET CODE

SHORT
SHIPMENT

13. WAREHOUSE CODE 8. TOTAL NEW WEIGHT

10. PRICE PER POUND

9. TOTAL GROSS WEIGHT
11. TOTAL VALUE

14. WAREHOUSE LOCATION

15. IDENTITY OF ORIGINAL SHIPMENT(S) AND QUANTITY REJECTED TO YOU:
A. COMMODITY
C.
LOT NO.

B. SIZE PACKAGE
D.
INBOUND ORDER NO.

E.
ORIGINAL NO.
OF UNITS

F.
NO. UNITS
REJECTED

G.
NET LBS.

H.
SHIPPER NAME AND ADDRESS

I. REASON FOR REJECTION

Disposition of the rejected commodity must be made in accordance with all local, State, and Federal law and regulations, including the Food, Drug
and Cosmetic Act. All Government markings must be obliterated within 10 days and prior to disposition. Rejected containers shall be removed from
USDA stocks within 10 days and set apart for final disposition.

NOTE:

16. THE FOLLOWING CHECKED SHORT IN YOUR WAREHOUSE:

17. THE FOLLOWING WAS SHIPPED SHORT FROM YOUR WAREHOUSE:

A. COMMODITY

A. COMMODITY

B. UNITS

C. SIZE

18.
IF SHIPPED
SHORT,
GIVE:

A. OUTBOUND ORDER NO.

B. UNITS
C. EXPLAIN DIFFERENCE IN ORDERED AND SHIPPED QUANTITIES

B. SHIPPING DATE (MM-DD-YYYY)

D. IS UNSHIPPED QUANTITY AVAILABLE FOR
FUTURE SHIPMENT?

YES

E. IF "NO," EXPLAIN

NO
20. BY WAREHOUSE EXAMINER:

19. BY COMMODITY INSPECTOR:
A. SIGNATURE

21.

C. SIZE

B. DATE (MM-DD-YYYY) A. SIGNATURE

A. Receipt of rejected items and liability for
loss and/or damage are hereby acknowledged

22A. SIGNATURE

B. DATE (MM-DD-YYYY)

B. I certify that the commodity was shipped short as
indicated above
22B. TITLE

WAREHOUSE OPERATOR

22C. DATE (MM-DD-YYYY)

WA-570

(Page 2) (02-22-06)

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. 7 CFR Part 1423.4 authorizes the collection of the following data. This information will be used to determine eligibility of warehouses for
storing Government-owned or loan commodities. Furnishing the data is voluntary; however, without it the Commodity Credit Corporation may cancel
the applicable Storage Agreement. This information may be furnished to any agency responsible for enforcing the provisions of the contract. 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. 714m, and 31 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 collection is estimated to average 30 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, WAREHOUSE LICENSE AND EXAMINATION DIVISION.

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.