COC-28B Olives-Packout Rept. of Canned Ripe Olives Limited Use

Form COC-28b
04-01

PACKOUT REPORT OF LIMITED USE OLIVES
MONTH

OMB#OS81-0178

20_

(1) TO:

(2) FROM:
California Olive Committee
1903 North Fine #102
Fresno CA 93727
(3) EIN#:

(4) REPORT OF PACKAGED LIMITED USE:

STYLE

6/1 0

24/300

I

24/Buffet! 24/4.5

I

24/2.25

TOTAL

Segmented
Sliced
Chopped

TOTAL
(4) CERTIFICATION AND SIGNATURE: The undersigned on behalf of the reporting handler 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 limited use olives as compiled. from Form COC-4 "Pack
and Certification Reports for Canned Ripe Olives" for the month above stated.

Date

Authorized Official

Trtle

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 Title 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.

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Note: The foUowingstatements are made in accordancewith the PrivacyAct of 1974 (5 U.S.C. 552a) and the Paperwork Reduction
Act of 1995. The authority for requesting this informationto be suppliedon this form is the AgriculturalMarketing AgreementAct of
1937, Secs. 1-19,48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishingthe requested information is necessary for the
administrationof the marketing order progmm.
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 informationunless it displaysa validOMB control number. The validOMB control number for this information
collection is 0581-0178. The time required to completethis informationcoUectionis estimatedto average 45 minutes per response,
including the time for reviewing instructions,searching existingdata sources, gathering and maintainingthe data needed, and
completingand reviewingthe coUectionof information.
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