KC-359 Applicaton for Port/Trans-load Facility Approval

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See Reverse for Privacy Act, Public Burden and Nondiscrimination Statements.

KC-359

Form Approved – OMB No. 0560-0177

U. S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

(01-04-07)

APPLICATION FOR PORT/TRANS-LOAD FACILITY APPROVAL
INSTRUCTIONS: To be completed by requesting party. Please complete a form for each requested facility. If under a port
authority tariff, please provide completed form to the port for their signature and submission to the Kansas City Commodity
Office.)
Approval to handle/store USDA commodities is requested for the following terminals/warehouses/locations:
1. PORT NAME
1.

2. TERMINAL NAME

3. MAILING ADDRESS
4. TERMINAL CONTACT:
a. PERSON

b. POSITION

c. TELEPHONE NO. (Include Area Code)

d. FAX NUMBER

e. e-MAIL ADDRESS

5. IDENTIFICATION AND DESCRIPTION OF WAREHOUSES REQUESTED FOR APPROVAL

6a. IS FACILITY/OPERATION UNDER A PORT AUTHORITY TARIFF?

Yes

No

b. If yes, provide port name:
7a. RAILROAD(s) SERVICING LOCATION

7b. IS LOCATION OPEN TO RECIPROCAL SWITCHING?

Yes

No

8. BARGE LINE SERVICING LOCATION

9. NUMBER OF RAILCARS THAT CAN BE SPOTTED

10. NUMBER OF TRUCK DOCKS

12. CAN COMMODITIES BE PROTECTED DURING INCLEMENT WEATHER WHILE
TRANSLOADING?

Yes

11. UNLOAD CAPABILITY PER DAY
a. RAILCARS
b. TRUCKS
13a. DO YOU HAVE A PEST CONTROL PROGRAM?

No

Yes

No

13b. IF COMMERCIAL, NAME OF FIRM:

14. HAS FACILITY IMPLEMENTED A U.S. COAST GUARD APPROVED SECURITY PLAN AND ISPS CODE?

Yes

No

15a. ARE THE FACILITIES

Owned

Leased

?

b. If leased, who is the lessor?
16. STEVEDORE COMPANY(ies)

17. ADDITIONAL COMMENTS

SIGNATURES
18a. REQUESTING PARTY

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18b. DATE

19a. PORT OFFICIAL (If Applicable)

19b. DATE

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KC-359 (REVERSE)
PRIVACY ACT AND PUBLIC BURDEN STATEMENTS
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork
Reduction Act of 1995, as amended. The authority for requesting the following information is 7 CFR, Subtitle B,
Chapter 14, part 1496.6. Information will be used to verify port suitability for consideration in handling and storage
of USDA food aid commodities and help with arrangements for conducting port inspections. Failure to furnish the
requested information will result in nonconsideration of port approval. This information may be provided to other
agencies, IRS, Department of Justice, or other State and Federal Law enforcement agencies, and in response to a
court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286,
287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.
Federal agencies may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is
estimated to average 15 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.
Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to U.S. Department of Agriculture, Kansas City Commodity Office (OMB No.
0560-0177, Chief, Business Operations Support Division, Stop 8768, Kansas City, Missouri 64141-6205.
NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program 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,
SW., Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.

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