PMC 4.72A (993) CA Dried Prunes Foreign Export Notice of Receipt o

OMB No. 0581-0178

PRUNE MARKETING COMMITTEE PMC Approval No.: ______________________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

FOREIGN EXPORT NOTICE OF RECEIPT OF

SUBSTANDARD PRUNES FOR MANUFACTURING PURPOSES

The undersigned certifies to the United States Department of Agriculture (USDA) and to the Prune Marketing Committee (Committee) that the following described shipment of dried substandard prunes was received for use in the specified and Committee-approved manner for manufacturing purposes. The undersigned further certifies that these substandard prunes will not be consumed in the form of prunes or pitted prunes but will completely lose their form and character as prunes in the manufacturing process and be used for the purpose approved by the Committee. In addition, the undersigned certifies that this product will not be transshipped to any other than the Committee-approved destination under any circumstances. The undersigned hereby agrees to permit access, by an authorized representative of the Committee or the USDA, to any facility where the product received hereunder is stored or used, or to observe the manufacturing process at any time during normal business hours. Failure to comply with the above stipulation can result in the disapproval of future requests to ship similar product.

PMC approved usage: ___________________________________________________________________________

Ocean Bill of Lading No.	Gross Weight	Net Weight	No. of Containers	Number of Suppliers	Date Received

Location - port where prunes were unloaded: _________________________________________________________

Plant or storage location - where prunes were delivered: ________________________________________________

Name and address of firm processing the prunes: _____________________________________________________

Name and address of purchasing firm: ______________________________________________________________

Signed by: _____________________________ Title: ________________________ Date: _________

INSTRUCTIONS: Complete in triplicate immediately upon receipt of the described dried substandard prunes. Return the original to the Committee; return a copy to your supplier; retain a copy for your records.

IMPORTANT NOTICE: This report is required by law (7 U.S.C. 608(d), 7 CFR § 993.50(e), §§ 993.73, 993.150(e)).

FAILURE TO REPORT can result in a fine for each such violation and each day during which such violation continues shall be deemed a separate violation. The issuance of a false certificate, knowing it to be false, is a violation of tide 18, section 1001 of the United States Code, which provides a penalty of a fine 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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

PMC 4.72A (Rev. 01/2014. Destroy previous editions.