COC-28A Olives- Packout Rept. of Canned Ripe Olives

Form COC-28a
04-01

PACKOUT REPORT OF CANNED RIPE OLIVES
MONTH

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

OMB #0581-0178

20_
(2) FROM:

(3) EIN#:

(4) REPORT OF PACKAGED OLIVES:
WHOLE

SIZE

D

6/10

PITTED

24/300

D

BROKEN PITTED

24/8 uffet

D
TOTAL

Small
Med iu m
Larg e
Extra Larg e
Ex Large Sev
J umbo
Colossal
Sup Colossal
Green Ripe

TOTAL

(5) CERTIFICATION AND SIGNATURE: The undersigned on behalf of the reporting hand ler certifies to the
California Olive Committee and the Secretary of Agriculture of the United States that this report represents
a complete and accurate record of the packout of packaged olives as compiled from Forms COC-4 "Pack and
Certification Reports for Canned Ripe Olives" for the month above stated.

Date

Authorized Official

Title
~

This information is used to verify the provisions of the order, 7 CFR 932.161. Making any false
statements or representations in any matter within the jurisdiction of any agency of the United States,
knowing it to be false, is a violation of Title18 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.

Note: The followingstatements are made in accordance with the PrivacyAct of 1974 (5 U.S.C. 5513) 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 information unless it displaysa validOMB control number. The valid OMB control number for this information
collection is 0581-0178. The time required to completethis informationcollectionis estimated to average45 minutes per response,
includingthe time for reviewing instructions,searching existingdata sources, gathering and maintainingthe data needed, and
completingand reviewing the collectionof information.
The U.S. Department of Agriculture(USDA) prohibitsdiscriminationin all its programs and activitieson the basis of race, color,
national origin, age, disability,and where applicable,sex, marital status, familialstatus, parental status, religion,sexual orientation,
genetic information,politicalbeliefs,reprisal,or because all or part of an individual's income is derivedfrom any public assistance
program (Not all prohibited bases apply to all programs.)Persons with disabilitieswho require alternativemeans 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 CivilRights, 1400 IndependenceAvenue, S.W.,
Washington,D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunityprovider
and employer.