CWB 7 (984) CA Walnuts - Quarterly Repot of Receipt of Walnuts

OMB No. 0581-0178

California Walnut Board Quarter (1, 2, 3, 4) ____

101 Parkshore Drive, Suite 250

Folsom, CA 95630

Ph (916) 932-7070; Fax (916) 932-7071

QUARTERLY REPORT OF RECEIPT OF WALNUTS PRODUCED OUTSIDE THE UNITED STATES

The undersigned certifies to the California Walnut Board (Board) and the Secretary of Agriculture of the United States that during the quarter ending ____________, 20___, the following quantities of walnuts produced outside the United States were received at _______________ (Plant Location), California and that copies of the substantiating product tags attached are true and correct.

	CURRENT QUARTER’S RECEIPTS			YEAR TO DATE FROM SEPTEMBER 1
	INSHELL
	Pounds		Country of Origin	Pounds	Country of Origin
TOTALS
		SHELLED
TOTALS

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, of the United States Code, which provides for the penalty of a fine for individuals and for organizations or imprisonment, 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 5 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 CWB 7

This report is submitted pursuant to the provisions of Section 984.476 of the Administrative Rules and Regulations of Marketing Order No. 984, as amended.

1. Reports covering the quarter applicable shall be submitted not later than the 5th day of the month following the end of the quarter (see below for specific dates). IT IS IMPORTANT THAT THE REPORTS COVER ALL IMPORTED WALNUTS.

Due Dates Quarter Covered

December 5 September - November

March 5 December - February

June 5 March - May

September 5 June - August

2. All quantities on the report shall be in pounds.

3. Reports shall be certified by a responsible official of the reporting handler.

4. Each report should be numbered consecutively, beginning with No. 1 for the first quarter of the crop year during which such walnuts were received.

5. The total receipts of the walnuts during the current quarter, as shown on the report in the first two columns, shall be supported by a copy of a product tag(s) covering each and every receipt of walnuts. These product tags shall clearly show the name of the tenderer from whom received, the number of containers and the customs entry ID number, whether or not the product is inshell or shelled, the volume of the shipment, country of origin, and the name of the DFA inspector and the date.

6. Contact the Board office in Folsom for any points that are not clear.

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 7 (Rev. 1/2017) Destroy previous editions.