COC-27B Olives - Inventory Holding of Limited Use Olives

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INVENTORY REPORT OF LIMITED USE OLIVES

Form COC-27b
04-01

QMBfP0581-O 178

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MONTH

20_

(2) FROM:

(1) TO:
California Olive Committee
1903 North Fine #102
Fresno CA 93727

(3) EIN#:
(4) REPORT OF PACKAGED LIMITED USE:

STYLE

6/1 0

24/300

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24/Buffet I 2'4/4.6

124/2.26

,TOTAL

Segmented
Sliced
Chopped

TOTAL
(5) CERTIFICATION AND SIGNATURE: The undersigned on behalf of the reporting handler certifies to the
California Olive Committee and the Secretary of Agriculture of the United States that this report represents a
compl~te and accurate record of the inventory holdings of all packaged limited use olives, held by the handler
or in pUblic warehouse in any and all locations for his accounts of the date above stated.

Date

I

Authorized Official

Title

This information is used to verify the provisions of the order, 7 CFR 932.161. Making any 1a1sestatements
or representations in any matter within the jurisdiction of any agency of the United States, Icnowing it to be
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.
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Note: The following statementsare made in accordance with the PrivacyAct of 1974 (5 U.S.C. 552a) and the Paperwork Reduction
Act of 1995. The authority for requesting this informationto be suppliedon this form is the AgriculturalMarketing AgreementAct of
1937. Sees. 1-19.48 Stat. 31. as amended. (7 U.S.C. 601-674). Furnishingthe requested information is 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 informationunless it displaysa valid OMB control number. The valid OMB control number for this information
collectionis 0581-0178. The time required to complete this informationcollectionis estimatedto average 30 minutes per response.
including the time for reviewing instructions.searching existingdata sources. gathering and maintainingthe data needed. and
completingand reviewingthe collectionof 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 ffom 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.