922-Apricots Application for Waiver of Inspection at Shi

OMB No. 0581-0189

WASHINGTON APRICOT MARKETING COMMITTEE

Marketing Order No. 922

105 South 18^th Street, Suite 205

Yakima, WA  98901

Phone: (509) 453-4837; Fax: (509) 453-4880 Waiver No.

APPLICATION FOR WAIVER OF INSPECTION AT TIME OF SHIPMENT

I. I hereby request that I be granted permission by the Washington Apricot Marketing Committee (Committee) to handle apricots during the period and in the manner specified below in accordance with the modified inspection requirements of the Committee as set forth in the Administrative Rules issued pursuant to Marketing Order No. 922.

1. Name and address

2. Location of packing facility

3. Distance of packing facility from the nearest inspection office

4. Period during which I expect to ship apricots

5. The estimated quantity of apricots I expect to ship to the fresh market during such period

6. The manner in which the majority of my apricots will be marketed (i.e. transported by myself to market, sold at orchard to truckers, etc.)

7. The areas or markets in which I expect to ship the majority of my apricots (i.e. local markets in the area of the orchard, major terminal markets within the State such as Spokane or the Seattle-Tacoma area, to markets outside the State of Washington, etc.)

II. Certification by Applicant

I hereby certify that all apricots shipped by me, pursuant to the authority granted by this permit, will be handled in accordance with all requirements of Washington Apricot Marketing Order No. 922, and the regulations issued pursuant thereto, and I hereby certify to the U.S. Department of Agriculture (USDA) that the information I have furnished in this application is true and correct to the best of my knowledge, and that I realize the making of a false certification, knowing it to be false, is a violation of Title 18, Section 1001 of the United States Code, among other statutes, which provides for a fine, imprisonment, or both.

Applicant’s Signature Address Date

III. Action by the Washington Apricot Marketing Committee -- Marketing Order No. 922

Permission is hereby (granted/denied) the above applicant to handle apricots during the period from to (dates) in accordance with the modified inspection requirements as set forth in the Administrative Rules of the Washington Apricot Marketing Order and subject to those conditions set forth in this application form.

Date Manager

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 5 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.

The following conditions are made part of the applicant’s certification, and the applicant, by signing such certification, agrees to abide by the following conditions:

1. I agree not to ship or handle any apricots unless such apricots meet the grade, size, maturity, container and all other requirements of the Marketing Order in effect at the time of handling.

2. I agree to report periodically to the Committee on reporting forms furnished by the Committee, the following information on each shipment: quantity, variety, grade, minimum size, container, date of shipment, destination, name and address of buyer or receiver.

3. I agree to permit representatives of the Committee or the USDA to inspect and observe my packing operations at any time for the purpose of determining compliance with the Marketing Order.

4. The Federal-State Inspection Program shall have the right to observe my packing operations at any time and make inspection of lots prepared by me for shipment to the fresh market. The cost of such inspection, including mileage and travel time, shall be borne by me and computed in accordance with the official fee schedule as published by the Washington State Department of Agriculture and in effect at the time such inspection is made.

5. At the request of the Committee, I agree to obtain inspection at destination on any individual shipment. The cost of such inspection shall be borne by me.

6. The Committee or its duly designated inspection agency shall have the right to obtain inspection in the name of the Committee on any apricots in terminal markets which were shipped by me pursuant to a permit issued under this Section. The Committee shall have the right to bill me for the cost of such inspection.

7. I agree to pay the committee the amount of $______ per container of apricots shipped under this Agreement. Such amount being paid in lieu of inspection charges at shipping point.

8. I understand that any violation of the terms and conditions of this permit will constitute a violation of the Washington Apricot Marketing Order No. 922, and, furthermore, will constitute cause for cancellation by the Committee of such permit.

9. The waiver number is required to appear on all documents that accompany each shipment.

INSTRUCTIONS TO APPLICANT

Part I and II of this form shall be prepared by the applicant and all three copies mailed to the Committee office. The Committee Manager will contact the applicable District Supervisor of the Inspection Department for his approval. The Committee Manager will then notify the applicant of the action taken on the application by mailing one copy to the applicant, and one copy to the applicable inspection office, and will keep one copy for the Committee’s files.

Rev. 9/13. Destroy previous editions.