CMC-DISP Handler Disposal Certification

OMB Control #: 0581-0189 CMC Form: DISP

Crop Year:

Disposal Date:

Filing Date:

HANDLER DISPOSAL CERTIFICATION

For any crop year in which a handler withholding is established under §929.54 of the Marketing Order, this certificate is required to be completed by all handlers of cranberries to certify to the Cranberry Marketing Committee that cranberries acquired by the handler have been withheld from handling. All definitions used in this form shall have the same meaning as those in §§929.1- 929.17 of the Marketing Order.

Note: This form applies to disposal activities. Handlers wishing to receive credit for withheld cranberries diverted to non-commercial outlets should use the “Application for Outlets for Excess Fruit.” This form must be filed no more than two weeks following the disposal date.

Handler Name:

Address:

Contact Name: Phone: Email:

Withheld Cranberry Details

1. Marketable Cranberries Disposed in this Lot:* (bbl.) *Disposal of forms other than whole fruit requires appropriate conversion applying approved CMC conversion rates.	2. Form of Disposed Cranberries Whole Fruit 50 Brix Concentrate Low Brix Juice Dried Cranberries Other	3. Amount of Processed Cranberries in Lot If form in Box 2 is other than Whole Fruit, identify volume in processed form: Concentrate/Low Brix Juice: (gallons) SDCs: (pounds) Other:	4. Lot Details Container Type: Bins Drums Bulk Other # Containers Reference # Storage/Delivery Location:
Withheld cranberries must meet the standards of grade, size, quality and condition established by the Committee under the applicable volume regulation.

Complete This Section if Disposing Whole Fruit

5. Lot Quality Percent Marketable: % Percent Defect : % Total Marketable: (bbl)

6. Receiving Information (Optional) Grower Name: Delivery Date: Receiving #: Receiving Location:

Complete This Section for All Disposals

Disposal Site/Lot Recipient: Address: Contact Name: Phone: Email:
Truck Info:	Transport Co:	Truck #:	Bin Weight:
	Gross Weight:	Net Weight:	Tare Weight
Disposal Method (Choose one):
Sanitary Landfill Composting Fermentation Incineration Other (Describe): Disposal of Concentrate/Low Brix Juice via Wastewater Treatment Process (*Attach documentation to confirm volumes.)

HANDLER CERTIFICATION
I, hereby certify to the CMC and the Secretary of Agriculture that this is a true and correct record of information regarding the undersigned Handler for the current crop year, and that the undersigned handler has a good faith intent to withhold cranberries in accord with the Marketing Order as described herein. I further certify that I have the authority to make such representation on behalf of the undersigned handler.
Name:	Title:
Signature:	Date:

INSPECTOR CERTIFICATION (If Applicable)
The undersigned recipient of the lot of withheld cranberries that are described herein has received them for the purposes of disposing of them in the manner described herein. I hereby certify to the CMC and to the Secretary of Agriculture that the withheld cranberries have been disposed as described herein.
Company Name:
Name:	Title:
Signature:	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 0581-0189. 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.

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To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or

(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.