CDGAC-5 925-CA Desert Grapes Experimental Container Permit

OMB No. 0581-0189

CALIFORNIA DESERT GRAPE ADMINISTRATIVE COMMITTEE

82901 Bliss Avenue

Indio, CA 92201

Phone: (760) 342-4385

Fax: (760) 342-0485

Email: [email protected]

EXPERIMENTAL CONTAINER PERMIT □ New

□ Renewal

Date ________________________________ Permit No. _____________________________

Applicant: __________________________________ Telephone No. __________________________

Maximum Number of Containers:

Product:

Shipment from Previous Year:

Description of Container and Department’s understanding of Container:

Material Depth Width Length

Container Manufacturer:

Effective Date: ____________________, 20__ Termination Date: ___________________, 20__

• Experimental Container Permit No. _____ shall be clearly and conspicuously stamped in letters not less than one half inch in height on one end of each container and NOT ON THE BOTTOM OF THE CONTAINER.

• The Permittee shall maintain a record for one year of the place and date of shipment and the number of containers shipped. Within this period and upon demand, the California Desert Grape Administrative Committee may inspect this record.

• It is unlawful to label containers in excess of the number shown on the permit.

• This permit will be canceled for violation of either its terms or the applicable section of the California Administrative Code.

• All applicable marking requirements of Fruit and Vegetable Quality Control Standardization shall apply to this experimental container.

By ________________________________________________

Manager

California Desert Grape Administrative Committee

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 0581-0189. The time required to complete this information collection is estimated to average 10 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.

CDGAC-5 (Exp. X/XXXX) Destroy previous editions.