CWB 7 (984) CA Walnuts - Quarterly Repot of Receipt of Walnuts

California Walnut Board OMB NO. 0581-0178

101 Parkshore Drive, Suite 250 CWB Form #7

Folsom, CA 95630

Ph (916) 932-7070 Fax (916) 932-7071

QUARTERLY REPORT OF RECEIPT OF WALNUTS

PRODUCED OUTSIDE CALIFORNIA OR THE USA

Quarter (1,2,3,4) ________

The undersigned certifies to the California Walnut Board and the Secretary of Agriculture of the United States that during the quarter ending ____________________, _______, the following quantities of walnuts produced outside the U.S. were received at _____________________ (Plant Location), California and that copies of the substantiating product tags attached are true and correct.

	CURRENT QUARTER’S RECEIPTS		YEAR TO DATE FROM SEPTEMBER 1
	INSHELL
	Pounds	State or Country of Origin	Pounds	State or Country of Origin
TOTALS
SHELLED
TOTALS

Handler: ___________________________________________________ By: _________________________________________

Title: ______________________________________________________ Date: ________________________________________

The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of Title 18, Section 1001, United States Code, which provides for the penalty of a fine for individuals and for organizations or imprisonment, or both.

INSTRUCTIONS FOR COMPLETING CWB FORM #7

This report is submitted pursuant to the provisions of Section 984.476 of the Administrative Rules and Regulations, as amended.

1. Reports covering the quarter applicable shall be submitted not later than the 5th day of the month following the end of the quarter (see below for specific dates). IT IS IMPORTANT THAT THE REPORTS COVER ALL IMPORTED WALNUTS FROM OUTSIDE CALIFORNIA OR THE US.

Due Dates Quarter Covered

December 5 September - November

March 5 December - February

June 5 March - May

September 5 June - August

2. All quantities on the report shall be in pounds.

3. Reports shall be certified by a responsible official of the reporting handler.

4. Each report should be numbered consecutively, beginning with No. 1 for the first quarter of the crop year during which such walnuts were received.

5. The total receipts of the walnuts during the current quarter, as shown on the report in the first two columns, shall be supported by a copy of a product tag(s) covering each and every receipt of walnuts. These product tags shall clearly show the name of the tenderer from whom received, the number of containers and the customs entry ID number for foreign imports, whether or not the product is inshell or shelled, the volume of the shipment, state or country of origin, and the name of the DFA inspector and the date.

6. Contact the CWB office in Folsom for any points that are not clear.

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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). 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.

CWB 7 (Exp. x/xxxx) Destroy previous versions.