SC-266-9 920-Kiwifruit Shipment Report

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

SHIPMENT REPORT

CROP YEAR 20___/20___

Kiwifruit Administrative Committee Company: _________________________________

Mail to: 1521 “I” Street, Sacramento, CA 95814 Contact: ___________________________________

Or Fax to (916) 446-1063; Email: [email protected] Phone No.: _________________________________

Phone No.: (916) 441-0678

Reporting Month: __________________ __________________ Check if this is your final report of the season

Please Note: The following information is to be current as of the last day of the reporting month and filed with the Committee/Commission no later than the fifth (5^th) day of the following month. This information is being required to assure accurate and timely statistics to assist you. Each individual handler report is completely confidential.

	Pack Style – Enter Pack Style at the Top of Each Column
Domestic
Canada
Taiwan
Japan
Hong Kong
Korea
Australia
Mexico
Singapore
Not list – note market
TOTALS

I hereby certify to the best of my knowledge and belief that this report is true and complete. I understand that records from which this report is compiled are subject to audit and must be preserved for a period of two years.

_________________________________________________ _____________________________

Signature Date

_________________________________________________

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 OMB 0581-0189 The time required to complete this information collection is estimated to average 30 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 the Shipment Report:

1. Reports are due on the fifth (5^th) of each month for the previous month’s shipments.

2. Enter appropriate Handler/Marketer information.

3. Enter reporting month.

4. Indicate if report is the final one of the season.

5. Across the top of the columns, enter the type of pack styles shipped during the given reporting period. (Select pack styles from list below).

6. For each country, enter the total number of containers shipped per each pack style reported.

7. Sign and date report.

Description	Enter this pack style on report
9 kg (19.8 lb.) Volume Fill	Volume Fill
Single layer tray	Trays
Container with 3-layers	3-Layers
125 lb. Bins	Bins
Master Container with 20 – 1 lb. Bags	20/1# Bags
Master Container with 10 – 1 kg Bags	10/1 kg Bags
Master Container with 4 – 4 lb. Clams	4/4# Clams
Master Container with 8 – 2 lb. Clams	8/2# Clams
Master Container with 27 – .8 lb Clams	27/.8# Clams
Master Container with 18 – 8 ct. Clams	18/8 ct. Clams and net wt. of master container
Master Container with 20 – 6 ct. Clams	20/6 ct. Clams and net wt. of master container
Returnable Plastic Containers, 9 kg	RPC 9kg
Containers with 2-layers	2-layers and net wt. of container
Euro Containers, must include description and net wt. (i.e. Euro 2-layers, 20#)	Type and net wt. of container
Any other container type/consumer pack must include the description and container net wt.	Type and net wt. of container

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.

SC-266-9 (Rev. 9/2016. Destroy previous editions.)