COC-4 Olives Pack and Certification Report

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE
PACK & CERTIFICATION REPORT FOR CANNED RIPE OLIVES

HANDLER _________________________________________________________ PAGE NO. _______________

ADDRESS _________________________________________________________ DATE PACKED ___________

	Variety (A)	Style of Pack (B)	Fruit Size (C)	Cans per Case & Size (D)	Container Code (Incl. Batch Nos.) (E)	Cases Packed (F)	Remarks (G)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
					Total Cases Packed

TO: California Olive Committee, Fresno, CA The undersigned certifies to the Committee and the Secretary of Agriculture of the United States that the above stated quantities, varieties and styles of olives were packed on the date shown above. By: __________________________________________________________________ Title: _________________________
Line Number __________________________________________________ listed above meet quality and size requirements for canned ripe olives under the Federal Marketing Order No 932.
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.	____________________________________________ Inspector USDA Agricultural Marketing Service Fruit and Vegetable Program, Specialty Crop Inspection Division 2202 Monterey Street, Suite 102C, Fresno, CA 93721

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-4 (Rev. 01/2014. Destroy previous editions.)