920-Kiwifruit Shipment Report

OMB No. 0581-0189

SHIPMENT REPORT
CROP YEAR 20__/20__
Kiwifruit Administrative Committee (KAC)
California Kiwifruit Commission (CKC)
Mail to: 1521 "I" Street, Sacramento, CA 95814
or Fax to (916) 446-1063; Email: [email protected]
KAC Phone No.: (916) 441-0678 - CKC Phone No.: (916) 441-0678

COMPANY:
CONTACT:
PHONE No.:

Reporting Month:

Check if this is your final report for the season.

PLEASE NOTE: The following information is to be current as of the last day of the reporting month and filed with the Commission/Committee no later than the
fifth (5th) day of the following month. This information is being required to assure accurate and timely statistics to assist you. Each individual handler report is
completely confidential.

Trays

3-Layers

Bag Masters

Volume Fill

Bins

Other Pounds *

(No. of Cartons)

(20#)

(9kg - 19.8#)

(125#)

(No. of Pounds)

(No. of Masters)

(No. of Containers)

(No. of Bins)

Domestic
Canada
Taiwan
Japan
Hong Kong
Korea
Australia
Mexico
Singapore
Not listed:

note

market

TOTALS
Note: If you shipped a container type or size not listed above, contact the CKC or KAC office for assistance.
* WEIGHT OF OTHER SHIPPED (complete only if OTHER column used above)
Container Weight (pounds) (A)

No. of Containers Shipped (B)

Other Pounds Shipped (A x B)

I hereby certify to the best of my knowledge and belief that this report is true and complete. I understand that records from which this report is compiled are
subject to audit and must be preserved for a period of two years:

Date:

Signature:

Title:

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this information collection is 0581-0189. The time required to complete this information collection is estimated to average 30 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.

Rev. 7/10. Destroy previous editions.