F/H Form 1(d) Hazelnuts Restricted Inshell Certified

F/H Fonn Id
OMB CONT. NO.
0581-0178

RESTRICTED
INSHELL CERTIFIED

Handler
Period
Merchantable
Date of
Inspection
Cert. No.
Inspection

JIG
Jumbo

Lar2e

Medium

Total

Location

Desc.

Total from continued
.
.
sheets No.
Totals for
(month)
Umuaded
Date of
Inspection

Inspection
Cert. No.

Total Wei!!ht

Net Credit
Wei2ht

Description

Total from continued
sheets No.
Totals for
(month)

This report is required by law (7 U.S.C. 608(d), and 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a
fine of not less than $50 or more than $5,000 for each such violation, and each day during which such violations continues
shall be deemed a separate violation.
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 O}.4B control number. The valid O}.4B control number for this information collection is 0581-0178. The time
required to complete this information collection is estimated to average 15 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. 202509410, or call (800) 795-3272 (voice) or (202) 720-6382 (IDD). USDA is an equal opportunity pravider and employer.