COC-23 Olives - Grower Authorization to Combine Lots

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

GROWER AUTHORIZATION TO COMBINE LOTS

CROP YEAR: __________________ DATE: ______________________

(1) TO: California Olive Committee 770 E. Shaw Avenue, Suite 210 Fresno, CA 93710	(2) FROM: (3) EIN: _____________________
(4) DATE: _________________________ VARIETY: ______________________________________ REPORT ON FORM(S) COC-3 NO.: ____________________________________________________________ ___________________________________________________________________________________________

(5) SIGNATURE OF AUTHORIZATION:
PRODUCER	AGENT	COUNTY	NO. OF CONTAINERS	NET WEIGHT

AUTHORIZATION: The above signature of the producer or his duly appointed agent does hereby authorize the above-named handler to combine the lot of natural condition olives shown above with other lots of natural condition olives for the purpose of weighing and size-grading in accordance with section 932.15 (a)(i)(ii) of Olive Marketing Order No. 932. This information is used to verify the provisions of the order, 7 CFR 932.161. Making any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for a 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 6 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-23 (Rev. 01/2014. Destroy previous versions.)