PMC 4.72B CA Dried Prunes--Foreign Export Notice of Usage of Subst

Form PMC 4.72B
OMB #0581-0178

PMC Approval No.

PRUNE MARKETING COMMITl'EE
FOREIGN EXPORT
NOTICE OF USAGE OF SUBSTANDARD PRUNES FOR MANUFACTIJRlNG PURPOSES
NOTE: Do not comDlete or forward until this entire shiDment of Drones has been used.

Certification: The undersignedhereby certifies to the United States Department of Agriculture and to the Prune
Marketing Committee that the following described shipment of dried substandard prunes has been used for the following
manufacturing purpose:
Date prunes were received:
Net weight used:
Date usage was completed:
Name and address of processing firm:
Name and address of purchasing firm:

Title:

Sigriedby:
Instructions:

Date:

Completein triplicateimmediatelyupon usaecof the abovedescribeddried substandardprunes. Return
the original to the Prune Marketing Committee, 3841No. Freeway Blvd., Ste. 120, Sacramento, Ca
95834; return a copy to your suppUer; retain a copy for your records.

IMPORTANT NOTICE
This report is required by law (7 U.S.C. 608 (d), 7CFR §993.S0 (e), §993.73 and §993.1S0 (e».
FAILURE TO REPORT can result in a fine of not less than $SO.OOor more than $S,OOOfor each such violation and each day during which
such violation continues shall be deemed a separate violation. The issuance of a false certificate, knowing it to be false, is a violation of Title
18, Section 1001 of the United States Code, which provides a penalty ofa fine ofoot more than $10,000, or imprisonment of not more than
S years, or both.

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 n\D11ber.The valid OMB control number for
this informatiOllcollection is 0581-0178. The time required to complete this information collection is estimated to average 5
minutes per responso, including the time for reviewing instructiOllS, searching existing data sources, gathering and
maif1tainingthe data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits disaimination in all its programs and activities on the basis of race,
color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or fiunily status. (Not
all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of
program informatioo (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice
and TOO).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400
Independence Avenue, SW, Washington, OC 20250-9410 or call (202) 720-5964 (voice and TOD). USDA is an equal
opportunity provider and employer.