OMB No. 0581-0178

CDAC-10 (Exp. 3/31/2024) Destroy previous editions.

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 CERTAINEXEMPTIONS 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: _________________________________

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 

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OMB No. 0581-0178

CDAC-10 (Exp. 3/31/2024) Destroy previous editions.

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.