FV-10D CA Raisins--Request for USDA Appeal Inspection

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

REQUEST FOR USDA APPEAL INSPECTION

I hereby request an appeal inspection of the raisins covered by Inspection Certificate No. ________________, (Form FV-489 or Form FV-490) and Weight Certificate No. _____________, in accordance with the regulations governing Inspection and Certification of Processed Fruits and Vegetables and Related Products, and paragraph 989.158(a)(5) or 989.158(h) of Marketing Order No. 989, as amended. These raisins are located at ________________________________ (original inspection point), California.

Name of Handler		Name of Producer
By:		By:
Handler Representative		Authorizing Agent
Title		Title

Inspectors performing appeal inspection:	Worksheet No.:
1.	Variety:
2.	Box Count:
	Fee:
	Net Weight:

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 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.

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