CDAC SP-1 CA Dates--Delivery Manifest

CDAP Form SP-1

Phone (760) 347-4610
\

OMS No. 0581.0178

CAUFORNIA

DATE ADMINISTRATIVE

0497

COMMITTEE

P.O. ~x 1736
INDIO, CA 92202-1736

~

DELIVERY MANIFEST
GROWERS and HANDLERS:
1.Account .
2.lacatIonoflo8dlng:
3. Iffteld SUrplus,Ioca~

of garden where grOwn:

4. Garden owned by:

.CONTAINERS

5. loading:

TYPE

I

ESTIMATED NET WEIGHT
THIS LdAD

DUMPED

.

NUMBER

.8. By:
DRIVER:
1. Name of canter:
2. Ucense No.

T....

TNCk
3. If .sUrplus dumped InIDbins, how m8l'lYbins 10this loading:

The SUrplus Dates described herein subject to adjustment of weight In accordance

with the weighmaster's

certlflcIate

were received

on

behalfof:
. Ddvets.Slgnature

._. ~__..
INSTRUCTIONS

DRIVER:

.

GROWERS and ~DLERS:

.

1. Request the person In charge of this loading to complete the Th~ DUPUCAT.E (yellow) copy 18your record of SUrplusDates
deUveredtottie Date AdinlnlstratlveCommItt8e.The CommIIt8e
"Growersand Hand
secdon.
.
2. You c:ompIe. the .DrIver" seeIIon.
wOI mal you a receipt coveringthis load shawlngthe net
3. Give the DUPUCATE (yellow) and the TRIPUCATE (pInk) copies
poundage you have delivered'" certified by a publlcwefghmaato the person In charge of the loading.
to public welghmaster's scale, weIgh the load, and attach
two copies of the welghmastBf'a C8t1IfIcate to the ORIGINAL (white)
cqpy and give to the Dat8 Administrative Committee.
5. Reta1r8QUADRUPUCATE (gold) copy for your use. .

4. ProCeed

tar. If you do not receIVe the receipt within 7 days. notify the
Committee. The TRIPUCA,TE (pink) copy Is an extra CDfIYfor
your fUeL

Aa:onIlng to the PapelWOl'k Reduction Ad of 1995, an agenc:y may not conduct or sponsor, and a person Is not required to respond to a collection of Infonnatlon unless it displays
a vaDd OMS control number. The valid OMS control number for this Information collection Is 0581-0178. The time required to complete this Infonnatlon 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.
lbe U.S. Department
of Agrlallture (USDA)prohibits dlsa'lmlnatlonInall Its programs and adivitles 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 belief's, reprisal, or because all or part of an IndMduars 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, etx:.) should contact USDA'sTARGET Center at (202) 720-2600 (voice and 100). To file a complaint of dlsa'lmlnatlon, write to USDA.
Director, OffIce of Ovll Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDAIs an equal
opportunity provider and employer.