OMB No. 0581-0178
California Walnut Board
101 Parkshore Drive, Suite 250
Folsom, CA 95630-4726
Ph (916) 932-7070; Fax (916) 932-7071
REPORT OF SUBSTANDARD WALNUTS DELIVERED
This report of substandard walnuts delivered is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended. In executing this form, the Handler certifies to the California Walnut Board (Board) and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.
Instructions: 1. All deliveries must be made to Approved Substandard Users.
2. Complete the information below.
3. Mail a copy of the form to the Board following each delivery. Substandard Users will complete CWB Form 24-15, Report of Substandard Walnuts Received. The Board will match the forms to verify disposition of substandard walnuts.
DFA Inspection Certificate Number (if applicable) |
Kernel % |
Kind & Number of Containers |
Lot No. |
Net Weight |
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The above kernelweight of walnuts was delivered to: |
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Name of Approved User: |
________________________________________________________ |
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Delivery Date: ___________________________________________ |
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Delivered By: |
Handler: _________________________________________________ |
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By: __________________________Title: ______________________ |
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If available, attach Weighmaster Certificate for each lot.
The making of 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 the penalty of a fine for individuals and for organizations or imprisonment, or both.
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.
CWB 20 (Rev. 1/2014. Destroy previous editions.)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Walnut Marketing Board |
| Author | Jodi Newman |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |