ABC 34 (981) CA Almonds Application to be Approved as Accepted

OMB No. 0581-0178

ALMOND BOARD OF CALIFORNIA

1150 9th Street, Suite 1500

Modesto, CA 95354

Tel: (209) 549-8262 Fax: (209) 550-5494

APPLICATION TO BE APPROVED AS AN ACCEPTED USER OF

INEDIBLE ALMONDS AND ALMOND WASTE

Application is made herewith to be listed by the Almond Board of California (ABC) as an Accepted User of inedible almonds and almond waste, and for approval of the use of such material in the outlet(s) checked below:

□ crushing for almond oil

□ mixing into feed

□ feeding directly to livestock or poultry

This will occur at (Street and City):

In consideration of the approval of this application, the undersigned agrees that all almond material acquired from almond handlers or growers will be used only for the purposes indicated, that none will be disposed of for human consumption, and that ABC employees may enter the applicant’s premises at any reasonable time to observe the storage or disposition of the almond material and to examine and audit all books and records necessary to substantiate compliance with quality control provisions governing inedible dispositions. The undersigned also agrees to obtain from each almond handler an executed ABC Form 8 on each lot of material received, and upon crushing, mixing or feeding the almonds, to execute part (b) of the form, and to mail it promptly to the ABC. The undersigned also agrees to furnish to the ABC with a public weight master certificate substantiating the weight of the inedible material received applicable to each Form 8. The weight tag will be issued at the time of receipt in the name of the undersigned. The undersigned also agrees to complete and submit an accepted user data sheet as part of the ABC’s annual process of granting accepted user status. The undersigned also acknowledges that accepted user status is subject to revocation at any time by the ABC for cause.

The undersigned hereby certifies to the U.S. Department of Agriculture and to the ABC that the information supplied herein is complete and correct, and that the above agreement as to usage and reporting is accepted.

The making of any false statement or representation on this form, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for the penalty of a fine or imprisonment of not more than five years, or both.

User Firm		Date
Address
Telephone		Fax
By		Title

Application is hereby approved, for the 20___ - 20___ crop year, _________________, 20___ through __________________, 20___, subject to revocation for cause.

Date ________________________, 20___

By _______________________________________ Title__________________________

Almond Board of California

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 0581-0178. 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.

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.

ABC-34 (Rev. 01/2017) Destroy previous editions.