ACP-2 Failed Lot Notification

OMB No. 0581-0215

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

4938 East Yale Avenue, Suite 102, Fresno, CA 93727

Tel (559) 255-6480; Fax (559) 255-6485

Email: [email protected]

FAILED LOT NOTIFICATION

Section A: Complete the following information for the failed lot and send the original to the Administrative Committee for Pistachios office within 10 days of test completion. Provide a copy to the Handler for their records.

Lot description: ________________________ Lot ID marks: _________________________

Weight: _______________ Lbs. Container size/description: _________________________

Handler of the product: ________________________________________________________

Address: _________________________ City: ______________ State: ____ Zip Code:_____

Sampled by: ______________________ Date: ______________ Of (Agency) ____________

Section B: To be completed by the Handler. Record whether lot failed minimum quality and the certificate number.

Did lot fail minimum quality standard? Yes: ____ No: ____ Certificate No.: ____________

Section C: To be completed by the Aflatoxin Testing Laboratory. Record whether lot failed aflatoxin and the certificate number. Record the aflatoxin results and averages.

Did lot fail aflatoxin test requirement? Yes: ____ No: ____ Certificate No.: ____________

Result for Test 1: _________ Result for Test 2: ________ Average result: _______________

(Average of Test 1 and 2)

Signature: _________________________________________ Date: ______________________ Form Initiator: ___________________________________ Company: _____________________

Address: ___________________________ City: __________ State: ______ Zip Code: _______

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 0581-0215. The time required to complete this information collection is estimated to average 12 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.

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.

ACP-2 (Rev. 05/2017. Destroy previous editions.)