COC-28A Olives- Packout Rept. of Canned Ripe Olives

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

PACKOUT REPORT OF CANNED RIPE OLIVES

Month: _____________________, 20__

TO: California Olive Committee 770 E. Shaw Avenue, Suite 310 Fresno, CA 93710	(2) FROM: (3) EIN: ____________________________________
(4) Report of packaged olives: □ WHOLE □ PITTED □ BROKEN PITTED

SIZE	6/10	24/300	24/Buffet	24/211x108	24/401x214	Total
Small
Medium
Large
Ex Large
Ex Large “Sev”
Jumbo
Colossal
Sup Colossal
Green Ripe
Total

(4) CERTIFICATION AND SIGNATURE: The undersigned, on behalf of the reporting handler, certifies to the California Olive Committee and the Secretary of Agriculture of the United States that this report represents a complete and accurate record of the packaged olives, as compiled from forms COC-4 “Pack and Certification Reports for Canned Ripe Olives” for the month above stated.

__________________ _______________________________________ ____________________________

Date Authorized Official Title

This information is used to verify the provisions of the marketing order, 7 CFR 932.161. Making any false statements or representations in any manner within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for penalty of a fine or imprisonment, or both.

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program.

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 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.

COC-28a (Rev. 10/2010. Destroy previous editions.)