CDAC-9 CA Dates--Producer Application for Exemption from Regula

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Send origlna' and one CODYto:

CDAC Fonn #9

California Date Administrative Committee
P.O. Box 1738, Indlo CA 92202.1738

PRODUCER
APPLICAnONFOREXEMPTION
FROMREGULA
TlON
(Section987.52 and 987.152) approvedfor use

OIlB#105I1.o17'

Appllcallon Is madeherewithto seOdatn of myownproductiondirectlyto consum.~ through: (1)roadsld. standor dati

shop own.d or op.rated by mys.1fwithin 25mil.. of India;(2)by mallorderandpare.1post or expreSl shipment; or (3)laid at
California CertIfIedFannll'l ~
or anycombination of the three, and to have luch ex.mpt from the requlr.m.nt of InspecUon
and certification,withholdingof restricteddatel, containerregulallonl,arida
m.nts for.xp.n881 (SectIon 987.41,987.45,
987.48,987.72 of Dom.stlcDateOrd.rNo.987,as amend.d).
Inconsiderationof approvalofthis application,
theundersigned agreesto sellthenam.d outletsonlydatesmeeting
modifiedU.s.GradeBor betterrequlrem.ntsfor domestic sale. Undersignedfurther agrees at the .nd of each crop year, but not
laterthan October10,to reportto the Committeeon CDACForm'2 thevarietyandquantityofdatel soldunder.xemptlon.

NameofProducer:
Address:
City:

State:

ZIp:

Variety(les)of dites producedto be exempted:

ARETOBEFROMROADSIDE
STAND
ORDATESHO

1.1

(a) Location of shop & description:

{b) Estimatedtotal sales(Inpounds):

2.IFDATESAR
(a) Estimated total sale. (In pounds):
3. IF DATE
(a) Estimated total sales (In pounds):

.

toverll'yeIJglblJIty.)
(PI.s. 8llcIoa..copy0' yourcertltfed
produatrcertificate

I HEREBY
CERTIFY
to the U.S.

an

.

at the

agreemental to lales and reporting II accepted and that the Informationlubmltted herein II complete and correct.

SignatureofApplicant
Approved for crop year ending September 30,
or (2) all the exemptlonl granted hereunder.

Date:

but IUbJect to revocaQon for cause (1) the exemption from Inlpectlon and certlflca~on

CAUFORNIADATEADMINISTRATIVE
COMMITTEE

By:

Date:

Thtl11llclnllofral...IDlMIItorNjllW8llllllononthllfolln, 1cnowI,.Illobl "'...Iuvlollllon
orTlII.18,l8dIon 1000.UnltlclSill" Cod8, which provtd18 for III. pen8lt10h IIn.oU1O,ooo
or Imprllonment of not more 11I11\
live yeIII, or boIII.
ThIII8fIOItIlIIqUIIId by law (1 use 801(d),7 CFR887.52..d 7 CFR887.152). Flllull 10llpolt CII\IIIUIt In .lIn. of ROC
181111I111
8~ or m0f8111111
85000for uch IUch vlollI/on end.8ch
d_ during which IUch vlollI/on contlnu~ IIIII! bl ~mtd . lip'"
violation.
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 Infonnatlon unless It displays
II vaDd OMS control number. 1be valid OMS control number for this Information collection Is 0581-0178. The time required to complete this Information collection Is estimated to
average 18 mln~
per response, Indudlng the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewingthe collection of Information.
The u.s. Department of Agriculture (USDA) prohibits dlsalmlnation 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 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'sTARGETCenter at (202) 720-2600 (voiceand TeD). To file a complaintof dlsalmlnatlon, 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 (lDD). USDAIs an equal
opportunity provider and employer.