CDAC-4 (987) CA Dates--Date Product Manufacturers Rept.

OMB No. 0581-0178

Date Products Manufacturer’s Report Send one signed copy no later than October 16 to:

(Section 987.65 and 987.165) California Date Administrative Committee
P.O. Box 1736, Indio, CA 92202-1736

Office: 760.347.4510 Facsimile: 760.347.6374

In accordance with our agreement with the California Date Administrative Committee, this report of our beginning and ending inventories of product dates, the quantity received during the crop year, the quantity used, the type and quantity of product manufactured, and our year-end inventory of products from the crop year ending September 30, 20__.

		Deglet Noor	Halawy	Khadrawy	Zahidi
		State in terms of whole dates (1)
	Product Dates
1	Beginning Inventory of Whole Dates October 1
2	Quantity purchased from other handlers during crop year*
3	Quantity transferred from your own inventory during crop year*
4	Total quantity of Whole Dates manufactured into date product
5	Ending inventory of Whole Dates September 30

2* Handler who purchased product grade dates (CDAC Form 8) from another handler during the crop year.

3* Handler who transferred product grade dates from own inventory, must complete CDAC Form 8.

		Quantity of Dates Manufactured into Product
Types of Date Product Manufactured into Finished Product	Conversion Factor	Actual Date	Whole Date Equivalent
Pitted	0.83
Paste, Macerate	0.80
Chopped, Diced, Sliced, Extruded	0.75
Granules, Fine, Powdered Sugar	0.50
Concentrate	0.75

Inventory of Finished Date Product on hand at September 30, 20_____:

Actual Pounds of Finished Date Products: _________________________

Equivalent of line above of Finished Date Products in Whole Weight: ________________________

I hereby certify to the U.S. Department of Agriculture and to the California Date Administrative Committee that the information contained in this report is complete and accurate.

Date Product Manufacturer: ________________________________By:_______________________________

Date:_____________________________________Title:__________________________________________

The making of false statement or representation on this form, knowing it to be false, is a violation of Title 18 section 1000, United States Code, which provides for the penalty of a fine or imprisonment, or both. This report is required by law (7 USC 608(d), CFR 987.51 and 987.151). Failure to report can result in a fine for each violation and each day during which such violation 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 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 30 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.

CDAC-4 (Exp. x/xxxx) Destroy previous editions.