CDAC-10 CA Dates--Handler Application for Certain Exemptions fro

OMB No. 0581-0178

Send original and one copy to:

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

P.O. Box 1736

Indio, CA 92202-1736

Tel: (760) 347-4510 Fax: (760) 347-6374

HANDLER APPLICATION FOR CERTAIN EXEMPTIONS FROM REGULATIONS

Application is made for the exemption(s) indicated below:

Name of Handler: ______________________________________________________________________________

Address: _____________________________________________________________________________________

Street City State Zip Code

A. Specialty Outlet (check applicable)

□ Health food, wholesaler or retailer, exemption from moisture requirement

□ Hand-pitted dates, candy manufacturer, exemption from size regulation

Name of Purchaser: _____________________________________________________________________________

Address: _____________________________________________________________________________________

Street City State Zip Code

B. Specialty Packs (exemption from packed inspection and container regulations)

Describe the container, weight of dates, wrapping: ____________________________________________________

_____________________________________________________________________________________________

Will there be pre-packing inspection followed by surveillance to prevent co-mingling with other dates?

□ Yes □No Estimated annual quantity to be sold (Oct.-Sept) ___________ pounds.

C. Sell to one purchaser up to 150 pounds (exemption from packed inspection)

Will there be pre-packing inspection followed by surveillance to prevent co-mingling with other dates?

□ Yes □No Estimated annual quantity to be sold (Oct.-Sept) ___________ pounds.

In consideration of approval of this application, the undersigned applicant agrees to sell, in the indicated outlet only, dates meeting free date grade and size (except for specific exemption) and at the end of each crop year, but no later than September 30, to report to the California Date Administrative Committee (CDAC) on form CDAC-2 the variety and quantity of dates sold under exemption.

Signature: ___________________________________ Title: ______________________________________

Print Name: __________________________________ Date: ______________________________________

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), 7CFR 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.

Approval for crop year ending September 30, 20___ but subject to revocation.

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

By: _________________________________________________ Date: _________________________________

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 its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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 Target Center (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.

CDAC-10 (Rev. 01/2014) Destroy previous editions.