ACP-2 Failed Lot Notification & Rework/Disposition Report Form

OMB No. 0581-0215

Federal Marketing Order 983 - Administrative Committee for Pistachios

Failed Lots: Notification and Rework/Disposition Report

Submit to:

Administrative Committee for Pistachios

4938 East Yale Avenue, Suite 102

Fresno, California 93727

Phone: (559) 255-6480 Fax: (559) 255-6485
Email: [email protected]

Federal Marketing Order §983.52: handlers shall notify the Administrative Committee for Pistachios (ACP) of all lots that fail to meet the order's maximum aflatoxin requirements by completing and submitting this report to the ACP. Use this form to report a failed lot (Section A) and to report the rework/disposition of this failed lot (Section B). Each section is to be signed and dated.

1. Failed Lot Report – complete, sign, date, and submit to the ACP within 10 days of lot failure. Save a copy for your records. Complete Section B to report the rework/disposition of this failed lot.

Handler Name

Sampled by (lab/name)

Sample Date

Lot Description

Lot ID/Marks

Weight in Pounds

Container size/description

Test 1 Result

Test 2 Result

Average Result

Certificate No.

Prepared By

Title

Signature

Signature Date

2. Failed Lot Rework/Disposition – complete Section B within 10 days of the rework or disposition of the failed lot. Sign, date and submit to the ACP

Rework Report

Pounds Reworked

Pounds Accepted

New Lot Description

New Lot ID/Marks

New Container size/description

Test 1 Result

Test 2 Result

Test 3 Result

Avg 1 & 2

Avg 1,2, & 3

Pass Retest? Yes / No

Certificate No.

Disposition Report – check method of disposition if not reworked.

	Exported	Pounds Shipped	Country	Customer	BL No.
	Non-Human Consumption	Pounds Shipped	Description of use:		BL No.
	Shelled Out	Pounds Shelled

Date of Rework/Disposition

Form Prepared By

Title

Signature

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- 0215. 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.

ACP-2 (Exp. XXXXXX. Destroy previous editions.)