This form is available electronically.

CCC-22-1A LEAVE BLANK - CCC USE ONLY U.S. DEPARTMENT OF AGRICULTURE

(08-01-03) Commodity Credit Corporation

1. Approved Date (MM-DD-YYYY) 2. Contract Number

SUPPLEMENT TO FORM CCC-22-1

APPLICATION FOR APPROVAL OF WAREHOUSE

Peanut Storage Agreement (PSA)

3. Warehouse Code Number 4. Master Code Number

INSTRUCTIONS: A separate CCC-22-1A must be filed for each section of the facility.

5. Legal Name of Entity (Enter same name as in Item 5 of CCC-22-1)

 6A. This Report Applies To

 Warehouse Section

 6B. Location (Give street address, town, county, and state. If not in town, give road, direction, and approximate distance

 from named town.)

7B. Lessor Name 7C. Expiration date of lease

 (MM-DD-YYYY)

7A. Applicant:

 9A. Enter name of railroad(s) and initial(s) on which rail shipments are

 received and loaded out if direct access. (Such as Burlington

 Northern Santa Fe, BNSF).

 9B. If no direct access is available but rail shipment is offered, enter the

 location and name of railroad(s) and initial(s) where rail shipments are

 received and loaded out. (Such as Jeanerette, LA; Burlington Northern

 Santa Fe, BNSF).

 H. Comments

13. CERTIFICATION: The applicant certifies that all statements made herein are true and correct and that the applicant will operate in accordance with the

 terms and provisions of the PSA. Form must be signed by an authorized individual, i.e. corporate officer, partner or proprietor. Manager cannot sign unless

 authorized by a resolution of the Board of Directors or Power of Attorney furnished by a partner or proprietor.

A. By B. Title C. Date (MM-DD-YYYY)

Owner

Leasee of Section

8. Does section have direct access to rail sidings? YES NO, truck only

 10A. Does Warehouse Operator have complete control of Warehouse

 Space?

 11. Construction: (Check)

10B. If Item 10A "NO", Explain:

 10C. Is Warehouse Ready to Operate? 10D. If Item 10C "NO", Explain:

YES NO

12. Operating Equipment at This Section:

 A. Receiving Scales (Weighing)

 B. Shipping Scales (Weighing)

 C. If No Scales, State Where Weighed:

 7D. Option To Renew

YES NO

YES NO

 D. Aeration

 E. Drying

 F. Permanent Operating Equipment

 G. Portable Operating Equipment

YES NO TYPE YES NO

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a). The authority for requesting this information is the Commodity Credit Corporation (CCC) Charter Act (15

USC 714 et seq.) and the regulations promulgated thereunder (7 CFR Part 1421). The information will be used to complete the terms of an agreement between the warehouse operator and CCC.

Furnishing the information is voluntary, however, without it, eligibility to enter into an agreement with CCC cannot be determined. This information may be provided to the IRS, the Department of

Justice, other governmental agencies, other State or Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud

statutes, including18 USC 286, 287, 371, 641, 651, 1001, 15 USC 714m, and 31 USC 3729, may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE KANSAS

CITY COMMODITY OFFICE, P.O. BOX 419205, STOP 8748, KANSAS CITY, MO 64141-6205.

NOTE: The authority for collecting the following information is Pub. L. 107-171. This authority allows for the collection of information without prior OMB approval mandated by the Paperwork Reduction Act of

 1995. The time required to complete this information collection is estimated to average 1 hour 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, gender, religion, age, disability, political beliefs, sexual orientation,

and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400

Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.

 A. Upright Warehouse

 B. Flat Warehouse

 C. Bins or Tanks

Concrete Metal Wood D. Additional Descriptive Comments Regarding Construction: