Report of Route Disposition into Federal Milk Marketing

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form HR-76(a)
1930-220th St. SE, Ste. 102

Form Approved, OMB No. 0581-0032
4835 E Cactus Rd., Ste. 365

Bothell, WA 98021

Scottsdale, AZ 85254

Phone: (425) 487-6009

Phone: (602) 547-2909

FEDERAL MILK ORDERS 124 & 131

Fax: (425) 487-2775

Fax: (602) 547-2906

E-mail: [email protected]

E-mail: [email protected]

This report is required by the order in accordance with 7 U.S.C. 608c and d. Failure to report can result in the assessment of a civil penalty
of up to $1,000 per day (7 U.S.C. 608c (14) (B)) or upon conviction, In a fine of up to $5,000 per day (7 U.S.C. 608c (14) (A)).

Partially Regulated Distributing Plant
Report of Route Dispositions Into Federal Milk Marketing Orders

Handler

Delivery Period

Federal Order:
Federal Order:
Federal Order:
Product Pounds Fat Pounds Product Pounds Fat Pounds Product Pounds

Product
Homo - Whole
Homo - Whole - Organic
Flavored Milk
Flavored Milk - Organic
2% Reduced Fat - Plain
2% Reduced Fat - Fortified
2% Reduced Fat - Organic
1% LowFat - Plain
1% LowFat - Fortified
1% LowFat - Organic
Skim Nonfat - Plain
Skim Nonfat - Fortified
Skim Nonfat - Organic
Flavored Drink
Flavored Drink - Organic

Buttermilk - Plain
Buttermilk - Whole
Buttermilk - Organic
Eggnog

Total

Signature

Date

Fat Pounds

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

1930-220th St. SE, Ste. 102
Bothell, WA 98021
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: [email protected]

FEDERAL MILK ORDERS 124 & 131

4835 E Cactus Rd., Ste. 365
Scottsdale, AZ 85254
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

HR - 76(a)
Report of Route Disposition Into Federal Milk Marketing Orders

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

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 0581-0032. 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.
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