COC-21 Olives - Rept. of Ripe Olive Sales

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Form COC-21
04-01

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REPORT OF RIPE OLIVE TOTAL SALES
MONTH

a M6#0581-0178

20_

(1) TO:

(2) FROM:

California Olive Committee
1903 North Fine #102
Fresno CA 93727
(3) EIN #:
ALL REPORTED FIGURES TO BE CONVERTED TO 24/300 BASIS
SALES

DESTINATION

CONSUMER

RJCX)

SIZE

SERVICE

LIMITEDUSE
CHOPPED

SLDIWDGD

TOTAL

UNITED STATES
GOVNMTAGENCIES
CANADA
OTHER FOREIGN
TOTAL

The undersigned on behalf of the reporting handler, certifies
to the California Olive Committee and the Secretary of Agriculture of the United States (1) that
CERTIFICA~ION AND SIGNATURE:

.

this represents a complete and accurate report of sales to the United States, governmental
agencies, Canada and other foreign countries for the month reported; and (2) that sales have
been reported by convertingcase and can size to the standardized case and can size 24/300 x
407.

.

-------Authorized Officiat

Title

Date

This information is used to verify the provisions of the order, 7 CFR 932.161
statement

any false

in any matter within the jurisdiction of any agency of the United States, knowing it
to be in violation of Trtle 18 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 arc made in accordance with the PrivacyAct of 1974 (5 U.S.C. 5518) and the Paperwork Reduction
Act of 1995. The authority for requesting this informationto be supplied on this form is the AgriculturalMarketing Agreement Act of
1937, Sees. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the
administrationof the marketing order program.
According to the PaperworkReduction 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
coUectionis 0581-0178. The time required to complete this information collectionis estimated to average 15 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintainingthe data needed, and
completingand reviewingthe collection of information.
The U.S. Department of Agriculture (USDA) prohibitsdiscriminationin an its programs and activitieson the basis of race, color,
national origin, age, disability,and where applicable,sex, marital status. familialstatus, parental status, religion, sexuaI orientation,
genetic information, politicalbeliefs,reprisal,or because an or part of an individual's income is derived from any public assistance
program (Not an prohibited bases apply to an programs.) Persons with disabilitieswho require alternativemeans for communication of
program information(BrailIe,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 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.