CDAC-10 (987) CA Dates--Handler Application for Certain Exemptio

OMB No. 0581-0178

Send original and one copy to:

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

P.O. Box 1736

Indio, CA 92202-1736

Tel: (760) 347-4510 Fax: (760) 347-6374

HANDLER APPLICATION FOR CERTAIN EXEMPTIONS FROM REGULATIONS

Application is made for the exemption(s) indicated below:

Name of Handler: ______________________________________________________________________________

Address: _____________________________________________________________________________________

Street City State Zip Code

A. Specialty Outlet (check applicable)

□ Health food, wholesaler or retailer, exemption from moisture requirement

□ Hand-pitted dates, candy manufacturer, exemption from size regulation

Name of Purchaser: _____________________________________________________________________________

Address: _____________________________________________________________________________________

Street City State Zip Code

B. Specialty Packs (exemption from packed inspection and container regulations)

Describe the container, weight of dates, wrapping: ____________________________________________________

_____________________________________________________________________________________________

Will there be pre-packing inspection followed by surveillance to prevent co-mingling with other dates?

□ Yes □No Estimated annual quantity to be sold (Oct.-Sept) ___________ pounds.

C. Sell to one purchaser up to 150 pounds (exemption from packed inspection)

Will there be pre-packing inspection followed by surveillance to prevent co-mingling with other dates?

□ Yes □No Estimated annual quantity to be sold (Oct.-Sept) ___________ pounds.

In consideration of approval of this application, the undersigned applicant agrees to sell, in the indicated outlet only, dates meeting free date grade and size (except for specific exemption) and at the end of each crop year, but no later than September 30, to report to the California Date Administrative Committee (CDAC) on form CDAC-2 the variety and quantity of dates sold under exemption.

Signature: ___________________________________ Title: ______________________________________

Print Name: __________________________________ Date: ______________________________________

The making of false statement or representation on this form, knowing it to be false, is a violation of title 18, section 1000 of the 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), 7CFR 987.51, 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.

Approval for crop year ending September 30, 20___ but subject to revocation.

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

By: _________________________________________________ Date: _________________________________

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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.

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CDAC-10 (Exp. x/xxxx) Destroy previous editions.