WMB 24-05 (NRY) CA Walnuts Application for Approved User of Substandard

OMB NO. 0581.0178
.. ,-'''~MBFORM#24-05
o:{Non-ReserveYear)

Walnut ..arketlng Board
1540 RIver Park Drive, Suite 203

Sacramento CA 95815-4609

"

Ph (918) 922-5888 Fax (918) 923-2548

APPLICATION TO BE AN APPROVED USER OF
SUBSTANDARD WALNUTS
This application to be an approved user of substandard walnuts Is submitted In compliance with the requirements of the Federal
Marketing Order No. 984, as amended. Inexecuting this form,the Substandard User respectively certifiesto the Walnut MarketIng
Board and tathe U.S. Deparbnent of Agricultureas to the correctness and completeness of"theirstatement

Instructions: 1.
2.
3.

Allsubstandard users ~mustcomplete the application to be an approved user.
Maneda signed originalto the WalnutMarketingBoard(WMB) office.
The application willbe reviewed by the WMB. If approved, your company wDlbe sent a
confirmation and listed as an Approved Substandard User.

Application is hereby made for designationas an approved user of substandard walnuts withthe
privilege of receiving substandard walnuts for such use, or uses, as designed below, as provided in

Section 984.464 of MarketingOrder No.984, as amended.
crush for walnut "oil

"

~"

manufacture livestock feed
feeding directly to livestock
In consideration of the granting of this approval, the undersigned agrees to:
(1)
(2)

Use such substandard walnuts as received for no other purpose than as designated above.
Store and manufacture such ~ubstandard walnuts as received only at the location or

locationsspecified.
(3)
(4)

(5)

"

Pennit inspection of such Storage and manufacturing facilities and of substandard walnuts
received and held and examination of books and records covering the walnut transactions
by the Walnut Marketing Board and the U.S. Department of Agriculture.
Keep written records of receipts which willshow the names and addresses of pe"rsonsfrom
whom walnuts were acquired and make such records, available for examination by
authorized representatives of the Wall1ut Marketing Board and the U.S~ Department of
Agriculture during regular business hours, for the period of two years after the end of the
marketing year in which the recorded transactions were completed.
Agree to negotiate with the handler a fair price for all substandard material received.

Manufacturing operations are conducted-at

Prior to disposition, substandard walnuts willbe stored at

"

Our daily ma>dmummanufacturing capacity of substandard walnuts is:

.

.

I hereby certify that substandard walnuts received will only be used for the use designated above
and will not be disposed of in any other form.

Date:

By:
Title:

Firm Name:

"

Address:

Phone No.

Fax No.

Application is hereby approved. subject to revocation for cause:
WALNUT MARKETING BOARD

By:

Date:

Title:

The making of any false statements or representations In any matter within the Jurisdiction of any agency of the United
States, knowing Itto be false, Is a violation of TItle 18, Section 1001. United Stat&sCode. which provides forthe penalty of a
fine of $250.000 for Individuals and $500.000 for organizations or Imprisonment of not more than 5 years. or both. No
walnut handlershall dispose of substandard walnuts .untilthis application has been received and approved by the Walnut
Marketing Board (7CFR984.64 and 7CFR984.464).
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 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,
]400 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.