H-1 Still Form (Class 1-green & Class 3-blue) Identification

Far

West Spearmint Oil Administrative Committee
100 North Fruitland, Suite B

OM8# 0581-0178

·

Kennewick, WA 99336
1-800-446-0852

Send Original to Committee Office
KeepAttachedCopyfor your Records

Date

Still Form for

StillW1.

Barrel'

Location to be Stored

1
2
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8
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~

AaxInIngto Ihe PI!prwOrt~
Actr# 1995,.. ~
IIIaYnot conductor sponsor,and a
ISnot ~
to respondIII
a coIlec1Ian
r# ~
itcIiIpIIp a WIldOle conIrDIrunber. ThevalidOt48mntraInumberlot INsInI'Crm8tlon
CXllIecIIon
Is 0581-G178.The_ requIn!dto eDIIII*te11MinfIInnatIIJn
cgIec;tIonIsSImated 1D~2IJI*IuIeS
_ retpCIIIR,incLdngtile
time for reviewing11I-'
seen:hlngI!>dsDI9data seances. gatIwing _ II8inIaInIngttIe ~
needed, and compII!tIng
and
.-na
tt. a>I_
ollnformotlan.
11Ie

U.s.

Department

01 AQrtCuIIure (USDA) prohIbb

disa1mlnatlan

In lilts

pragrams

and IIdMIies

0I11he bllsis 01 racf, mIcr, national

origin, age, dlsabllty, and where appIIciIIIe. sell, mdaI status, ramllal swus. pan!l'llal status, reIigDI, seroaI Dllenlallon, genetic
inrorm.tlan, poIitkiII beliefs, repII5aI, or because 811or part of an Ind~~
OOJIIII!Isderived from iIIII'IUIIc assistance program (Not
III prohibltied !lilies apply to 811pragrwns.) PersIns wit> dIsabIIIIes who regram
infomIIIIan (8File Typeapplication/pdfFile Modified2007-08-02File Created2007-08-02