RAC-5 CA Raisins--Notification of Intention to Handle Raisins

RAC-5
Revised12/06

NOTIFICATION OF INTENTION TO HANDLE RAISINS
AND APPLICATION FOR INSPECTION POINT
RAISIN ADMINISTRATIVE COMMITTEE
P.O. Box 5217
Fresno,CA 93755-5217

Office of Management and Budget
Control Number 0581-0178

The
hereby gives notice that it intends to handle
raisins as a packer (Section 989.14), or handler (Section 989.15), as defined in the Marketing Order Regulating Raisins
Produced from Grapes Grown in California and requests that the premises outlined in the description on file with the RAC be
designated as an inspection point for the
crop year.
The undersigned declares the following concerning the ownership, organization and management of the company named:
Name of Company:
Principal Address:
Mailing Address:
Fax Number:

Phone Number:
Type of Company:

Tax Identification Number (TIN):
Corporation

Partnership

Cooperative

Sole Proprietor

Officers, owner or managers:
Title:
Title:
Title:
Location of plant(s) and receiving point(s) to be designated as inspection point(s):

Reserve raisins will be stored at

Premises description on file with RAC still applicable
Signed

Title

Premises description attached
Date

Note: The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 5528) and the Paperwork Reduction Act of 1995. The authority for requesting
this information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Sees. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Fmnisbing the
requested information is necessary for the administration of the marketing order program.
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 5 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 uom 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 TOD). To file a complaint of discrimination,
write to USDA, Director, Office of Civil Rights, 1400 independence Avenue, S.W., Wasbington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TOD).
USDA is an equal opportunity provider and employer.