COC-23 Olives - Grower Authorization to Combine Lots

FORM COC-23
04-01

(1) TO:

GROWER

AUTHORIZATION

CAUFORNIA OUVE COMMITTEE
1903 NORTH FINE #102
FRESNO CA 93727

TO COMBINE LOTS

OMB#0581-Q178

(2) FROM:

(3) EIN #:
VARIETY:

(4) DATE:
REPORTED ON FORM(S) COC-3 NO:

(5) SIGNATURE OF AUTHORIZATION:
AGENT

PRODUCER

NOTE:

COUNTY

# CONTAINERS

NET WEIGHT

MAKE SEPARATE FORM FOR EACH VARIETY

AUTHORIZATION: The above signature of the producer or his duly appointed agent does hereby authorize
the above named handler to combine the lot of natural condition olives shown above with other lots of
natural condition olives for the purpose of weighing and size-grading in accordance with Section
932.15 (a)(i)(ii) of the Olive Marketing Order No. 932.
This information is used to verify the provisions of the order, 7 CFR 932.161 making an}' false statements

or
representations in any matter within the jU!isdiction of any agency of the United States, knowing it to be false,
is a violation of Title 18 Section 1001, United States Code, which provides for penalty of a finE 01 $10,000 or
imprisonment 01 not more than five vears or both.

Note: The following statements are made in accordancewith the Privacy Act of 1974 (5 U.S.C. 5518) and the Paperwork Reduction
Act of 1995. The authority for requesting this infonnation to be supplied on this fonn is the AgriculturalMarketing AgreementAct of
1937, Sees. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested infonnation is necessary for the
administrationof 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 displaysa valid OMB control number. The validOMB control number for this information
collection is 0581-0178. The time required to completethis infonnation collectionis estimated to average 6 minutes per response,
including the time for reviewing instructions, searching existingdata sources, gathering and maintainingthe data needed, and
completingand reviewing the collectionof information.
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