H-11 Expected Producer Milk and Bulk Movements

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102
Bothell, WA 98021-8471
Phone: (425) 487-6009

Fax: (425) 487-2775
E-mail: [email protected]

AGRICULTURAL MARKETING SERVTCE
DAIRY PROGRAMS
FEDERAL MILK ORDERS I24

&

13I

10050 N 25th Ave., Ste. 302
Phoenix, 42 85021-1664

Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

H-11
Expected Producer Milk and Bulk Movements

Note: This cover page is for information purposes only and does not need to be submitted to the market aclministrator's office

According to the Papenivork 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 0581-0032. The time reguired to complete this information collection ís estimated to average I hour 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 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, political beliefs genetic informalion, reprisal, or because all or part of an individual's income is derived from any public
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Assistant Secretary for Civil Rights, 1400 lndependence Avenue, S.W., Washington, D.C. 20250-9410, or call (866) 632-9992
(English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federat-retay). USDA is
an equal opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
Form H-1

AGRICULTURAL MARKETING

'l

SERVICE

DAIRY PROGRAMS

1930-220th St. SE, Ste. 102
Bothell, WA98021-8471
Phone: (425) 487-6009

Form Approved, OMB No. Osgl-0032
10050 N 25th Ave., Ste. 302

Phoenix, A285021-1664
Phone: (602) 547-2909
Fax (602) 547-2906
E-mail: [email protected]

FEDERAL MILK ORDERS I24 & 13I

Fax: (425) 487-2775

E-mail: [email protected]

POOL SUPPLY PLANT
EXPECTED PRODUCER MILK AND BULK MOVMENTS
Month:

Handler:

Plant Location:

A) Expected Producer Milk

1.
2.

Receipts

product pounds

Producers (lnclude milk diverted to other plants)
$ .9(c) coops. (specify)
ct.

b.

3.

c.

Total

B) Expected Movements of Bulk FMP to Pool and Other Order Distributing Plants

1.

Pool Distributing Plants
a.
b.

2.

c.
d.

s ll or lll
cr.

b.

3.

c.
d.

Total

This report is required by the order in accordance with 7 U.S.C. 60Bc and d. Failure to report can result in the
assessment of a civil penalty of up to $1,000 per day (7 U.S.C. 608c (14)(B)) or, upon conviction, in a fine of up to
$5,000 per day (7 U.S.C. 608c (14XA)).
I declare under the penalties provided by law, that this report (including any accompanying schedules and
statements) has been examined by me and to the best of my knowledge and belief is a true, correct, and
complete report. I also certify that I am authorized to sign this report.

Name of Handler

Date

Authorized Signature

Title