COC-5 (932) Olives Rept. of Limited, Undersized, and Cull Oliv

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE

REPORT OF LIMITED AND UNDERSIZE AND CULL OLIVES

INSPECTION AND DISPOSITION

CROP YEAR: __________ PAGE NO. ___________

(1) (1) TO: California Olive Committee 770 E. Shaw Avenue, Suite 310, Fresno, CA 93710 (2) FROM: __________________________________________________________ __________________________________________________________

(4) CONSIGNED TO: __________________________________________________ __________________________________________________ __________________________________________________

(3) EIN NO.: ___________________________

(5) DISPOSITION

No. of Containers	Type of Containers	Variety	LIMITED	UNDERSIZE	CULLS	Whole/ Pitted	Outlet	Handler
			Net Weight	Net Weight	Net Weight
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)
FOR COC USE ONLY

(6) CERTIFICATION AND SIGNATURE: The undersigned, on behalf of the reporting handler, certifies to the California Olive Committee and the Secretary of Agriculture of the United States: (1) That this represents a complete and accurate report of Limited, Undersize, and Cull olives presented for disposition; and (2) That such olives are to be used by the consignee listed above and for the purpose reported.

____________________________________________________________ _________________________________________ ______________________
Authorized Official Title Date

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 15 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 COC-5

GENERAL: Use this form for reporting all Limited and Undersize and Cull olives for disposition in satisfaction of requirements imposed by the Marketing Order and the California Olive Committee’s (COC) Rules and Regulations. This report will be used by the COC to credit your account against your obligations of Limited, Undersize, and Cull olives. Each form COC-5 is to be numbered consecutively from the beginning of each new crop year.

ITEM (2): Name and address of reporting handler

ITEM (3): Handler’s Employer Identification Number

ITEM (4): Name and address of consignee (another handler, oil processor, etc.)

ITEM (5): Complete each column in accordance with headings:

(a) Total number of containers

(b) Type of containers (boxes, bins)

(c) List variety of olive, one variety to a line

(d)(e)(f) LIST NET WEIGHT UNDER LIMITED, UNDERSIZE, OR CULLS, AS APPLICABLE (use columns for weights only). Net weight may either be actual net weight, or may be estimated net weight. If estimated net weights are used, show “Est” as the estimated weight.

CO-MINGLED LOTS OF LIMITED, UNDERSIZE, AND CULL OLIVES WILL NOT SATISFY OLIGATION.

(g) Show whether Whole (W) or Pitted (P) weights are reported. The Committee allows 1.333% pit allowance.

(h) List outlet (Green, Sicilian, Oil, etc.)

(i) To be used by Handler for notation of Count per Pound, Whole, Green Fruit, etc.

ITEM (6): Certification and Signature

This information is used to verify the provisions of the Marketing Order, 7 C.F.R. 932.51. Making false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing to be false, is a violation of title 18, section 1001, of the United States Code, which provides for penalty of a fine or imprisonment, or both.

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674).  Furnishing the requested information is necessary for the administration of the marketing order program.

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.

COC-5 (Rev. 06/2016) Destroy previous editions.