SC-170 (993) Prune Form No. 1-Sec. 8e Entry Declaration

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

PRUNE FORM NO. 1

Prunes – Section 8e Entry Declaration

I certify to the U.S. Department of Agriculture (USDA) and the U.S. Customs and Border Protection that none of the manufacturing grade substandard prunes being imported and which are identified below will be used other than in manufacturing in which the prunes lose their form and identity as prunes.

1. NAME OF VESSEL	2. COUNTRY OR ORIGIN OF PRUNES	3. DATE OF ARRIVAL
4. CITY OF ARRIVAL	5. UNLOADING PIER	6. USDA CERTIFICATION OF QUALITY AND CONTAINER NO.

7. SUBSTANDARD PRUNES ENTERED:

LOT OR CHOP MARK	NO. OF CONTAINERS	TOTAL NET WEIGHT (pounds)

I agree to obtain from each person to whom any of the manufacturing grade substandard prunes listed under item 7 are delivered, an executed Prune Form No. 2 (Prunes-Section 8e Certification of Processor or Reseller) and to file the same with the Specialty Crops Program, Agricultural Marketing Service, U.S. Department of Agriculture, Washington, D.C. 20250, not later than the 5^th day of the month following the month in which the prunes were delivered.

NAME OF FIRM:

ADDRESS:

SIGNATURE OF AUTHORIZED OFFICIAL

TITLE

DATE

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.

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.

SC-170 (Exp. x/xxxx) Destroy previous editions.

DISTRIBUTION: Original – U.S. Customs and Border Protection; Copy – Specialty Crops Program, AMS, Washington, D.C.