COC-155 California Olives Special Purpose Shipment

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

REPORT OF SPECIAL PURPOSE SHIPMENTS

20___ CROP YEAR

TO: California Olive Committee 770 E. Shaw Avenue, Suite 310 Fresno, CA 93710

FROM: EIN: _________________________________________

The above handler is requesting permission to package and market the following experimental shipments in order to conduct marketing research and development projects. For each application, the requesting handler must provide information including, but not limited to:

Purpose of Request:

Market Outlet:

Time Frame:

Place of Inspection: ________________________________ Anticipated Date of Pack: ____________________

Quantity	Variety(ies)	Fruit Size	Style	Type: Black/Green	Container Size	Can Code(s)	Type of flavoring; other amendments, etc

CERTIFICATION AND SIGNATURE: The undersigned, on behalf of the reporting handler, certifies to the California Olive Committee (COC) and the Secretary of Agriculture of the United States that the marketing order reporting requirements for receipt and disposition have been met; that all assessments under the marketing have been met; and that this fruit will be kept separate from other packaged olives by a means satisfactory to the inspection service.

______________________________________ ________________________________ _____________

Signature: Title: Date:

COC USE Inspection notified: __________________________________________________

ONLY Date: _____________________________________________________________

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 20 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-155 (Rev. 01/2014. Destroy previous editions.)