ACP-2 Failed Lot Notification & Rework/Disposition Report Form

OMB No. 0581-0215

Federal Marketing Order 983 - Administrative Committee for Pistachios

Failed Lots: Notification and Rework/Disposition Report
Federal Marketing Order §983.52: handlers shall notify the Administrative Committee for Pistachios (ACP) of all lots that fail to meet the order's maximum aflatoxin requirements
by completing and submitting this report to the ACP. Use this form to report a failed lot (Section A) and to report the
Submit to:
rework/disposition of this failed lot (Section B). Each section is to be signed and dated.

Administrative Committee for Pistachios

A. Failed Lot Report – complete, sign, date, and submit to the ACP within 10 days of lot failure. Save a copy for

499 West Shaw Avenue, Suite 140
Fresno, California 93704
Phone: (559) 255-6480 Fax: (559) 255-6485
Email: admin@acpistachios.org

your records. Complete Section B to report the rework/disposition of this failed lot.

Handler Name

Sampled by (lab/name)

Lot Description

Lot ID/Marks

Prepared By

Weight in Pounds

Title

Sample Date

Container size/description

Test 1 Result

Signature

Test 2 Result

Average Result

Certificate No.

Signature Date

B. Failed Lot Rework/Disposition – complete Section B within 10 days of the rework or disposition of the failed lot. Sign, date and submit to the ACP
Rework Report
Pounds
Reworked

Pounds
Accepted

New Lot Description

New Lot
ID/Marks

Disposition Report – check method of disposition if not reworked.
Exported

Pounds Shipped

Country

Non-Human
Consumption
Shelled Out

Pounds Shipped

Description of use:

New Container
size/description

Customer

Test 1
Result

Test 2
Result

Test 3
Result

Avg 1 & 2

Avg 1,2, & 3

Pass Retest?
Yes / No

Certificate No.

BL No.
BL No.

Pounds Shelled

Date of Rework/Disposition

Form Prepared By

Title

Signature

Signature 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 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 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, 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.

ACP-2 (Exp. 07/31/2027. Destroy previous editions.)