OMB No. 0581-0178

COC-155 (3/31/2024) Destroy previous editions.

CALIFORNIA OLIVE COMMITTEE

REPORT OF SPECIAL PURPOSE SHIPMENTS

20___ CROP YEAR

TO: California Olive Committee

 770 E. Shaw Avenue, Suite 310

 Fresno, CA 93710

FROM:

EIN: _________________________________________

The above handler is requesting permission to package and market the following experimental shipments in order to 

conduct marketing research and development projects. For each application, the requesting handler must provide 

information including, but not limited to:

Purpose of Request: Market Outlet: Time Frame:

Place of Inspection: ________________________________ Anticipated Date of Pack: ____________________

Quantity Variety(ies) Fruit 

Size Style Type: 

Black/Green

Container 

Size

Can 

Code(s)

Type of flavoring; 

other amendments, 

etc

CERTIFICATION AND SIGNATURE: The undersigned, on behalf of the reporting handler, certifies to the 

California Olive Committee(COC) and the Secretaryof Agriculture of the United States that the marketing order 

reporting requirements for receipt and disposition have been met; that all assessments under the marketing have 

been met; and that this fruit will be kept separate from other packaged olives by a means satisfactory to the 

inspection service.

______________________________________ ________________________________ _____________

Signature: Title: Date:

COC USE Inspection notified: __________________________________________________

ONLY Date: _____________________________________________________________

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The 

authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as 

amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program. 

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 OMB 0581-0178. The time 

required to complete this information collection is estimated to average 20 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.