ABC 34 (981) CA Almonds Application to be Approved as Accepted

OMB No. 0581-0178

ALMOND BOARD OF CALIFORNIA

1150 9th Street, Suite 1500

Modesto, CA 95354

Tel: (209) 549-8262 Fax: (209) 550-5494

APPLICATION TO BE APPROVED AS AN ACCEPTED USER OF

INEDIBLE ALMONDS AND ALMOND WASTE

Application is made herewith to be listed by the Almond Board of California as an Accepted User of inedible almonds and almond waste, and for approval of the use of such material in the outlet(s) checked below:

□ crushing for almond oil

□ mixing into feed

□ feeding directly to livestock or poultry

This will occur at (Street and City):

In consideration of the approval of this application, the undersigned agrees that all almond material acquired from almond handlers will be used only for the purposes indicated, that none will be disposed of for human consumption, and that Board employees (or designated parties) may enter the applicant’s premises at any reasonable time to observe the storage or disposition of the almond material and to examine and audit all books and records necessary to substantiate compliance with quality control provisions governing inedible dispositions. The undersigned also agrees to the following requirements:

• Submission of Business Data Sheet (ABC-31) to the Board.

• Submission of Accepted User Plan (ABC-30) to the Board.

• Submission of Inedible and Exempt Outlet Disposition Notice (ABC-8) Part B to the Board for each lot of almond material received. Each lot of almond material received must be supported by a public weighmaster weight certificate that was issued at the time of receipt of the lot. The weighmaster weight certificate must be submitted to the Board within 10 business days of issuance.

• Disposal of almond material within 6 months of receipt.

• Direct disposal of almond material received with no transfer of almond material between accepted users.

The undersigned acknowledges that accepted user status is subject to revocation at any time by the Board for cause.

The undersigned hereby certifies to the U.S. Department of Agriculture and to the Board that the information supplied herein is complete and correct, and that the above agreement as to usage and reporting is accepted.

The making of any false statement or representation on this form, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for the penalty of a fine or imprisonment of not more than five years, or both.

User Firm		Date
Address
Telephone		Fax
By		Title

Application is hereby approved, for the 20___ - 20___ crop year, _________________, 20___ through __________________, 20___, subject to revocation for cause.

Date ________________________, 20___

By _______________________________________ Title__________________________

Almond Board of California

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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.

ABC-34 (Exp. x/xxxx) Destroy previous editions.