RAC-15 CA Raisins--Daily Packout Reports

RAC-15
Revised12/06

DAILY PACK-OUT REPORT
RAISINADMINISTRATIVECOMMITTEE
P.O. Box 5217
Fresno, CA93755-5217

Office of Management and Budget
Control Number 0581-0178

Date Packed:
The undersigned certifies to the Raisin Administrative Committee and the Secretary of Agriculture of the United States that the following quantities of processed
raisins were packed on the date shown above and that each shipping container was marked with a legible code indicating the date on which such raisins were

packed.
Cases
No.

Size

Size or Color

Varietal Type

Brand

Code

Net Weight

The making of any false statement or representationsin any matter within the jurisdiction of any agency of the United States, knowingit to be false, is a
violation of Title 18, Section 1001, United States Code, which provides for a penalty of a fine of $10,000 or imprisonment of not more than five years, or both.
Handler

By

Date

Title

This report is required by law (7 U.S.C 608 (d), 7 CFR 989.173 (a)(3)). Failure to report can resul1 in afme o/not less than $50, or more than $1,100/or
violation and each day during which such violation continues shall be deemed a separate violation.

each such

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 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.

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.