COC-5 Olives Rept. of Limited, Undersized, and Cull Olives

Form COC-5
04-01

OMS#, 0581-0178

REPORTOF LIMITEDAND UNDERSIZE
AND CULL OLIVES
INSPECTIONAND DISPOSITION
CROPYEAR:
PAGENO. ~--(4) Consignedto:

( 1) To: CALIFORNIA
OLIVECOMMITTEE
1903 N Fine #102, Fresno CA 93727

'

(2) From:

(3) EIN #:
(5)

REQUESTFOR INSPECTION:

Number
Containers
(a)

Type
Containers
(b)

Variety

LIMITED
Net Weight

(c)

(d)

UNDERSIZE
Net Weight

CULLS
Net Weight
(f)

(e)

Whole/
Pitted

OUTLET

(g)

(h)

Handler or
Inspection Service
(I)

FOR COC USE ONL Y
(6) CERTIFICATION
AND SIGNATURE:The undersigned, on behalf of the reporting handler, certifies to the CalfiornlaOlive Committee and the Secretary Of Agriculture

of theUnitGd
~tilt;~i (1) thit thi~rcpres,ents a complete and accurate report of limited and undersize and cull olives presented for Inspection and d~positio!1: (2)
that such olives are to be used by the consignee listed above and for the purpose reported.

Authorized

Official

Title

Date

(7) INSPECTIONVERIFICATION: The olives Inspected conform to the information listed above.

Inspector

Date

INSTRUCTIONS FOR COMPLETING FORM COC-5
GENERAL:

Use this form for reporting all Limited and Undersize and
Cull olives to be inspected for disposition in satisfaction of
requirements imposed by the Order and the Committee's
Rules and Regulations.
This report will be used by the COC to credit your account
against your obligation of Limited and Undersize and Cull
olives.
Each COC-5 is to be numbered consecutively from the
beginning of each new crop year.

ITEM (2):

Name and address of reporting handler.

ITEM (3):

Handler's EIN (Employer Identification

ITEM (4):

Name and address of consignee (Another
handler, oil processor, etc.)

ITEM (5):

Complete each column in accordance with headings:

Number).

(a) Total number of containers
( b) Type of containers (boxes, bins)
(c) List variety of olive, one variety to a line.
(d) (e) (f) LIST NET WEIGHT UNDER LIMITED, UNDERSIZE OR
CULLS, AS APPLICABLE (Use columns for weights only.)
Net weight may either be actual net weight or may be
estimated net weight. If estimated net weights are used,
show "Est" after the estimated weight.
CO-MINGLED LOTS OF LIMITED AND UNDERSIZE A NO CULL
CULL OLIVES WILL NOT SATISFY OBUGATION.
(g) Show whether Whole (W) or Pitted (P) weights are
reported. We will allow 1.3333% Pit Allowance.
(h) List outlet (Green, Sicilian, Oil, etc.)
(Q To be used by Handler or Inspection Service for notation
of Count per Pound, Whole, Green Fruit, etc.
ITEM (6):

Certification and Signature.

ITEM (7):

Inspection may be made by an inspector of either
Inspection Service.

This information is used to verify the provisions of the order, 7 CFR 932.15 1 making any
false statements or representations in any matter within the jurisdiction of any agency of
the United States, knowing it to false, is a violation of Title 18 Section 1001, United States
Code, which provides for penalty of a fine of $10,000 or imprisonment of not more than
five years or both.

Note: The followingstatements are made in accordance with the PrivacyAct of 1974 (5 U.S.C. 5518) and the Paperwork Reduction
Act of 1995. The authority for requesting this informationto be suppliedon this form is the AgriculturalMarketing Agreement Act of
1937, Secs. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested informationis necessary for the
administrationof the marketing order program.
Accordingto the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to
a collectionof information unless it displaysa validOMB control number. The validOMB control number for this information
collection is 0581-0178. The time required to complete this information collectionis estimatedto average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintainingthe data needed, and
completingand reviewing the collectionof information.
The U.S. Department of Agriculture (USDA) prohibits discriminationin all its programs and activitieson the basis of race, color,
national origin, age, disability,and where applicable,sex, marital status, familialstatus, parental status, religion, sexual orientation,
genetic information,politicalbeliefs, reprisal,or because all or part of an individual's income is derivedfrom any public assistance
program (Not all prohibitedbases applyto all programs.) Persons with disabilitieswho require alternativemeans 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 CivilRights, 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.