CDAC-10 CA Dates--Handler Application for Certain Exemptions fro

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Sendoriainalandone CODY
to:

CDAC Form #10

CaliforniaDateAdministrativeCommittee
P.o. Box 1736,lndlo CA 92202.1736

HANDLERAPPUCATIONFORCERTAINEXEMPTIONS
FROMREGULATIONS
(Section987.52 and 987.152)

approved for u.. 0118#0581.0178

NameofHandler:

0.

Address:

State:

City:
A.

~

Zip:

(checkapplicable)
Health Food, wholesaler or retailer, exemption from moisturerequirement
Hand-pltted dates. 'Candy manufacturer exemptionfromsizeregulation

_

Name of purchaser.
Purchase(s Address:

State:

CIty:

Zip:

Ibs

Estlniated annual quantity to be sold .(Octoberthrough SeptBmb."

B. SDeclaltv Packs (exemption
frompacked Inspectionand containerregulations)
Describethe container,weightof dates, wrapping

_

Willthere be pre-packing Inspection followed by sUNelllance to prevent co-mlngllngwith

Yes

otherdates?

No

Estimatedannual quantityto besold (OctoberthroughSeptember)

Ibs

-c. Sellto one Purchaser UDto 150 Dounds (exemptionfrom packed Inspection)
Will there be pre-packlng Inspection followed by surveillance to prevent co-mlngllng with other dates?

Yes

_

No

Estimated annual quantity to be sold (OctoberthroughSeptember)

Ibs

-------------------------------------------------------------------------------------In consideration of approval of this applfcatlon, the undersigned applicant agrees to sell, In the Indicated ouOetonly, dates meeting
free date grade and size (except for speclRc exemption) and at the end of each crop year, but no later than.September 30, to report to
the Committee on its form .2 the variety and quantity of dates sold under exemption.
Signature of Applicant:
Approved for crop year ending September 30,

Date:

but subject to prior revocation.

CALIFORNIADATEADMINISTRATIVE
COMMITTEE

By:

Date:

TIMmlldng of fII8e 8f8t8m.nt or IIpmentallon on thlt form, knowing IIto be fII... It I ¥lolltlon of TItle Ia.slCllon 1000. Unlltcl Silt" Cod.. which pro¥ld" for the ptnllty
of I fin. of $10,000 or ImprilOnm.nt of not mOil thin live yt
or both.
Thlll1pG1tl8rtqUf11d
byllw(7USC608(d).
7 CFR987.52Ind 7CFR987.152).Fe/lull to reportcan re.ulI InI IIn.of not I... thin $SOor mOilthin $5000for.ach .uch vlol.lon
and .ach day during which such vlolltlon c:onUnu" .hIIl be d"mtcl I ..parat. violation.

Accordingto the PaperworkReduction Actof 1995, an agency may not conduct or sponsor, and a person Is not requiredto respond to a collectionof Infonnationunless It displays
a vaRd OMS control number. The vaRd OMS control number for this Information collection Is 0581-0178. The time required to complete this tnformatlon collection Is esUmated to
average 12 minutes per response, Indudlng the time for reviewing InstrucUons, searching exlsUng data sources, gathering and maintaining the data needed, and completing and
reviewing the collec:tlon of Information.
The u.s. Deparbnent of Agriculture (USDA) prohibits dlsa1mlnatlon In aU lis programs and adivltles on the basis of race, color, national origin, age, disability, and where applicable,
sex, marital status, familial status, parental status, religion, sexual ortentatIon, gene\fc information, political beliefs, reprisal, or because all or part of an IndMdual's Income Is
derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require altl!matlve means for communication of program
Information(Braille,large print. audiotape, eIx:.)should contad: USDA'sTARGETCenter at (202) 720-2600 (voiceand 100). To file a complaintof dlsalmlnaUon,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 (roD). USDAIs an equal
opportunity provider and employer.