REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189 

SHIPMENT REPORT 

CROP YEAR 20___/20___ 

Kiwifruit Administrative Committee Company: _________________________________ 

Mail to: 1521 “I” Street, Sacramento, CA 95814 Contact: ___________________________________ 

Or Fax to (916) 446-1063; Email: calkiwi@agamsi.com Phone No.: _________________________________ 

Phone No.: (916) 441-0678 

Reporting Month: __________________ __________________ Check if this is your final report of the season 

Please Note: The following information is to be current as of the last day of the reporting month and filed with the 

Committee/Commission no later than the fifth (5th) day of the following month. This information is being required to assure 

accurate and timely statistics to assist you. Each individual handler report is completely confidential. 

Pack Style – Enter Pack Style at the Top of Each Column 

Domestic 

Canada 

Taiwan 

Japan 

Hong Kong 

Korea 

Australia 

Mexico 

Singapore 

Not list – note 

market 

TOTALS 

I hereby certify to the best of my knowledge and belief that this report is true and complete. I understand that records 

from which this report is compiled are subject to audit and must be preserved for a period of two years. 

_________________________________________________ _____________________________ 

Signature Date 

_________________________________________________ 

Title 

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 0581-0189. 

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. 

SC-266-9 (Exp. 1/31/2027. Destroy previous editions.) 
 

 

 

 

 

 

 

 

 

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189 

Instructions for completing the Shipment Report: 

1. Reports are due on the fifth (5th) of each month for the previous month’s shipments. 

2. Enter appropriate Handler/Marketer information. 

3. Enter reporting month. 

4. Indicate if report is the final one of the season. 

5. Across the top of the columns, enter the type of pack styles shipped during the given reporting period. (Select pack styles from 

list below). 

6. For each country, enter the total number of containers shipped per each pack style reported. 

7. Sign and date report. 

Description Enter this pack style on report 

9 kg (19.8 lb.) Volume Fill Volume Fill 

Single layer tray Trays 

Container with 3-layers 3-Layers 

125 lb. Bins Bins 

Master Container with 20 – 1 lb. Bags 20/1# Bags 

Master Container with 10 – 1 kg Bags 10/1 kg Bags 

Master Container with 4 – 4 lb. Clams 4/4# Clams 

Master Container with 8 – 2 lb. Clams 8/2# Clams 

Master Container with 27 – .8 lb Clams 27/.8# Clams 

Master Container with 18 – 8 ct. Clams 18/8 ct. Clams and net wt. of master container 

Master Container with 20 – 6 ct. Clams 20/6 ct. Clams and net wt. of master container 

Returnable Plastic Containers, 9 kg RPC 9kg 

Containers with 2-layers 2-layers and net wt. of container 

Euro Containers, must include description and net wt. (i.e. 

Euro 2-layers, 20#) 

Type and net wt. of container 

Any other container type/consumer pack must include the 

description and container net wt. 

Type and net wt. of container 

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. 

SC-266-9 (Exp. 1/31/2027. Destroy previous editions.)