920-Kiwifruit Application for Inspection Waiver Form

KIWIFRUIT ADMINISTRATIVE COMMITTEE

OMB No. 0581-0189

APPLICATION FOR INSPECTION
(Waiver Form)
SECTION I (To be completed by shipper)
To:

(Federal-State Inspection Service)
Office

I hereby request inspection of

of
(No. & type of containers)

(Fruit)

on

(Date)

between the hours of

(Variety)

at

(Place)

. If inspection is not available and a waiver is

issued to cover the above-described fruit, I will certify that it will meet all requirements of the
Kiwifruit Administrative Committee.
(Date)

(Name)

(Address)

Section II (To be completed by the Federal-State Inspection Service)
This will acknowledge your request for inspection. Inspection cannot be performed at
the time and place specified and you are hereby assigned waive number:
WTo cover the fruit for which you requested inspection. You are reminded that you must report
all shipments of fruit controlled by the Kiwifruit Administrative Committee including those
which move under waiver to the Kiwifruit Administrative Committee, 1550 Harbor Blvd.,Suite
206, West Sacramento, CA 95691.
(Date)

(Name)

FEDERAL-STATE INSPECTION SERVICE
Office
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 0581-0189. The time required to complete this information collection is
estimated to average 6 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.