PMC 4.72A CA Dried Prunes Foreign Export Notice of Receipt of Subs

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Form PMC 4.72A
OMB IOS81.{)178

PMC Approval No.

PRUNE MARKETING COMMITTEE
FOREIGN EXPORT

NOTICE OF RECEIFI' OF SUBSTANDARDPRUNFS FOR MANUFACTURINGPURPOSES
The undersigned cenifies to the United States Department of Agriculture and to the Prune Marketing Committee that the
following described shipment of dried substandard prunes was received for use in the specified and PMC approved manner for
manufacturing purposes. The undersigned hereby further certifies that these substandard prunes will not be consumed in the form
of prunes or pitted prunes but will completely lose their form and character as prunes in the manufacturing process and be used
for the purpose approved by the PMC. In addition, the undersigned certifies that this product will not be transhipped to any other
than the PMC approved destination under any circumstances.
The undersigned hereby agrees to permit access, by an authorized representative of the Prune Marketing Committee or the
United States Department of Agriculture, to any facility where the product received hereunder is stored or used, or to observe the
manufacturing process at any time during normal business hours.
Failure to comply with the above stipulation can result in the disapproval of future requests to ship similar product.
PMC approved usage:

Gross
Wei

Net
Wei

No. of
ontainers

.

Nameof
Suoolier

Date

-port where prunes were unloaded:
Plant or storage location - where prunes were delivered:

Location

Name and address of fll111processing the prunes:

Name and address of purchasing firm:

Tide:

Signed by:
Instructions:

Date:

Complete in triplicate immediately upon ~
of the described dried substandard prunes. Return the original to the
Prune Marketing Committee, 3841 No. Freeway Blvd., Ste. 120, Sacramento, Ca 95834; return a copy to your supplier;
retain a copy for your records.

IMPORTANT NOTICE
This report is required by law (7 U.S.C. 608 (d). 7CPR §993.5O(e). §993.73 and §993.150 (e».
FAILURE TO REPORT can result in a (me of not less than $50.00 or more than S5.000 for eacb 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 Tide 18. Section 1001 of the United
States Code, which provides a penalty of a fine of not more than $10.000. or imprisonment of not more than 5 years. or both.
Acoording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond 10a tOllection of information unless
it displays a valid OMB tOntrol number. The valid OMB control number fur this information tOllcction is 0581-0178. The time required to tOmpicte this information
tOlicction is estimated to averago 5 minutes per response, including the rime for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information.
The:u.s. Department of AgricuItuR: (USDA) prohibits discrimination in all its programs and activities on the basis of race. color, national origin. gender, religion, age,
disability, political belie&, sexual orientation. and marital or liunily status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require
alternative means for communication of program infurmation (Braille:,large print, audiotape, cb:.) should contact USDA.s TARGET Center at (202) 720-2600 (voice
and TOD).
To file a complaint of discrimination. write USDA, Director, Office of Civil Rights, Room 326-W. Whitten Building. 1400 Independence Avenue. SW, Washington.
DC 20250-9410 or call (202) 720-5964 (voice and TOD). USDA is an equal opportunity provider and employer.