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

California Walnut Board
110 Woodmere Rd., Suite 250
Folsom, CA 95630
Ph (916) 932-7070 Fax (916) 932-7071

OMB NO. 0581-0178
CWB Form #1
Due Date: JANUARY 15, 20__

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:

COUNTY
Alameda
Amador
Butte
Calaveras
Colusa
Contra Costa
El Dorado
Fresno
Glenn
Kern
Kings
Lake
Madera
Merced
Placer
Riverside
Sacramento
San Benito
San Joaquin
San Luis

1.
2.
3.
4.

Report ALL crop acquisitions, except Interhandler transfers, by county and variety including your own production as a grower.
Report all quantities in inshell pounds. If you did not have any acquisitions, write “NONE” on the form.
Please complete BOTH Section 1 and Section 2. Your totals for county and variety must agree.
Submit a signed original to the California Walnut Board (CWB) office on or before January 15, 20__.

SECTION 1: COUNTY

INSHELL POUNDS

Conventional

Organic

COUNTY

Santa Barbara
Santa Clara
Santa Cruz
Shasta
Solano
Sonoma
Stanislaus
Sutter
Tehama
Tulare
Yolo
Yuba
Other (list):

INSHELL POUNDS

Conventional

Organic

SECTION 2: VARIETY

VARIETY

Ashley
Chandler
Chico
Eureka/Eureka types
Franquette
Hartley
Howard
Ivanhoe
Livermore
Payne
Serr
Solano
Sunland
Tehama
Tulare
Vina
Other (list):

TOTAL:

TOTAL (must = Section 1):

TOTAL Acquired:

TOTAL Acquired:

INSHELL POUNDS

Conventional

Organic

Handler: _____________________________________________________

By: ______________________________________________

Title: ________________________________________________________

Date: ____________________________________________
OVER→

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.
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.
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.

CWB Form 1 (Exp. 4/30/2027) Destroy previous versions.