CMB 1 CA Walnuts - Crop Acquisition Report by County & Variety

OMB No. 0581-0178

CALIFORNIA WALNUT BOARD Due Date: ______________________. 20___

101 Parkshore Drive, Suite 250

Folsom, CA 95630

Ph (916) 932-7070 Fax (916) 932-7071

CROP ACQUISITION REPORT, BY COUNTY AND VARIETY, FOR CROP YEAR 20___

This report of crop acquisitions by county and variety is submitted in compliance with the requirements of Marketing Order No. 984, as amended. In executing this form, the handler respectively certifies to the California Walnut Board (Board) and the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions: 1. Report ALL crop acquisitions, except Interhandler transfers, by county and variety including your own production as a grower.

2. Report all quantities in inshell pounds. If you did not have any acquisitions, write “NONE” on the form.

3. Your total crop figures for county and variety must agree.

4. Mail a signed original to the Board office on or before January 15, 20___.

COUNTY	INSHELL POUNDS	COUNTY	INSHELL POUNDS		VARIETY	INSHELL POUNDS
Alameda		Riverside			Ashley
Amador		Sacramento			Chandler
Butte		San Benito			Eureka/Eureka types
Calaveras		San Joaquin			Franquette
Colusa		San Luis Obispo			Hartley
Contra Costa		San Mateo			Howard
El Dorado		Santa Barbara			Payne
Fresno		Santa Clara			Serr
Glenn		Santa Cruz			Tehama
Kern		Shasta			Tulare
Kings		Solano			Vina
Lake		Sonoma			Other
Madera		Stanislaus
Marin		Sutter
Mendocino		Tehama
Merced		Tulare
Monterey		Ventura
Napa		Yolo
Nevada		Yuba
Placer		Other ____________________
		TOTAL			TOTAL

Handler: ______________________________________________________________ By: ____________________________________________________________

Title: _________________________________________________________________ Date: ___________________________________________________________

The making of 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, of the United States Code, which provides for the penalty of a fine or imprisonment of not more than 5 years, or both.

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 5 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 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, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, 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 Civil Rights, 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.

CWB-1 (Rev. 10/2010) Destroy previous editions.