COC-5 Olives Rept. of Limited, Undersized, and Cull Olives

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

REPORT OF LIMITED AND UNDERSIZE AND CULL OLIVES

INSPECTION AND DISPOSITION

CROP YEAR: __________ PAGE NO. ___________

(1) (1) TO: California Olive Committee 770 E. Shaw Avenue, Suite 310, Fresno, CA 93710 (2) FROM: __________________________________________________________ __________________________________________________________

(4) CONSIGNED TO: __________________________________________________ __________________________________________________ __________________________________________________

(3) EIN NO.: ___________________________

(5) REQUEST FOR INSPECTION:

No. of Containers	Type of Containers	Variety	LIMITED	UNDERSIZE	CULLS	Whole/ Pitted	Outlet	Handler or Inspection Service
			Net Weight	Net Weight	Net Weight
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)
FOR COC USE ONLY

(6) 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: (1) That this represents a complete and accurate report of Limited, Undersize, and Cull olives presented for inspection and disposition; and (2) That such olives are to be used by the consignee listed above and for the purpose reported.

____________________________________________________________ _________________________________________ ______________________
Authorized Official Title Date

(7) INSPECTION CERTIFICATION: The olives inspected conform to the information listed above.

____________________________________________________________ _________________________________________
Inspector Date

INSTRUCTIONS FOR COMPLETING FORM COC-5

GENERAL: Use this form for reporting all Limited and Undersize and Cull olives to be inspected for disposition in satisfaction of requirements imposed by the Marketing Order and the California Olive Committee’s (COC) Rules and Regulations. This report will be used by the COC to credit your account against your obligations of Limited, Undersize, and Cull olives. Each form COC-5 is to be numbered consecutively from the beginning of each new crop year.

ITEM (2): Name and address of reporting handler

ITEM (3): Handler’s Employer Identification Number

ITEM (4): Name and address of consignee (another handler, oil processor, etc.)

ITEM (5): Complete each column in accordance with headings:

(a) Total number of containers

(b) Type of containers (boxes, bins)

(c) List variety of olive, one variety to a line

(d)(e)(f) LIST NET WEIGHT UNDER LIMITED, UNDERSIZE, OR CULLS, AS APPLICABLE (use columns for weights only). Net weight may either be actual net weight, or may be estimated net weight. If estimated net weights are used, show “Est” as the estimated weight.

CO-MINGLED LOTS OF LIMITED, UNDERSIZE, AND CULL OLIVES WILL NOT SATISFY OLIGATION.

(g) Show whether Whole (W) or Pitted (P) weights are reported. The Committee allows 1.333% pit allowance.

(h) List outlet (Green, Sicilian, Oil, etc.)

(i) To be used by Handler or Inspection Service for notation of Count per Pound, Whole, Green Fruit, etc.

ITEM (6): Certification and Signature

ITEM (7): Inspection may be made by an inspector of either Inspection Service

This information is used to verify the provisions of the Marketing Order, 7 C.F.R. 932.51. Making false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing 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 15 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-5 (Rev. 01/2014. Destroy previous editions.)