CWB 6 (984) CA. Walnuts - Report of Merchantable Wallnuts Ship

California Walnut Board OMB NO. 0581-0178

101 Parkshore Drive, Suite 250 CWB Form #6

Folsom, CA 95630 Due Date: ___________

Ph (916) 932-7070 Fax (916) 932-7071 Month: ______________

REPORT OF MERCHANTABLE WALNUTS SHIPPED

This report of merchantable walnuts shipped 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 walnut receipts for the month in Inshell Pounds.

2. Report inshell and shelled by domestic and export shipments (in pounds).

3. Report all export shipments by country of destination on the attached page.

4. If you did not make any shipments, write “NONE” on the form.

5. Fax or email a copy to the California Walnut Board (CWB) office on or before __________.

WALNUT RECEIPTS
		Inshell Pounds
Received for the month of ______ _______:
WALNUT SHIPMENTS (in pounds)
	Inshell		Shelled
Domestic
Export
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 a penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more than five 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 10 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.

OMB NO. 0581-0178

Handler Name:_______________________________________ CWB Form #6

Due Date: ____________

Month: ______________

SHIPMENTS BY COUNTRY OF DESTINATION

	INSHELL (Pounds)	SHELLED (Pounds)		INSHELL (Pounds)	SHELLED (Pounds)
MIDDLE EAST/AFRICA			NORTH AMERICA
Algeria			Canada
Bahrain			Mexico
Egypt			CENTRAL & SOUTH AMERICA
Iraq			Chile
Israel			Ecuador
Jordan			ASIA/PACIFIC RIM
Kuwait			Australia
Lebanon			China
Morocco			Hong Kong
Pakistan			India
Qatar			Japan
Saudi Arabia			Korea
Tunisia			Malaysia
Turkey			New Zealand
U.A.E.			Philippines
EUROPE			Singapore
Austria			Taiwan
Belgium			Thailand
Denmark			Vietnam
France
Germany			OTHERS (please list)
Greece
Italy
Netherlands
Norway
Portugal
Spain
Sweden
Switzerland
U.K.
			TOTALS

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.

CWB 6 (Rev. 10/2018) Destroy previous editions.