COC-4 (932) Olives Pack and Certification Report

OMB No. 0581-0178

CALIFORNIA OLIVE COMMITTEE
PACK & CERTIFICATION REPORT FOR CANNED RIPE OLIVES

HANDLER _________________________________________________________ PAGE NO. _______________

ADDRESS _________________________________________________________ DATE PACKED ___________

	Variety (A)	Style of Pack (B)	Fruit Size (C)	Cans per Case & Size (D)	Container Code (Incl. Batch Nos.) (E)	Cases Packed (F)	Remarks (G)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
					Total Cases Packed

TO: California Olive Committee, Fresno, CA The undersigned certifies to the Committee and the Secretary of Agriculture of the United States that the above stated quantities, varieties and styles of olives were packed on the date shown above. By: __________________________________________________________________ Title: _________________________
Line Number __________________________________________________ listed above meet quality and size requirements for canned ripe olives under the Federal Marketing Order No 932.
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.	____________________________________________ Inspector USDA Agricultural Marketing Service Specialty Crops Program, Specialty Crop Inspection Division 2202 Monterey Street, Suite 102C, Fresno, CA 93721

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 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.

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-4 (Exp. x/xxxx) Destroy previous editions.