Walnut Marketing Board

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California Walnut Board											                                 OMB NO. 0581‑0178
101 Parkshore Drive, Suite 250										                                 CWB Form #1
Folsom, CA  95630											                                              Due Date: JANUARY __, 20__
Ph (916) 932-7070  Fax (916) 932-7071				

CROP ACQUISITION REPORT, BY COUNTY AND VARIETY, FOR CROP YEAR 2017

This report of crop acquisitions by county and variety is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended.  In executing this form, the handler respectively certifies to the California Walnut Board and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions:	1.	Report ALL crop acquisitions, except Interhandler transfers, by county and variety including your own production as a grower.
2.	Report all quantities in inshell pounds. If you did not have any acquisitions, write “NONE” on the form.
3.	Your total crop figures for county and variety must agree.
4.	Mail a signed original to the California Walnut Board (CWB) office on or before January __, 20__.



COUNTY
INSHELL POUNDS
COUNTY
INSHELL POUNDS

VARIETY
INSHELL POUNDS
Alameda

Riverside


Ashley

Amador

Sacramento


Chandler

Butte

San Benito


Eureka/Eureka types 

Calaveras

San Joaquin


Franquette

Colusa

San Luis Obispo


Hartley

Contra Costa

San Mateo


Howard

El Dorado

Santa Barbara


Livermore

Fresno

Santa Clara


Payne

Glenn

Santa Cruz


Serr

Kern

Shasta


Tehama

Kings

Solano


Tulare

Lake

Sonoma


Vina

Madera

Stanislaus


Other (please list):

Marin

Sutter




Mendocino

Tehama




Merced

Tulare




Monterey

Ventura




Napa

Yolo




Nevada

Yuba




Placer

Other ____________________






TOTAL


TOTAL


Handler: _____________________________________________________	By: ______________________________________________

Title: ________________________________________________________	Date: ____________________________________________

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, United States Code, which provides for the penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more than 5 years, 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 1 hour 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.