CDGAC-5 925-CA Desert Grapes Experimental Containers

OMB No. 0581-0189

CALIFORNIA DESERT GRAPE ADMINISTRATIVE COMMITTEE

82901 Bliss Avenue

Indio, CA 92201

Phone: (760) 342-4385

Fax: (760) 342-0485

E-Mail: [email protected]

EXPERIMENTAL CONTAINER PERMIT □ New

□ Renewal

Date ________________________________ Permit No. _____________________________

Applicant: __________________________________ Telephone No. __________________________

Maximum Number of Containers:

Product:

Shipment from Previous Year:

Description of Container and Department’s understanding of Container:

Material Depth Width Length

Container Manufacturer:

Effective Date: ____________________, 20__ Termination Date: ___________________, 20__

• Experimental Container Permit No. _____ shall be clearly and conspicuously stamped in letters not less than one half inch in height on one end of each container and NOT ON THE BOTTOM OF THE CONTAINER.

• The Permittee shall maintain a record for one year of the place and date of shipment and the number of containers shipped. Within this period and upon demand, the California Desert Grape Administrative Committee may inspect this record.

• It is unlawful to label containers in excess of the number shown on the permit.

• This permit will be canceled for violation of either its terms or the applicable section of the California Administrative Code.

• All applicable marking requirements of Fruit and Vegetable Quality Control Standardization shall apply to this experimental container.

By ________________________________________________

Manager

California Desert Grape Administrative Committee

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. A valid OMB control number for this information collection is 0581-0189. The time required to complete this information collection is estimated to average 10 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 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 the 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.

CDGAC-5 (Rev. 07/10. Destroy previous editions.)