CWB 1 (984) CA Walnuts - Crop Acquisition Report by County & V

California Walnut Board OMB NO. 0581‑0178

101 Parkshore Drive, Suite 250 CWB Form #1

Folsom, CA 95630 Due Date: JANUARY 15, 20__

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

CROP ACQUISITION REPORT, BY COUNTY AND VARIETY, FOR CROP YEAR 20__

This report of crop acquisitions by county and variety is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended. In executing this form, the handler respectively certifies to the California Walnut Board and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions: 1. Report ALL crop acquisitions, except Interhandler transfers, by county and variety including your own production as a grower.

2. Report all quantities in inshell pounds. If you did not have any acquisitions, write “NONE” on the form.

3. Please complete BOTH Section 1 and Section 2. Your totals for county and variety must agree.

4. Mail a signed original to the California Walnut Board (CWB) office on or before January 15, 20__.

SECTION 1: COUNTY					SECTION 2: VARIETY
COUNTY	INSHELL POUNDS	COUNTY	INSHELL POUNDS		VARIETY	INSHELL POUNDS
Alameda		Santa Barbara			Ashley
Amador		Santa Clara			Chandler
Butte		Santa Cruz			Chico
Calaveras		Shasta			Eureka/Eureka types
Colusa		Solano			Franquette
Contra Costa		Sonoma			Hartley
El Dorado		Stanislaus			Howard
Fresno		Sutter			Ivanhoe
Glenn		Tehama			Livermore
Kern		Tulare			Payne
Kings		Yolo			Serr
Lake		Yuba			Solano
Madera		Other (please list): list): ____________________			Sunland
Merced					Tehama
Monterey					Tulare
Placer					Vina
Riverside					Other (please list):
Sacramento
San Benito
San Joaquin
San Luis Obispo		TOTAL (must = Section 2)			TOTAL (must = Section 1)

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. OVER

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 1 hour 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 Form 1 (Exp. x/xxxx) Destroy previous versions.