No Form number OR/CA Potatoes--Handlers Application for Establishment o

OMB No. 0581-0178

OREGON-CALIFORNIA POTATO COMMITTEE
Marketing Order No. 947
700 NE MULTNOMAH, SUITE 460
PORTLAND, OREGON 97232
Phone: 503-731-3300
HANDLERS APPLICATION FOR ESTABLISHMENT OF
APPROVED MANUFACTURERS CLASSIFICATION
In consideration of the granting of an authorization for our company to be designated as an approved
manufacturer of processing potatoes (potatoes not meeting the requirements of regulations for fresh
market table stock), the undersigned agrees:
1. That all potatoes for commercial processing received by our company will be processed at the
plant located at
2. That potatoes received for processing will not be diverted to the fresh market.
3. That our company will report to the Committee all shipments of processing potatoes received
from the Oregon-California production area. Such shipments will be reported by immediately
submitting to the Committee the Special Purpose Shipment from sent by the shipper and
received with the potato shipment. Such shipments will be identified by name of receiver,
address of receiver, date received, hundredweight received, and special purpose for which the
potatoes will be utilized. The form is to be signed and dated.
4. That failure to report, or the filing of false or incomplete reports, will result in the removal of
my company ITomthe list of approved manufacturers.
The principal potato products produced at our processing plant are

Company Name (please Print)

Authorized Representative's Signature

Address

Title

City, State, Zip

Telephone Number

Fax Number

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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,
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1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.
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