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Within 24 hours of disposition, send one signed copy to:
CALIFORNIA DATE ADMINISTRATIVE COMMITTEE
P.O. Box 1736
Indio, CA  92202-1736
Tel: (760) 347-4510  Fax: (760) 347-6374

REPORT OF DISPOSITION OF PRODUCT GRADE DATES

This report must be completed for each disposition of product grade dates and filed with the California Date Administrative Committee (Committee) within 24 hours.  The following quantities of dates were disposed of as indicated below on _________________, 20___.
Item No.
Variety
Grade
Inspection Certification or Report Grading No.
Lot No. or Lot Grade
Outlet (Manufacturer) or County of Export
No. of Containers
Net Weight
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The undersigned Handler certifies that these dates are being disposed of in accordance with Committee regulations.
Handler: ________________________________________	Signature: __________________________________

Date: ___________________________________________	Title: ______________________________________

The undersigned Manufacturer acknowledges receipt of and certifies that the above dates will be disposed of in accordance with Committee regulations.
Manufacturer: ____________________________________	Signature: __________________________________

Date: ___________________________________________	Title: ______________________________________

Net pounds received at plant: ________________________

Copies (four) must be distributed as follows:
Original:  Must be sent to the Committee within 24 hours.
Duplicate and Triplicate:  Must be given to the party receiving the fruit.  Upon arrival at destination the party transporting the fruit must turn both copies over to the party actually receiving the fruit; whereupon said party shall complete the Manufacturer section and mail to the Committee.  The triplicate copy is to be retained by the Manufacturer for record keeping.
Quadruplicate:  To be retained for record keeping by Handler authorizing movement of the fruit from its source.

The making of false statement or representation on this form, knowing it to be false, is a violation of title 18, section 1000 of the  United States Code, which provides for the penalty of a fine or imprisonment, or both.  This report is required by law (7 USC 608(d), 7 CFR 987.51, 987.151).  Failure to report can result in a fine for each violation and each day during which such violation continues shall be deemed a separate violation.

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 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 all of 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, political beliefs, genetic information, 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.