Form 79-003A "Application to Operate a Poultry Plant" - California

What Is Form 79-003A?

This is a legal form that was released by the California Department of Food & Agriculture - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the California Department of Food & Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 79-003A by clicking the link below or browse more documents and templates provided by the California Department of Food & Agriculture.

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Download Form 79-003A "Application to Operate a Poultry Plant" - California

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STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
Distribution:
1220 N Street
1 - Headquarters
Sacramento, CA 95814
2 - Inspector
3 - Area Supervisor
(916) 900-5004
79-003A (Rev. 01/13)
Date:
APPLICATION TO OPERATE A
POULTRY PLANT
FEE $500.00
Establishment Number:
Please Print or Type:
Name of Business:
Phone Number:
Mailing Address:
Fax Number:
Location Including County:
Name of Owners, Managers, and Partners:
Name of Contact Person:
Contact Person E-mail Address:
Name of Poultry Meat Inspectors (PMIs) Employed (Including Managers, Owners, if Licensed):
Any changes in the information given must be reported to the Meat, Poultry and Egg Safety Branch within 15 days.
Obtaining all information requested is mandatory and required before a license can be issued according to
requirements in Division 9 of the California Food and Agricultural Code.
Mail application and Five Hundred dollar ($500.00) fee to:
Cashier, Department of Food and Agriculture,
1220 N Street, Sacramento, CA 95814. Please make check payable to: CDFA PL 90316
Printed Name of Applicant:
Signature of Applicant:
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
Distribution:
1220 N Street
1 - Headquarters
Sacramento, CA 95814
2 - Inspector
3 - Area Supervisor
(916) 900-5004
79-003A (Rev. 01/13)
Date:
APPLICATION TO OPERATE A
POULTRY PLANT
FEE $500.00
Establishment Number:
Please Print or Type:
Name of Business:
Phone Number:
Mailing Address:
Fax Number:
Location Including County:
Name of Owners, Managers, and Partners:
Name of Contact Person:
Contact Person E-mail Address:
Name of Poultry Meat Inspectors (PMIs) Employed (Including Managers, Owners, if Licensed):
Any changes in the information given must be reported to the Meat, Poultry and Egg Safety Branch within 15 days.
Obtaining all information requested is mandatory and required before a license can be issued according to
requirements in Division 9 of the California Food and Agricultural Code.
Mail application and Five Hundred dollar ($500.00) fee to:
Cashier, Department of Food and Agriculture,
1220 N Street, Sacramento, CA 95814. Please make check payable to: CDFA PL 90316
Printed Name of Applicant:
Signature of Applicant: