RAC-510 (989) Non-California Raisins

OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE Deliver or mail to:

2445 Capitol Street, Suite 200 Raisin Administrative Committee

Fresno, California 93721 and

Phone: (559) 225-0520 USDA Processed Products Inspection Service

NON-CALIFORNIA RAISINS

1.	Producer’s name
2.	Mailing address
3.	Email address
4.	Location and address of production unit, including Section, Township, and Range
5.	Acreage of production unit								acres
	County of production unit
6.	Raisin net fruit weight									pounds
	Variety
7.	Documents required and attached
	a.	For USA raisins produced outside of California:
			Commission processing order
			Bill of lading or equivalent, with State of California stamp and date obtained at border crossing
			Weight tags
	b.	For raisins produced outside of USA:
			US Customs entry form

I hereby agree to comply with all the regulations established for non-California raisins and certify that the raisins produced from grapes on the production unit identified herein are true and correct.

The making of any false statement 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 of not more than five years, or both.

Handler _____________________________________ Date ____________________________

Signature ____________________________________ Title ____________________________

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.

INSTRUCTIONS FOR COMPLETING FORM RAC-510

This report is supplemental to the RAC-500 and the information herein is required pursuant to section 989.157 of Federal Marketing Order No. 989, as amended.

1. Insert the name of producer, tenderer or equity holder as applicable (Individual, Partnership or Corporation name).

2. Show mailing address and phone number.

3. Show the location and address of the production unit, including the Section, Township and Range.

4. Show acreage of production unit, and County where produced.

5. Show raisin net fruit weight in pounds and varietal type.

6. All documents listed below are REQUIRED to be attached to this form and submitted to the Raisin Administrative Committee and the USDA Processed Products Inspection Service.

1. For USA raisins produced outside of California:

The Commission Processing Order from the State where produced, the bill of lading or equivalent with the State of California stamp and date obtained at the border crossing, and weight tag(s).

2. For raisins produced outside the U.S.A.:

The U.S. Customs import entry form.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

RAC-510 (Rev. 01/2017) Destroy previous editions.