FV-170 Prune Form No. 1-Sec. 8e Entry Declaration

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

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAM PRUNE FORM NO. 1 Prunes – Section 8e Entry Declaration

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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

I certify to the U.S. Department of Agriculture (USDA) and the U.S. Customs and Border Protection that none of the manufacturing grade substandard prunes being imported and which are identified below will be used other than in manufacturing in which the prunes lose their form and identity as prunes.

1. NAME OF VESSEL	2. COUNTRY OR ORIGIN OF PRUNES	3. DATE OF ARRIVAL
4. CITY OF ARRIVAL	5. UNLOADING PIER	6. USDA CERTIFICATION OF QUALITY AND CONTAINER NO.

7. SUBSTANDARD PRUNES ENTERED:

LOT OR CHOP MARK	NO. OF CONTAINERS	TOTAL NET WEIGHT (pounds)

I agree to obtain from each person to whom any of the manufacturing grade substandard prunes listed under item 7 are delivered, an executed Prune Form No. 2 (Prunes-Section 8e Certification of Processor or Reseller) and to file the same with the Fruit and Vegetable Program, Agricultural Marketing Service, U.S. Department of Agriculture, Washington, D.C. 20250, not later than the 5^th day of the month following the month in which the prunes were delivered.

NAME OF FIRM:

ADDRESS:

SIGNATURE OF AUTHORIZED OFFICIAL

TITLE

DATE

FV-170 (Rev. 05/2014. Destroy previous editions.)

DISTRIBUTION: Original – U.S. Customs and Border Protection; Copy – Fruit and Vegetable Program, AMS, Washington, D.C.