Almond Form ABC 34 Application to be Approved as an Accepted User of Inedib

OMB Approval No. 0581-0178
ABC Form 34

APPLICATION TO BE APPROVED AS AN ACCEPTED USER OF
INEDIBLE ALMONDS AND ALMOND WASTE
To:

Almond Board of California, 1150 9thStreet, Suite 1500, Modesto, CA 95354

Application is made herewith to be listed by the Almond Board as an Accepted User of inedible almonds and almond waste
and for approval of the use of such material in the outlet(s) checked below:

_
_
_

crushing for almond oil
mixing into feed
feeding directly to livestock or poultry

This will occur at (give location):

(street)

(city)

In consideration of the approval of this application, undersigned agrees that all almond material acquired from almond
handlers or growers will be used only for the purposes indicated, that none will be disposed of for human consumption and
that Board employees may enter applicant's premises at any reasonable time to observe the storage or disposition of the
almond material, and to examine and audit all books and records necessary to substantiate compliance with quality control
provisions goveming inedible dispositions. Undersigned also agrees to obtain from each almond handler an executed ABC
Form 8, on each lot of material received, and upon crushing, mixing or feeding the almonds, to execute part (b) of the form and
mail it promptly to the Board. Undersigned also agrees to furnish to the Board a public weighmaster certificate substantiating
the weight of the inedible material received applicable to each Form 8. The weight tag will be issued at time of receipt, in the
name of the undersigned. Undersigned also agrees to complete and submit an accepted user data sheet as part of the
that accepted user status is
Board's annual process of granting accepted user status. Undersigned also acknowledges

subject to revocation

at any time by the Board for cause.

Undersigned hereby certifies to the U.S. Department of Agriculture and to the Almond Board that the information supplied
herein is complete and correct and that the above agreement as to usage and reporting is accepted.
Note: The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18,
Section 1001, United States Code, which provides for the penalty of a fine of $10,000 or imprisonment of not more than five
years, or both.

Date

,20xx

User Firm
Address
Fax<-)

Telephone(

Title

By.
(authorized person)

Application is hereby approved, for the 20xx-20xx crop year, xx/xx/xx through xx/xx/xx, subject to revocation for cause:
Date

,20xx

Almond Board of California
By.

Title

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 number. The valid OMB control number for this information collection is 0581-0178. The time required to complete this information collection is estimated
to average 30 minutes per response, including the time 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 Agriculture (USDA) prohibits
applicable, sex, marital status, familial status, parental
income is derived fi'om any public assistance program
of program information (Braille, large print, audiotape,
wrile to USDA, Director, Office of Civil Rights, 1400
USDA is an equal opportunity provider and employer.

discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where
status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
(Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication
etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination,
Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (IDD).

AhnoJUi Board of Califonda
1150 9th Street, Suile 1500

June 8, 2U

ModestO. CA 9!}354 I:SA
Tel: 209.549.8262
Fax: 209.549.8267
wwwAlmondsArdn.com

ACCEPTED USERS:
We are currently updating the list or Accepted Users of Inedible Almonds for ttIe 20t t-2G Crop
Year and, as a result, the approved status of those currently listed are inactive as of September

1,20
If you Intend to acquire Inediblealmond materialfor the 2C -20 (which begins August 1), you
must complete the enclosed applicationand data sheet and ret1JmIt to this ofl'Jce. A copy of the
Boardpolicytor Aixepted User approval Is attached for your review.
Bysigningthis agreement you wRlbe stating that you will:

.
.

.
.

USeInediblealmond material onlyin permittedoutlets.
Obtainfrom each almond handler an executed ABCForm a for each disposition.
Complete Part (b) of the Fonn 8 and man It to the Board along with a weight
certfflcate Issued at the time of receipt of tnedIblematerial (I.e., destinat10nweight)
Ina timelyfashion.
Allow Board employees or their designee's access to premises tor Inspectfon and audit.

Please retum two signed originalsor the appncatlon,ABC Form 34, whlctlls enclosed along with
the Data Sheet. Upon approval of your application and completion of any required audit
procedures, you will be listed as an Accepted User (for Crop Year 2001-2002 only) and a signed
application wtll be returned to you.
Thank you tor your cooperation.

Sincerely,

~g~

Director of Administration

TK:ta
Endosures
cc:
RodgerWasson
Martin Engeler, USDAjAMS
Board r:XDIrectors

OMB Approval No. 0581-0178

ALMOND BOARD OF CALIFORNIA
1150 9thStreet, Suite 1500
Modesto, California 95354
Telephone (209) 549-8262, FAX (209) 550-5494
ACCEPTED USER
BUSINESS DATA SHEET
Name:
Mailing Address:
Street Address:

Location of Facility:

Fax:

Telephone Number:

SSN or EIN:

Email:

*********************************************************************************************************************************

Business/Organization

D
D
D

Type:

Years in Business:

Sole Proprietor
Partnership
Corporation

Principals (Persons owning/managing the business) Please list names and titles:

Please check box that applies to Principals:
Almond Grower

DYes

Handler

DYes

If growers, please provide number of acres and location of orchards

Bank Reference

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 number. The valid OMB control number for this information collection is 0581-0178. The time required to complete this information collection is estimated
to average 30 minutes per response, including the time 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 Agriculture (USDA) prohibits
applicable, sex, marital status, familial status, parental
income is derived &om any public assistance program
of program information (Braille, large print, audiotape,
write to USDA, Director, Office of Civil Rights, 1400
USDA is an equal opportunity provider and employer.

discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where
status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
(Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication
etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination,
Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).