No Form Number 906-TX Citrus Application & Certification Citrus By-Prod

OMB No. 0581-0189

TEXAS VALLEY CITRUS COMMITTEE Telephone: (956) 581-2190

901 Business Park Drive, Suite 400 Fax: (956) 584-3307

Mission, Texas 78572

APPLICATION & CERTIFICATION

CITRUS BY-PRODUCTS PURCHASE AGREEMENT

Firm: ___________________________________________________ Phone No.: ___________________________

Mailing Address: _______________________________________________________________________________

(Address, City, State, Zip Code)

Physical Address: _____________________________________________ Fax No.: _________________________

(If Different Than Mailing Address)

Our firm, which is engaged in the manufacture of citrus products, hereby requests that the Texas Valley Citrus Committee (Committee) approve this application for eligibility under sections 906.34 and 906.40 of Marketing Order No. 906.

In submitting this application, the undersigned organization understands that all the Texas citrus our firm receives that is exempt from regulations must be used solely for the processing of juice products. We agree:

1. that citrus received for processing will under no circumstances enter into fresh fruit marketing channels;

2. not to sell or transfer for sale, directly or indirectly, any fruit from Texas for processing;

3. to maintain our Perishable Agricultural Commodities Act (PACA) license during the period when buying fruit from Texas;

4. to undergo random inspection by the Committee or by a designated State/Federal Agency;

5. to not have facilities, equipment, or outlets to repack or sell fruit in its fresh form;

6. to report on the “Orange and Grapefruit Diversion Report” provided by the Handler from whom the fruit is purchased, the actual weight of the fruit, by attaching the scale ticket at the point of receiving to the proper copy of the Diversion Report. This shall be returned to the Committee within the week; and

7. that failure to comply with the terms of this Agreement, will cause removal of our name from the list of certified processors.

This Agreement, when signed by an authorized agent and returned to the Committee, will serve as certification of a receiver of Texas citrus for processing into juice products.

By: ___________________________________________ _____________________________

Signature of Processor Date

______________________________________________ _____________________________

Name (please print) Title

Person Responsible for Orange & Grapefruit Diversion Report: __________________________________________

NO SHIPMENTS OF SPECIAL PURPOSE ORANGES OR GRAPEFRUIT MAY BE MADE UNTIL THIS FORM HAS BEEN APPROVED BY THE COMMITTEE.

Approved by: ____________________________________________ ____________________

Texas Valley Citrus Committee 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 OMB 0581-0189. The time required to complete this information collection is estimated to average 20 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.

(Exp. x/xxxx) Destroy previous editions.