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OMB No. 0581-0215

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS

4938 East Yale Avenue, Suite 102, Fresno, CA 93727

Tel (559) 255-6480; Fax (559) 255-6485

Email:

FAILED LOT NOTIFICATION

Section A: Complete the following information for the failed lot and send the original to the Administrative

Committee for Pistachios office within 10 days of test completion. Provide a copy to the Handler for their records.

Lot description: ________________________ Lot ID marks: _________________________

Weight: _______________ Lbs. Container size/description: _________________________

Handler of the product: ________________________________________________________

Address: _________________________ City: ______________ State: ____ Zip Code:_____

Sampled by: ______________________ Date: ______________ Of (Agency) ____________

Section B: To be completed by the Handler. Record whether lot failed minimum quality and the certificate

number.

Did lot fail minimum quality standard? Yes: ____ No: ____ Certificate No.: ____________

Section C: To be completed by the Aflatoxin Testing Laboratory. Record whether lot failed aflatoxin and the

certificate number. Record the aflatoxin results and averages.

Did lot fail aflatoxin test requirement? Yes: ____ No: ____ Certificate No.: ____________

Result for Test 1: _________ Result for Test 2: ________ Average result: _______________

(Average of Test 1 and 2)

Signature: _________________________________________ Date: ______________________

Form Initiator: ___________________________________ Company: _____________________

Address: ___________________________ City: __________ State: ______ Zip Code: _______

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 0581-

0215. The time required to complete this information collection is estimated to average 12 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin,

age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political

beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C.

20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

ACP-2 (Rev. 05/2014. Destroy previous editions.)

Form Acp-2 - Failed Lot Notification - Administrative Committee For Pistachios - 2014

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