Request for Cooperative Pool Mfg. Plant System Status

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAM

Address: XXX

Form Approved, 0MB No. 0581-0032
Exp. XX/XXXX

XXX
Phone:XXX

XXX FEDERAL MILK ORDER XXX

Fax: XXX
E-mail: XXX

Request for Cooperative Pool Manufacturing Plant System Status
Date:
To:

Market Administrator

From:
(Cooperative Handler Name which is Responsible for System)

Subject:

Request for Cooperative Pool Manufacturing Plant System Status

The cooperative(s) listed in Section 2 hereby request(s) pool plant status for the plants identified below:
Section 1: Sequence of Cooperative Manufacturing Plants Within System
City
Plant Names
Affiliation*

State

* Abbreviated cooperative name.
Section 2: Names/Signatures of Cooperative Representatives Within System
Cooperative Name
Signature
Name of Representative/Title**

** Persons signing System forming document must be authorized to sign reports.
Section 3: Effective Date
Month:

Year:

Date

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